1419例绝经后骨量减少妇女不同年龄段中医证候特征分析

Analysis of Characteristics of Traditional Chinese Medicine Syndromes in 1419 Cases of Postmenopausal Bone Loss in Women of Different Ages

目的探讨绝经后骨量减少妇女不同年龄段的中医证候特征,为中医药预防骨质疏松症提供理论依据。方法制定骨质疏松症研究调查表,收集1419例绝经后骨量减少妇女临床资料,对不同年龄段(41~59岁、60~69岁、70~85岁)患者进行中医辨证分型,虚证辨证分为肝虚、心虚、脾虚、肺虚、肾虚、气虚、血虚证,常见证型为肾虚血瘀、肝肾阴虚、肾阳虚、脾胃虚弱、脾肾阳虚、肾阴虚证。比较不同年龄段患者体重指数(BMI)、骨密度(包括腰椎、大转子、股骨颈)及主要症状、虚证、常见证型的分布情况。结果 41~59岁患者549例,60~69岁患者679例,70~85岁患者191例,各组患者BMI差异有统计学意义(P <0. 05)。与41~59岁比较,60~69岁患者腰椎、股骨颈骨密度降低,70~85岁患者大转子、股骨颈骨密度亦降低(P <0. 05)。与60~69岁比较,70~85岁患者大转子、股骨颈骨密度降低(P <0. 05)。在3个年龄段中,排名第一位的症状均为健忘。肾虚、肝虚在3个年龄段的比例均位列前二,且心虚、脾虚比例也较高,气虚、血虚比例较低。随着年龄增长,肝肾阴虚证、肾阴虚证的比例不断下降,肾虚血瘀证、肾阳虚证的比例不断上升。结论绝经后骨量减少妇女在不同年龄段均以肾虚、肝虚为主,随着年龄增长肾虚血瘀证、肾阳虚证明显,总体证型变化不明显。

Objective To explore the characteristics of traditional Chinese medicine( TCM) syndromes in different age of postmenopausal women with reduced bone mass,and to provide a theoretical basis for the prevention of osteoporosis by TCM. Methods A questionnaire for osteoporosis research was developed,and the clinical data of1419 postmenopausal women with reduced bone mass was collected. TCM syndrome differentiation was performed for patients of different ages( 41-59 years old,60-69 years old,70-85 years old). The syndrome differentiation of deficiency syndrome was divided into liver deficiency,heart deficiency,spleen deficiency,lung deficiency,kidney deficiency,qi deficiency and blood deficiency syndrome. Common syndrome types were kidney deficiency and blood stasis,liver and kidney yin deficiency,kidney yang deficiency,spleen and stomach weakness,spleen and kidney yang deficiency,and kidney yin deficiency. The distribution of body mass index( BMI),bone mineral density of lumbar vertebrae,greater trochanter,and femoral neck,main symptoms,deficiency syndrome,and common syndromes were compared between different age groups. Results There were 549 patients aged 41-59 years,679 patients aged 60-69 years,and 191 patients aged 70-85 years. The difference of BMI in each group was statistically significant( P < 0. 05). Compared with 41-59 years old patients,the bone density of lumbar vertebrae and femoral neck decreased in patients aged 60-69 years. The bone density of the greater trochanter and femoral neck of 70-85 years old patients also decreased( P < 0. 05). Compared with 60-69 years old,the bone density of the greater trochanter and femoral neck was decreased in patients aged 70-85 years( P < 0. 05). The first symptom was forgetfulness in all groups. The proportion of kidney deficiency and liver deficiency in the 3 groups ranked the top two,and the proportion of heart deficiency and spleen deficiency was also higher,and the proportion of qi deficiency and blood deficiency was lower. With the increase of age,the proportion of liver and kidney yin deficiency syndrome and kidney yin deficiency syndrome was decreasing,and the proportion of kidney deficiency and blood stasis syndrome and kidney yang deficiency syndrome was rising. Conclusion Postmenopausal women with reduced bone mass are mainly composed of kidney deficiency and liver deficiency at different ages. With age increasing,kidney deficiency and blood stasis syndrome and kidney yang deficiency are obvious,and the overall syndrome type is not obviously changed.