广州市社区中老年骨质疏松症患者中医体质类型与骨代谢指标关系的病例对照研究

Case-control Study of Relationship Between Traditional Chinese Medicine Constitution Types and Bone Metabolic Markers of Middle-aged and Elderly Osteoporosis Patients in Guangzhou Community

【目的】探讨广州市社区中老年骨质疏松症患者的中医体质分布规律及其与骨代谢指标的相关性。【方法】采用现场问卷调查收集受试者的基本资料(包括性别、年龄、身高、体质量、骨折史等)及进行中医体质类型调查,双能X线骨密度仪测量1 529例40岁以上社区中老年人群的腰椎正位骨密度(BMD),并收集受试者的血钙(Ca^(2+))、碱性磷酸酶(ALP)、25-羟-维生素D[25(OH)D]、血清骨钙素(OC)、I型前胶原氨基末端前肽(PINP)、I型胶原羧基端肽β特殊序列(β-CTX)等,按年龄配比,将检测出的470例骨质疏松症患者与470例骨量正常人群进行病例对照研究,并运用SPSS 18.0统计软件进行数据的统计分析。【结果】2组人群的体质构成比比较,差异有统计学意义(P<0.05),骨质疏松症患者中气虚质、阳虚质、阴虚质、血瘀质、湿热质的构成比明显高于正常人群。在年龄分层方面,骨质疏松症患者早期主要以阴虚质、血瘀质、湿热质为主,后期以阳虚质、阴虚质为主,而气虚质贯穿骨质疏松的整个过程。阴虚质、瘀血质、湿热质是骨质疏松症患者的体质影响因素。气虚质、阳虚质、湿热质的OC、PINP及β-CTX水平较其他体质类型高,经多重比较后,差异均有统计学意义(P<0.05)。【结论】在社区中老年骨质疏松症防治中建议应用中医体质辨识,气虚质、阳虚质、阴虚质、血瘀质、湿热质等5种体质的骨质疏松人群为重点防治对象。

Objective To explore the distribution of traditional Chinese medicine（TCM）constitution types in theelderly osteoporosis patients from Guangzhou community and to investigate their correlation with bone metabolicmarkers. Methods The basic information（including the sex,age,body height,body weight,fracture history,etc.）and TCM constitution types were investigated by field questionnaire. The bone mineral density（BMD） oflumbar vertebra in 1 529 middle-aged and elderly examinees over 40 years old were measured by dual energyX-ray absorptiometry（DEXA）,and the indexes of serum calcium,alkaline phosphatase（ALP）,25-hydroxyvitamin D[（25（OH）D], osteocalcin（OC）, type Ⅰ procollagen amino-terminal peptide（PINP）, beta type（collagen carboxy-terminal peptide（β-CTX）were collected. By age matching, a case-control study of 470 patients with osteoporosis and 470 cases of examinees with normal bone mass（healthy control）was conducted,andSPSS was used for analyzing the data. Results The constitution ratio of the two groups was statistically different（P〈0.05）,and the constituent ratio of Qi deficiency,yang deficiency,yin deficiency,blood stasis,and damp heatconstitution type in patients with osteoporosis was significantly higher than that in the healthy control. The results ofage stratification analysis showed that constitution types of yin deficiency, blood stasis and damp heat werefrequently seen in the early period of osteoporosis patients,and in the later period,constitution types of yangdeficiency and yin deficiency were frequently seen,while Qi deficiency was the dominant type in the whole processof osteoporosis. Yin deficiency, blood stasis, and damp heat were the factors affecting the constitution ofosteoporosis. The levels of OC,PINP and β-CTX of patients with Qi deficiency,yang deficiency and damp heatconstitution type were higher than those in the patients with other constitution types,and the results of multiplecomparison showed that the differences were statistically significant（P〈0.05）. Conclusion The application ofTCM constitution identification was recommended in the prevention and treatment of the elderly osteoporosispatients in the community, and the osteoporosis population with the constitution types of Qi deficiency, yangdeficiency,yin deficiency,blood stasis,and damp heat are the target for prevention and treatment.