中医“肾主骨生髓”理论联合运动疗法治疗糖尿病骨质疏松患者的疗效观察

Clinical Observation on Diabetic Osteoporosis Treated with Chinese Medicine Based on Theory of Kidney Governing Bones and Generating Marrow Combined with Exercise Therapy

【目的】观察以中医"肾主骨生髓"理论为指导原则的中药辨证治疗配合运动疗法治疗糖尿病性骨质疏松(DOP)的临床疗效。【方法】将71例DOP患者随机分为试验组35例和对照组36例。2组患者均在控制血糖基础上给予中药辨证治疗(主要以右归丸加减),治疗组在此基础上给予配合运动疗法治疗,疗程8周。观察2组患者干预前后血糖控制指标[空腹血糖(FPG)、餐后2 h血糖(2hPG)和糖化血红蛋白(HbA1c)]、脂质代谢指标[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、骨密度(BMD)、骨代谢指标[血清钙、磷和碱性磷酸酶(ALP)]和肥胖指标[腰围和体质量指数(BMI)]的变化情况,并评价2组的疗效。【结果】(1)干预8周后,试验组的总有效率为88.6%,对照组为72.2%,试验组的疗效优于对照组(P<0.05)。(2)干预后,2组患者的FPG、2hPG、HbA1c水平均较干预前下降(P<0.01),且试验组对FPG、2hPG、Hb A1c水平的下降作用均优于对照组(P<0.05或P<0.01)。(3)干预后,试验组的股骨颈、三角骨及大转子骨的BMD值均较干预前有不同程度升高(P<0.05或P<0.01),且试验组对股骨颈、三角骨及大转子骨的BMD值的升高作用均优于对照组(P<0.05)。(4)干预后,试验组的血钙、血磷和ALP等骨代谢指标均较干预前改善(P<0.05),而对照组仅血磷较干预前改善(P<0.05);组间比较,试验组对血钙和ALP水平的改善作用优于对照组(P<0.05或P<0.01)。(5)干预后,试验组的TC、TG、LDL-C水平均较干预前降低(P<0.01),HDL-C水平均较干预前升高(P<0.01),而对照组患者仅TC、TG水平较干预前降低(P<0.01);组间比较,试验组对TC、TG、LDL-C水平的降低作用和对HDL-C水平的升高作用均优于对照组(P<0.05或P<0.01)。(6)干预后,2组患者BMI和腰围均较干预前降低(P<0.01),且试验组在降低BMI方面优于对照组(P<0.01)。【结论】以中医"肾主骨生髓"为指导原则的中药治疗配合运动疗法治疗DOP的临床疗效优于单纯中药治疗。

Objective To observe the clinical effect of syndrome differentiation and treatment with Chinese medicine based on the theory of kidney governing bones and generating marrow combined with exercise therapy on diabetic osteoporosis(DOP). Methods Seventy-one DOP patients were randomized into trial group(35 cases)and control group(36 cases). Both groups were given syndrome differentiation and treatment mainly with modified Yougui Pills on the basis of controlling blood glucose,and additionally the trial group was given exercise therapy.The treatment for the two groups covered 8 weeks. Before and after intervention,we monitored the glucose-related indicators of fasting plasma glucose(FPG), 2-hour postprandial blood glucose(2 hPG) and glycosylated hemoglobin(HbA1 C), lipid metabolism indicators of total cholesterol(TC), triglyceride(TG), low-density lipoprotein cholesterol(LDL-C) and high-density lipoprotein cholesterol(HDL-C), bone mineral density(BMD),bone metabolism-related biochemical indicators of serum calcium,phosphorus and alkaline phosphatase(ALP),and obesity-related indicators of waist circumference and body mass index(BMI). After treatment,the clinical efficacy in the two groups was evaluated. Results(1)After intervention for 8 weeks,the total effective rate in the trial group was 88.6% and that in the control group was 72.2%,the trial group having stronger efficacy than the control group(P<0.05).(2)After intervention,the levels of FPG,2 hPG,and HbA1 c were decreased in the two groups(P<0.01 compared with those before intervention),and the decrease in the trial group was superior to that in the control group(P<0.05 or P<0.01).(3)After intervention,BMD of femoral neck,trigonal bone and greater trochanter in the trial group was increased to various degrees(P<0.05 or P<0.01 compared with that before intervention),and the increase in the trial group was superior to that in the control group(P<0.05).(4)After intervention,the levels of serum calcium,phosphorus,and ALP in the trial group as well as the serum phosphorus in the control group were improved(P<0.05 compared with those before intervention), and the improvement of serum calcium and ALP levels in the trial group was superior to that in the control group(P<0.05 or P<0.01).(5)After intervention,the levels of TC,TG,and LDL-C in the trial group as well as the TC and TG levels in the control group were decreased,and the HDL-C level in the trial group was increased(P<0.05 compared with those before intervention);the intergroup results showed that the decrease of TC,TG,and LDLC as well as the increase of HDL-C in the trial group was superior to that in the control group(P<0.05 or P<0.01).(6)After intervention,BMI and waist circumference in the two groups were decreased(P<0.01 compared with those before intervention),and the decrease of BMI in the trial group was superior to that in the control group(P<0.01). Conclusion Syndrome differentiation and treatment with Chinese medicine based on the theory of kidney governing bones and generating marrow combined with exercise therapy is more effective on treating DOP than Chinese medicine alone.