雷火灸对原发性骨质疏松症伴低肌肉质量女性患者平衡功能和肌骨代谢的影响

Effects of thunder-fire moxibustion on balance function and musculoskeletal metabolism in female patients of primary osteoporosis with low muscle mass

目的:观察雷火灸对原发性骨质疏松症(POP)伴低肌肉质量女性患者平衡功能和肌骨代谢水平的影响。方法:将60例POP伴低肌肉质量女性患者随机分为观察组(30例,脱落5例)和对照组(30例,脱落2例)。对照组予钙尔奇D(1.5 g碳酸钙+125 IU维生素D3)口服,每次1片,每天1次,共治疗12周;观察组在对照组基础上予雷火灸治疗,穴取命门、腰阳关及双侧肝俞、肾俞、大肠俞,每穴艾灸30 min,隔日1次,每周3次,共治疗12周。比较两组患者治疗前后平衡功能指标[足底压力中心(COP)95%置信椭圆面积、总位移、平均速度]及腰部疼痛视觉模拟量表(VAS)评分,检测两组患者治疗前后血清肌肉代谢因子[肌肉生长抑制素(MSTN)、过氧化物酶体增殖物激活受体γ辅激活因子1α(PGC-1α)]和骨代谢因子[Ⅰ型胶原N端前肽(PINP)、Ⅰ型胶原C末端交联肽(CTX-Ⅰ)]水平。结果:治疗后,观察组患者COP 95%置信椭圆面积、总位移、平均速度均较治疗前降低(P<0.01),且观察组低于对照组(P<0.05);两组患者腰部VAS评分均较治疗前降低(P<0.01),且观察组低于对照组(P<0.01)。治疗后,观察组患者血清MSTN、PINP、CTX-Ⅰ水平较治疗前降低(P<0.01),血清PGC-1α水平较治疗前升高(P<0.01),对照组患者血清MSTN水平降低(P<0.05);观察组患者血清MSTN、PINP水平低于对照组(P<0.05),血清PGC-1α水平高于对照组(P<0.01)。结论:雷火灸可有效缓解POP伴低肌肉质量女性患者腰部疼痛,改善平衡功能,并调节肌骨代谢水平。

Objective To observe the effects of thunder-fire moxibustion on the balance function and musculoskeletal metabolism in female patients of primary osteoporosis(POP)with low muscle mass.Methods Sixty female patients of POP with low muscle mass were randomly divided into an observation group(30 cases,5 cases dropped out)and a control group(30 cases,2 cases dropped out).The patients in the control group were treated with oral administration of Caltrate D(1.5 g calcium carbonate+125 IU vitamin D3),one tablet per day for 12 weeks.In addition to the control treatment,the patients in the observation group were treated with thunder-fire moxibustion at Mingmen(GV 4),Yaoyangguan(GV 3),bilateral Ganshu(BL 18),Shenshu(BL 23),and Dachangshu(BL 25),30 min per acupoint,once every other day,three times a week,for 12 weeks.Balance function indexes(95%confidence ellipse area of the center of pressure[COP],total displacement,average speed),lumbar pain visual analogue scale(VAS),serum muscle metabolism factors(myostatin[MSTN],peroxisome proliferator-activated receptorγcoactivator-1α[PGC-1α])and bone metabolism factors(aminoterminal propeptide typeⅠprocollagen[PINP],C-terminal telopeptide of typeⅠcollagen[CTX-Ⅰ])were compared before and after treatment in both groups.Results Compared before treatment,the 95%confidence ellipse area of COP,total displacement,and average speed in the observation group were decreased after treatment(P<0.01),and the above indexes in the observation group were lower than those in the control group(P<0.05).Compared before treatment,the VAS scores in both groups were decreased after treatment(P<0.01),the score in the observation group was lower than that in the control group(P<0.01).Compared before treatment,the serum levels of MSTN,PINP and CTX-Ⅰin the observation group were reduced after treatment(P<0.01),while the serum level of PGC-1αwas increased(P<0.01).The control group showed a decrease in serum level of MSTN(P<0.05).The observation group had lower serum levels of MSTN and PINP(P<0.05)and higher serum level of PGC-1α(P<0.01)compared to the control group.Conclusion The thunder-fire moxibustion can effectively relieve lumbar pain,improve balance function,and regulate musculoskeletal metabolism in female patients of POP with low muscle mass.