女性冠心病合并骨质疏松辨证分型规律探讨

The Research on Syndrome Differentiation of Traditional Chinese Medicine in Female Patients with Coronary Heart Disease and Osteoporosis

目的探讨女性冠心病合并骨质疏松患者的中医辨证分型规律。方法将2017年1月—2018年9月收治的绝经后女性冠心病患者112例作为观察组,进行中医辨证分型,另选取同期进行常规体检的106例非冠心病绝经后女性患者作为对照组,2组均采用双能X线骨密度仪检测腰椎前后L1~4及左侧股骨颈、左侧髋关节骨密度,比较2组骨密度测定结果,统计分析各中医证型的骨密度特点。结果观察组有45例骨质疏松患者,对照组有21例骨质疏松患者,2组对比差异有统计学意义(P<0.05);三支病变组骨质疏松患病率较单支病变组和双支病变组高,差异有统计学意义(P<0.05);气虚血瘀型、气阴两虚型、阳气虚衰型3组冠心病患者的骨质疏松患病率高于心血瘀阻和痰浊壅塞2型,差异有统计学意义(P<0.05);在部位分类上,心血瘀阻型女性冠心病患者腰椎骨密度最高,痰浊壅塞型次之,阳气虚衰型女性冠心病患者股骨颈和髋关节骨密度最低。结论骨密度特征与女性冠心病中医证型之间存在一定的相关性,阳气虚衰型冠心病患者应尽早进行骨密度检测并加以预防,以改善患者远期生活质量。

Objective To investigate the laws in syndrome differentiation of traditional Chinese medicine in female patients with coronary heart disease (CHD) and osteoporosis (OP). Methods 112 female CHD patients admitted into our hospital from January 2017 to September 2018 were selected as observation group, and the differentiation was performed on this group according to their traditional Chinese medicine syndromes. 106 cases of non CHD with health examination were selected as control group. The anterior and posterior lumbar vertebrae L1-4, the left femoral neck and the left hip bone mineral density of all selected cases were detected by dual energy X-ray absorptiometry (DEXA). The results of bone density and incidence of osteoporosis were compared between the two groups. The bone mineral density characteristics of each TCM syndrome were analyzed. Results There were 45 cases of osteoporosis in the observation group, 21 cases in control group with significant difference between the two groups (P<0.05). The osteoporosis prevalence rate in three-vessel lesion was higher than one-vessel lesion and two-vessel lesion with significant difference between the two groups (P<0.05). The osteoporosis prevalence rate in the syndromes of qi-deficiency and blood stasis, qi yin deficiency, yang qi asthenia were higher than heart blood stasis syndrome and phlegm-turbib syndrome with significant difference (P<0.05). The BMD of vertebrae L1-4 in heart blood stasis syndrome was the highest among all the groups, the phlegm-turbib syndrome was the second. The BMD of the left femoral neck and the left hip in yang qi asthenia syndrome was the lowest. Conclusion There is some kind of relevance among the bone mineral density and the syndrome differentiation of female coronary heart disease. It should be advocated that the patients with yang qi asthenia should take the bone mineral density test as early as possible in order to prevent bone fracture, and to improve their life qualities.