慢性阻塞性肺疾病患者骨密度变化与中医脏腑辨证的相关性研究

Study on Correlation between Bone Mineral Density and Syndrome Type of TCM in Patients with Chronic Obstructive Pulmonary Disease

目的 :对慢性阻塞性肺疾病 (COPD)患者进行中医辨证分型并测定骨代谢、骨密度变化 ,探讨骨密度变化与中医证候的关系 ,为中西医结合的临床治疗提供依据。方法 :应用双能X线吸收测定仪 (DEXA)对男性COPD患者 2 7例、对照组 2 5例及健康组 2 5名行腰椎 (L2～ 4 )、股骨颈 (Neck)、股骨三角 (Ward′stri angle ,Ward)和股骨大转子 (Troch)的骨密度 (BMD)测定 ,并检测血清总蛋白 (TP)、白蛋白 (ALB)、碱性磷酸酶 (AKP)、血清骨钙素 (BGP)、尿羟脯氨酸 (HOP)、血Ca、血P、尿Ca/Cr、尿P/Cr及动脉血气。结果 :COPD伴呼吸衰竭或病程 >10年的患者骨密度较无呼吸衰竭或病程≤ 10年的患者低 (P <0 0 5 ) ;COPD肺脾肾型的骨密度明显较肺脾型低 (P <0 0 5 ) ,且尿HOP高于肺脾型患者 (P <0 0 5 )。结论 :(1)COPD是骨质疏松的危险因素 ;(2 )肾虚是COPD继发骨质疏松的关键与核心 ;(3)推测早期补肾可能有预防COPD继发骨质疏松症的作用。

Objective:To explore the correlation between bone mineral density and Syndrome type of TCM in patients with chronic obstructive pulmonary disease (COPD) for providing the base of clinical integrative traditional Chinese and western medical therapy for the disease through the Syndrome typing and determination of changes in bone metabolism and bone density. Methods:Bone mineral density (BMD) of lumbar vertebrae 2～4, femoral neck, Ward′s triangle and trochanter in 27 COPD male patients, 25 male control subjects and 25 healthy persons were determined using dual energy X-ray absorptiometry, patient′s Syndrome type, their blood levels of total protein, albumin, alkaline phosphatase, bone glaprotein, hydroxyproline, calcium, phosphate, urine levels of calcium/creatine and phosphorous/creatine as well as arterial blood gas were also determined. Results:The BMD in COPD patients accompanied with respiratory failure or with course >10 years was higher than that in COPD patients without respiratory failure or with course ≤10 years, BMD in COPD patients of Fei-Pi-Shen type was lower than that in those of Fei-Pi, but the urine hydroxyprdine in the former was higher than that in the latter (all P<0.05). Conclusion:(1) COPD is a risk factor for osteoporosis; (2) Shen Deficiency is the key and nucleus of secondary osteoporosis to COPD; (3) It is inferred that early regulation of Shen may be facilitated to prevent osteoporosis in COPD patients.