老年原发性骨质疏松患者危险因素及中医证型分布研究

Analysis on Risk Factors in Senile Patients with Primary Osteoporosis and theDistribution of Chinese Medicine Syndrome Types

目的:研究老年原发性骨质疏松(OP)患者危险因素及中医证型分布情况。方法:选取2015年1月—2017年1月间在本院确诊为原发性骨质疏松的老年患者132例,记录患者一般临床资料、患者的生活相关资料如饮食、运动、和日照情况,有无不良嗜好等,分析OP患者的相关危险因素,并统计其中医证型分布。另选取同期体检的健康老年人50例作为对照组,比较分析2组患者血清胰岛素样生长因子结合蛋白-3 (IGFBP-3)、胰岛素样生长因子-1 (IGF-1)、骨钙素(OC)、生长激素(GH)和甲状旁腺激素(PTH)的水平情况。结果:所有患者中,女性106例(80.3%),男性26例(19.7%);男性平均年龄(70.3±5.18)岁,女性平均年龄(66.2±7.6)岁。中医辨证分型:脾肾两虚25例(18.9%),肝肾不足型8例(6.1%),脾肾两虚兼血瘀型99(75.0%)。饮食均衡、偏素食、偏肉食等饮食习惯不同的患者间骨密度比较,差异无统计学意义(P> 0.05)。不饮用或偶尔、经常、每天饮奶患者间骨密度比较,差异有统计学意义(P <0.05)。是否食用鱼虾和豆制品的患者骨密度比较,差异有统计学意义(P <0.05)。经常日照与很少日照患者间骨密度比较,差异有统计学意义(P <0.05)。经常、偶尔、很少运动的患者间骨密度比较,差异有统计学意义(P <0.05)。OP患者血清PTH含量高于健康老年人,GH和IGF-1低于健康老年人,差异均有统计学意义(P <0.05);OP患者血清OC、IGF-BP-3含量低于健康老年人,但差异无统计学意义(P> 0.05)。不同中医证型间血清OC、PTH、GH、IGF-1及IGF-BP-3含量比较,差异均无统计学意义(P> 0.05)。结论:年龄、不食用鱼虾和豆制品、不经常饮奶、不经常运动为老年原发性OP患者的主要危险因素;其中中医证型分布以脾肾两虚兼血瘀为主。

Objective: To study risk factors in senile patients with primary osteoporosis(OP) and the distribution of Chinese medicine syndrome types. Methods: Selected 132 cases of senile patients who were diagnosed with primary osteoporosis in our hospital from January 2015 to January 2017, recorded the general clinical data of patients and such life-relevant data as diet, physical exercise, exposure to the sun and with or without bad habits, analyzed the relevant risk factors in patients with OP, and statistically analyzed the distribution of Chinese medicine syndrome types. Another 50 cases of healthy elderly subjects undergoing physical examination in the same period were selected as the control group. Compared and analyzed the levels of insulin-like growth factor binding protein-3(IGFBP-3), insulin-like growth facto-1(IGF-1), osteocalcin(OC),growth hormone(GH) and parathyroid horm one(PTH) in serum of patients in both groups. Results: Among all the patients,there were106 cases of female patients(80.3%) and 26 cases of male patients(19.7%);the average age was 70.3 ± 5.18 among male patients and 66.2± 7.6 among female patients. Chinese medicine syndrome types were distributed as followed,25 cases of spleen-kidney deficiency type(18.9%), liver-kidney deficiency type(6.1%) and 99 cases of spleen-kidney deficiency combined with blood stasis type(75.0%). Comparing the bone mineral density among patients with such different diet habits as balanced diet, vegetarian-orientation and carnivore-orientation, there was no significant difference being found(P > 0.05).Comparing the bone mineral density among patients with such different milk-drinking habits as drinking no milk and drinking milk occasionally, frequently or every day,there was significant difference being found(P < 0.05). Comparing the bone mineral density of patients who eat fish and shrimps and bean products with that of patients who eat no fish or shrimps or bean products, there was significant difference being found(P < 0.05). Comparing the bone mineral density of patients who were exposed to the sun frequently with that of patients who were exposed to the sun scarcely, there was significant difference being found(P < 0.05). Comparing the bone mineral density among patients with such different physical exercise habits as doing physical exercise frequently, occasionally or scarcely, there was significant difference being found(P < 0.05).The content of PTH in serum of senile patients with OP was higher than that of healthy elderly subjects, and contents of GH and IGF-1 were lower than those of healthy elderly subjects,differences being significant(P < 0.05);the contents of OC,IGF-BP-2 in serum of senile patients with OP were lower than those of healthy elderly subjects, difference being insignificant(P > 0.05). Comparing the contents of OC, PTH, GH, IGF-1 and IGF-BP-3 in serum of patients with different Chinese medicine syndrome types,there were no significant differences being found(P > 0.05). Conclusion: The main risk factors in senile patients with primary OP are age, eating no fish or shrimps or bean products, drinking milk infrequently and doing physical exercise sporadically. The main Chinese medicine syndrome type is spleen-kidney deficiency combined with blood stasis.