上海市社区骨质疏松症患者中医体质类型与骨代谢指标的相关性

Correlation between TCM Constitution and Serum Bone Metabolism Parameters in Cases with Osteoporosis in Shanghai

目的调查骨质疏松症(osteoporosis,OP)患者的中医体质分布类型,探讨血清骨代谢指标与中医体质的相关性。方法 2016年10月—2017年2月,选取上海市40～70岁中老年常住居民,采用《中医体质分类与判定》标准调查中医体质类型。双能X线吸收检测法测定受试者的腰椎骨密度,并检测血清钙、磷、肌酐、25-羟维生素D[25-hydroxy-vitamin D,25(OH)D]、甲状旁腺素(parathyroid hormone,PTH)、碱性磷酸酶(alkaline phosphatase,ALP)、骨钙素(osteocalcin,OC)、Ⅰ型原胶原N-端前肽(procollagen type Ⅰ N-peptide,PⅠNP)及Ⅰ型胶原交联C-末端肽(beta cross linked C-lelopeptide of type Ⅰ collagen,β-CTX),分析骨代谢指标与中医体质的相关性。结果共纳入802例调查对象,平均年龄为(61.8±4.4)岁,其中男性184例、女性618例,骨量正常组235例,骨量减少组361例,骨质疏松组206例。骨质疏松组阳虚质构成比大于骨量正常组,差异有统计学意义(27.67%vs 14.89%,P=0.004)。骨量减少组和骨质疏松组痰湿质构成比均小于骨量正常组,差异有统计学意义(P=0.004)。3组受试者的中医体质构成比在其余7种偏颇体质中,差异均无统计学意义。选取骨质疏松组40例非阳虚质人群与57例阳虚质人群进行匹配,阳虚质人群的肌酐水平低于非阳虚质人群,差异有统计学意义(P<0.01)。2组人群在血钙、血磷、25(OH)D、ALP、β-CTX、PTH及PⅠNP之间差异均无统计学意义。结论 OP患者偏颇体质中阳虚质明显增多,且OP患者阳虚质与血清肌酐水平相关。

Objective To investigate the constitution of Traditional Chinese Medicine(TCM)in cases with osteoporosis(OP)and to explore the correlation between serum bone metabolism parameters and TCM constitution.Methods Residents in Shanghai,aged from 40 to 70 years,were selected during the period from Oct.,2016 to Feb.,2017 and the investigation of TCM constitution was made based on"Classification and Judgment of TCM Constitution";dual-energy X-ray absorptiometry was applied in measuring the bone mineral density(BMD)of lumbar spine and serum concentrations of calcium,phosphate,creatinine,25-hydroxy-vitamin D[25(OH)D],parathyroid hormone(PTH),alkaline phosphatase(ALP),osteocalcin(OC),procollagen type I N-peptide(PINP),beta cross linked C-lelopeptide of type I collagen(β-CTX)were detected;thecorrelation between TCM constitution and the bone metabolism parameters were analyzed.Results A total of 802 residents,184 male and 618 female with an average age of(61.8±4.4)years,were enrolled,including 235 in normal bone mass group,361 in osteopenia group and 206 in osteoporosis group;the proportion of yang deficiency constitution in osteoporosis group was significantly bigger than that in normal bone mass group(27.67%vs 14.89%,P=0.004)with the difference of statistical significance;the proportions of dampness constitution in osteopenia group and osteoporosis group were significantly smaller than that in normal bone mass group,the difference was of statistical significance(P=0.004);the TCM constitution proportions of the 3 groups were of no statistical differences from those of the other 7 abnormal constitutions;the matching between 40 cases with no yang deficiency and 57 cases with yang deficiency in osteoporosis group indicated that the level of creatinine in cases with yang deficiency was obviously lower than that in cases with no yang deficiency and the difference was of statistical difference(P<0.01)while there existed o statistical differences in serum concentrations of calcium,phosphate,PTH,ALP,25(OH)D,OC,PINP andβ-CTX between them.Conclusions The proportion of yang deficiency in OP cases with abnormal constitution is obvious bigger and the yang deficiency is correlated to the level of serum creatinine.