老年原发性骨质疏松症患者骨密度、性激素与中医证型的相关性研究

A study on Correlation Between Bone Density,Sex Hormones,and Traditional Chinese Medicine Syndrome Types in Elderly Patients with Primary Osteoporosis

目的 分析社区老年原发性骨质疏松症(Osteoporosis, OP)患者骨密度、性激素与中医证型的相关性,为社区中医药治疗老年原发性OP提供依据。方法 回顾2020年1月-2022年5月深圳市宝安区中医院社区健康服务中心就诊的老年原发性OP患者共347例,分别为肝肾阴虚证、脾肾阳虚证、气滞血瘀证及肾阳虚衰证,记录患者年龄、性别、骨密度值、血清睾酮(T)和血清雌二醇(E2)值,分析骨密度、性激素与中医辨证分型之间的相关性。结果 347例老年原发性OP患者中,肝肾阴虚证80例、脾肾阳虚证88例、气滞血瘀证90例及肾阳虚衰证89例;其中60~70岁患者以气滞血瘀证为主、71~80岁患者以肾阳虚衰证为主、81~90岁患者以肝肾阴虚证为主;在骨密度值比较当中,气滞血瘀证高于其他组(P<0.05);在血清睾酮(T)值比较当中,气滞血瘀证高于其他组(P<0.05)、肾阳虚衰证低于其他组(P<0.01);在血清雌二醇(E2)值比较当中,气滞血瘀证和肾阳虚衰证高于其他组(P<0.05),差异均有统计学意义;气滞血瘀证骨折病史比例高于其他组(P<0.05)、肾阳虚衰证患骨质疏松比例高于其他组(P<0.05)、脾肾阳虚证患严重骨质疏松比例高于其他组(P<0.05)。结论 老年原发性OP患者早期以气滞血瘀证为主,后期则逐渐发展为脾肾阳虚证、肝肾阴虚证、肾阳虚衰证;骨密度值、性激素(血清睾酮、血清雌二醇)值可作为评判老年原发性OP患者虚实证型的指标,与虚证呈负相关,与中医证型具有相关性。

Objective To analyze the correlation between bone density,sex hormones,and traditional Chinese medicine syndrome types in elderly patients with primary osteoporosis(OP)in the community,and to provide a basis for the treatment of OP in the elderly with traditional Chinese medicine in the community.Methods A total of 347 elderly patients with primary osteoporosis who visited the Community Health Service Center of Bao an District Traditional Chinese Medicine Hospital in Shenzhen from January 2020 to May 2022 were reviewed,including liver and kidney Yin deficiency syndrome,spleen and kidney Yang deficiency syndrome,Qi stagnation and blood stasis syndrome,and kidney Yang deficiency failure syndrome.The age,gender,bone density,serum testosterone(T),and serum estradiol(E2)values of the patients were recorded,and the correlation between bone density,sex hormones,and traditional Chinese medicine syndrome differentiation was analyzed.Results Among 347 elderly patients with primary OP,there were 80 cases of liver and kidney Yin deficiency syndrome,88 cases of spleen and kidney Yang deficiency syndrome,90 cases of Qi stagnation and blood stasis syndrome,and 89 cases of kidney Yang deficiency failure syndrome;Among them,patients aged 60-70 are mainly characterized by Qi stagnation and blood stasis,patients aged 71-80 are mainly characterized by kidney Yang deficiency and failure,and patients aged 81-90 are mainly characterized by liver and kidney Yin deficiency;In the comparison of bone density values,the Qi stagnation and blood stasis syndrome was higher than other groups(P<0.05);In the comparison of serum testosterone(T)values,the Qi stagnation and blood stasis syndrome was higher than the other groups(P<0.05),and the Kidney Yang deficiency syndrome was lower than the other groups(P<0.01);In the comparison of serum estradiol(E2)values,the Qi stagnation and blood stasis syndrome and kidney Yang deficiency and failure syndrome were higher than other groups(P<0.05),and the differences were statistically significant;The proportion of fracture history in Qi stagnation and blood stasis syndrome was higher than that in other groups(P<0.05),the proportion of osteoporosis in kidney Yang deficiency syndrome was higher than that in other groups(P<0.05),and the proportion of severe osteoporosis in spleen kidney Yang deficiency syndrome was higher than that in other groups(P<0.05).Conclusion In the early stage of elderly patients with primary OP,Qi stagnation and blood stasis syndrome are the main symptoms,while in the later stage,they gradually develop into spleen kidney Yang deficiency syndrome,liver kidney Yin deficiency syndrome,and kidney Yang deficiency failure syndrome;The bone density value and sex hormone(serum testosterone,serum estradiol)value can be used as indicators to evaluate the deficiency excess syndrome type in elderly patients with primary osteoporosis,which is negatively correlated with deficiency syndrome and correlated with traditional Chinese medicine syndrome type.