基于“脾主肌肉”探讨补中益气汤对骨质疏松椎体压缩性骨折术后临床疗效及骨转换标志物的影响

Clinical Efficacy and Bone Turnover Markers of Buzhong Yiqitang in Treatment of Senile Osteoporotic Vertebral Compression Fracture After Operation Based on ’’Spleen Governing Muscle’’

目的:基于“脾主肌肉”理论探讨补中益气汤对脾胃气虚型老年性骨质疏松椎体压缩性骨折(OVCF)椎体成形术后患者骨转换标志物及生存质量的影响。方法:选取自2020年1月至2021年1月,在日照市中医医院诊疗行椎体(后凸)成形术的老年性OVCF患者135例,采用区组随机方法,将受试者以2∶1分为观察组(90例)和对照组(45例),两组均采用骨化三醇胶丸(0.5μg·d^(-1))、钙尔奇D(1 200 mg·d^(-1))进行抗骨质疏松基础治疗,观察组在此基础上采用补中益气汤治疗。观测两组以下指标:治疗前、治疗6、12个月后骨密度、血清Ⅰ型原胶原氨基端前肽(PINP)、血清骨钙素(OST)、血清β-胶联降解产物(β-CTx)、四肢骨骼肌指数(ASMI)、股四头肌肌力;治疗前、治疗3、6个月后中医证候积分、疼痛视觉模拟评分(VAS);治疗前、治疗3、6、12个月后欧洲骨质疏松症基金会生活质量问卷(QUALEFFO)评分。结果:观察组和对照组分别有85、41例患者获得随访,观察组一般疗效优于对照组(χ~2=10.503,P<0.05)。与对照组比较,观察组PINP升高,β-CTx降低(P<0.05,P<0.01),骨密度和ASMI升高,股四头肌肌力增加(P<0.05,P<0.01),中医证候评分、VAS评分、QUALEFFO量表评分降低(P<0.05,P<0.01);未发现与补中益气汤相关不良反应。结论:补中益气汤可以调节脾胃气虚型老年OVCF术后患者骨代谢指标,可促进成骨,提高骨密度,同时可以增加四肢骨骼肌肌量和股四头肌肌力,减轻临床症状,改善生存质量,值得临床应用。

Objective:To study the effect on quality of life and the bone turnover markers of Buzhong Yiqitang in the treatment of senile osteoporotic vertebral compression fracture(OVCF,syndrome of Qi deficiency in spleen and stomach)after operation based on ’’spleen governing muscle’’.Method:A total of 135senile patients with OVCF treated by percutaneous kyphoplasty in Rizhao Hospital of Traditional Chinese Medicine from January 2020 to January 2021 were enrolled in this study.They were randomly assigned to two groups on the basis of block randomization at a ratio of 2∶1(90 cases in the observation group and 45 cases in the control group).Both groups were administrated with calcitriol capsules(0.5 μg·d^(-1)) and caltrate D(1 200 mg·d^(-1))for basic treatment of osteoporosis.The observation group was additionally treated with Buzhong Yiqitang.Bone mineral density(BMD),procollagen type Ⅰ N-terminal propeptide(PINP),osteocalcin(OST),β cross-linked C-telopeptide of type 1 collagen(β-CTx),appendicular skeletal muscle mass index(ASMI),and quadriceps muscle strength were compared between the two groups before and 6,12 months after treatment.Additionally,traditional Chinese medicine(TCM)symptom score and visual analogue score(VAS)before and 3,6 months after treatment,as well as quality of life questionnaire of the European Foundation for osteoporosis(QUALEFFO)score before and 3,6,12 months after treatment,were compared between the two groups.Result:A total of 85 patients in the observation group and 41 patients in the control group were followed up.The general curative effect of the observation group was better than that of the control group(χ~2=10.503,P<0.05).Specifically,the observation group had higher PINP,BMD,ASMI,and quadriceps muscle strength but lower β-CTx,TCM symptom score,VAS,and QUALEFFO score than the control group(P<0.05,P<0.01).No adverse reactions related to Buzhong Yiqitang were observed.Conclusion:Buzhong Yiqitang can regulate bone metabolism indexes,promote osteogenesis,increase bone density,enhance skeleton appendiculare and quadriceps muscle strength,relieve clinical symptoms,and improve quality of life in patients with senile OVCF(syndrome of Qi deficiency in spleen and stomach),being worthy of promotion in clinical application.