基于肾主骨生髓探讨益和汤治疗骨质疏松症的临床疗效及对骨重构标志物的影响

Clinical efficacy of Yihe Decoction in treating osteoporosis and its impact on bone remodeling markers based on the concept of kidney governing bone and generating marrow

目的:基于“肾主骨生髓”探讨益和汤治疗骨质疏松症的临床疗效及对骨重构标志物的影响。方法:遴选2019年1月—2021年10月在黑龙江中医药大学附属第二医院就诊的60例骨质疏松症患者,随机分为中药组和对照组,每组各30例。对照组给予碳酸钙D3片联合阿仑膦酸钠治疗,中药组在对照组基础上增服益和汤水煎剂。治疗3个月后,计算总有效率,并检测各组患者血清中雌二醇(E2)、骨钙素(BGP)、抗酒石酸酸性磷酸酶(TRAP-5b)等骨重构标志物水平,测量腰椎及股骨颈骨密度(BMD),并采用SF-36评分表对患者生存质量评分。结果:治疗后,中药组总有效率76.67%(23/30)显著高于对照组的73.33%(22/30)(P<0.05);治疗后,两组腰椎及股骨颈BMD较治疗前显著改善(P<0.01,P<0.05),且中药组BMD显著高于对照组(P<0.05)。与治疗前比较,两组治疗后血清骨重构标志物BGP和TRAP-5b含量显著降低(P<0.05,P<0.01),E2含量增加(P<0.05,P<0.01);且治疗后,中药组E2含量显著高于对照组(P<0.01),BGP、TRAP-5b含量显著低于对照组(P<0.05)。中药组患者SF-36总体评分显著高于对照组(P<0.01)。结论:在碳酸钙D3片联合阿仑膦酸钠治疗基础上,加服补肾活血、益和通络功效的益和汤更利于改善血清骨重构标志物水平,增加BMD并改善生活质量,值得临床推广。

Objective:To investigate the clinical efficacy of Yihe Decoction in the treatment of osteoporosis and its effect on bone remodeling markers based on‘kidney governing bone and generating marrow’.Methods:A total of 60 osteoporosis patients who were treated in the Second Affiliated Hospital of Heilongjiang University of Chinese Medicine from January 2019 to October 2021 were selected and randomly divided into a traditional Chinese medicine(TCM)group and a control group,30 cases in each group.The control group was treated with Calqi D3 combined with sodium alendronate,and the TCM group was supplemented with Yihe Decoction on the basis of the control group.After 3 months of treatment,the total effective rate and the serum levels of estradiol(E2),bone gla protein(BGP),tartrate-resistant acid phosphatase(TRAP-5b)in the patients of each group were detected,and the bone mineral density(BMD)of the lumbar spine and femoral neck was measured,and the SF-36 scoring table was used to evaluate the patients,quality of life score.Results:The total effective rate in the TCM group was 76.67%(23/30),which was significantly higher than 73.33%(22/30)in the control group(P<0.05).After the treatment,the BMD of the lumbar spine and femoral neck in both groups was improved significantly whten compared before the treatment(P<0.01,P<0.05),and the BMD in TCM group was significantly higher than that of the control group(P<0.05).Compared with before treatment,the contents of serum bone remodeling markers BGP and TRAP-5b in both groups decreased significantly(P<0.05,P<0.01),and the E2 increased(P<0.05,P<0.01).After the treatment,the content of E2 in TCM group was significantly higher than that in the control group(P<0.01),and the contents of BGP and TRAP-5b were significantly lower than those in the control group(P<0.05).The total score of SF-36 in TCM group was higher than that in the control group(P<0.05).Conclusion:On the basis of Calqi D3 combined with sodium alendronate treatment,Yihe Decoction with the effect of tonifying kidney and promoting blood circulation,benefiting and dredging collaterals is more beneficial to improve the level of serum bone remodeling markers,increase BMD and improve the quality of life.It is worthy of clinical promotion.