续断补骨汤联合阿法骨化醇软胶囊对T2DM并发骨质疏松患者血清LCN2、BMP4表达的影响

Effects of Xuduan Bugu Decoction(续断补骨汤)Combined with Alfacalcidol Soft Capsules on Expressions of Serum LCN2 and BMP4 in Patients with T2DM Complicated with Osteoporosis

目的 观察续断补骨汤联合阿法骨化醇软胶囊对2型糖尿病(T2DM)并发骨质疏松患者血清脂质运载蛋白2(LCN2)、骨形态发生蛋白4(BMP4)表达的影响。方法 选取2021年1月—2022年6月两家医院门诊及住院收治的197例T2DM并发骨质疏松患者为研究对象,采用简单随机化法分为两组。依安凡组98例给予阿法骨化醇软胶囊治疗,续断补骨汤组99例给予续断补骨汤联合阿法骨化醇软胶囊治疗。比较两组中医证候积分、骨密度、血清相关因子及骨痛评分的变化,同时记录两组疗效和不良反应。结果 治疗前,两组中医证候积分、骨痛视觉模拟量表(visual analogue scale, VAS)评分比较,差异无统计学意义(P>0.05)。治疗后,两组主症积分(口干咽燥、腰背疼痛、腰膝酸软)、次症积分(目眩耳鸣、下肢痿弱)、总积分及骨痛VAS评分均明显下降,且续断补骨汤组较依安凡组下降程度更大,差异有统计学意义(P<0.05)。治疗前,两组骨密度比较,差异无统计学意义(P>0.05)。治疗后,两组腰椎1~4、股骨颈及全髋的骨密度均明显升高,且续断补骨汤组较依安凡组升高程度更大,差异有统计学意义(P<0.05)。治疗前,两组血清相关因子比较,差异无统计学意义(P>0.05)。治疗后,两组LCN2、1型前胶原N-端前肽(P1NP)、1型胶原羧基末端肽(β-CTX)均明显下降,而BMP4、血磷、血钙均明显升高,续断补骨汤组LCN2、P1NP、β-CTX较依安凡组下降程度更大,BMP4、血磷、血钙较依安凡组升高程度更大,差异有统计学意义(P<0.05)。续断补骨汤组总有效率为91.92%(91/99)高于依安凡组的81.63%(80/98),差异有统计学意义(P<0.05)。结论 续断补骨汤联合阿法骨化醇软胶囊可改善T2DM并发骨质疏松患者骨密度,减轻骨痛,可能与调节血清LCN2、BMP4等相关因子的表达有关。

Objective To observe the effect of Xuduan Bugu Decoction(续断补骨汤)combined with alfacalcidol soft capsules on the expressions of serum lipocalin 2(LCN2)and bone morphogenetic protein 4(BMP4)in patients with type 2 diabetes mellitu(T2DM)complicated with osteoporosis.Methods A total of 197 patients with T2DM complicated with osteoporosis who were admitted to the hospital from January 2021 to June 2022 were selected as the research objects,and were divided into two groups by simple randomization method.Ninety-eight cases in the Yi′anfan group were given alfacalcidol soft capsules,while 99 cases in the Xuduan Bugu Decoction group were given Xuduan Bugu Decoction combined with alfacalcidol soft capsules.The changes of TCM syndrome scores,bone mineral density,serum-related factors and bone pain scores were compared between the two groups,and the curative effects and adverse reactions of the two groups were recorded at the same time.Results Before treatment,there was no difference in TCM symptom scores or visual analogue(VAS)score of bone pain between the two groups(P>0.05).After treatment,the main syndrome scores(dry mouth and throat,low back pain,weak waist and knees),secondary syndrome scores(dizziness and tinnitus,lower extremity atrophy),total score and VAS score of bone pain in both groups were significantly decreased,and the supplementation was continued.Compared with the Yi′anfan group,the Xuduan Bugu Decoction group had a greater decrease,and there was a difference(P<0.05).Before treatment,there was no difference in bone mineral density between the two groups(P>0.05).After treatment,the bone mineral density of lumbar vertebrae 1-4,femoral neck and total hip were significantly increased in both groups,and the increase was greater in the Xuduan Bugu Decoction group than that in the Yi′anfan group,with a difference(P<0.05).Before treatment,there was no difference in serum related factors between the two groups(P>0.05).After treatment,the levels of LCN2,type 1 procollagen N-terminal propeptide(P1NP)and type 1 collagen carboxyl terminal peptide(β-CTX)in the two groups were significantly decreased,while the levels of BMP4,blood phosphorus and blood calcium were significantly increased.Compared with those of the Yi′anfan group,the levels of LCN2,P1NP andβ-CTX in the Xuduan Bugu Decoction group decreased more obviously,and the levels of BMP4,serum phosphorus and calcium increased more obviously than those of the Yi′anfan group,and there were differences(P<0.05).The total effective rate of the Xuduan Bugu Decoction group was 91.92%(91/99),higher than that of Yi′anfan group[81.63%(80/98)],and there was a difference(P<0.05).Conclusion Xuduan Bugu Decoction combined with alfacalcidol soft capsule can improve bone mineral density and relieve bone pain in patients with T2DM complicated by osteoporosis,which may be related to regulating the expressions of serum LCN2,BMP4 and other related factors.