Prevalence and risk factors of osteoporosis detected by dual-energy X-ray absorptiometry among Chinese patients with primary biliary cholangitis

BACKGROUND Osteoporosis is an extrahepatic complication of primary biliary cholangitis(PBC)that increases the risk of fractures and mortality.However,Epidemiological studies of osteoporosis in patients with PBC in China and the Asia-Pacific region is lack.AIM To assess the prevalence and clinical characteristics of osteoporosis in Chinese patients with PBC.METHODS This retrospective analysis included consecutive patients with PBC from a tertiary care center in China who underwent bone mineral density(BMD)assessment using dual-energy X-ray absorptiometry between January 2013 and December 2021.We defined subjects with T-scores≤-2.5 in any sites(L1 to L4,femoral neck,or total hip)as having osteoporosis.Demographic,serological,clinical,and histological data were collected.Independent risk factors for osteoporosis were identified by multivariate logistic regression analysis.RESULTS A total of 268 patients with PBC[236 women(88.1%);mean age,56.7±10.6 years;163 liver biopsies(60.8%)]were included.The overall prevalence of osteoporosis in patients with PBC was 45.5%(122/268),with the prevalence of osteoporosis in women and men being 47.0%and 34.4%,respectively.The prevalence of osteoporosis in postmenopausal women was significantly higher than that in premenopausal women(56.3%vs 21.0%,P<0.001).Osteoporosis in patients with PBC is associated with age,fatigue,menopausal status,previous steroid therapy,body mass index(BMI),splenomegaly,gastroesophageal varices,ascites,Mayo risk score,histological stage,alanine aminotransferase,albumin,bilirubin,platelet and prothrombin activity.Multivariate regression analysis identified that older age,lower BMI,previous steroid therapy,higher Mayo risk score,and advanced histological stage as the main independent risk factors for osteoporosis in PBC.CONCLUSION Osteoporosis is very common in Chinese patients with PBC,allowing for prior screening of BMD in those PBC patients with older age,lower BMI,previous steroid therapy and advanced liver disease.

Comparison between recombinant human parathyroid hormone(1-34) and elcatonin in treatment of primary osteoporosis

Objective:To evaluate the efficacy and safety of rhPTH(1-34) vs.elcatonin.Methods:Sixty palients with primary OP were randomly divided into two groups according to the ratio of 3:1.rhPTH(1-34) group(PTH group) was treated with subcutaneous injection of rhPTH(1-34) 20 μg daily for 18 months,and the elcalonin group(CT group) was treated with intramuscular injection of elcatonin 20 U weekly for 12 months.Bone mineral density(BMD) of the lumbar spine 2-4(L_(2-4))and femoral neck,serum calcium and phosphorus,urinary calcium,serum hone specific alkaline phosphatase(BSAP).and urinary c-terminal telopeptides of type Ⅰ collagen/creatinine(uCTX-Ⅰ /Cn were tested at baseline,and 6.12.and 18 months after treatment.Results:In PTH group.HMD of L_(2-4),at 6,12.and 18 months,BDM of Femoral neck at 18 month,BSAP at 6 and 12 months and uCTX- Ⅰ /Cr at 6.12 and 18 months were all significantly raised.In CT group.HMD of L_(2-4) at12 month and that of femoral neck at 12 and 18 months were significantly elevated,while HSAP was significantly decreased at 12 and 18 months,and no significant difference on CTX- Ⅰ /Cr was observed.When BMD growth and growth rate between two groups were compared.PTH group had better improvement in L_(2-4) BMD and growth rate than CT group at 6.12.and 18 months.BMD growth and growth rale of femoral neck al 12 month and its growth at 18 month in CT group were higher than in PTH group,hut there was no significant difference between two groups regarding the growth rates at 18 month.Besides,there were no significant differences regarding the rales ol adverse reactions between two groups.Conclusions:rhPTH(1—34),is safe and effective in the treatment of primary OP.It is superior to elcatonin in improving vertebral HMD at onset time,growth rate and growth range,but inferior to elcatonin at HMD of femoral neck.

Is osteoporosis a peculiar association with primary biliary cirrhosis?

AIM: (1) To compare the prevalence of osteoporosis (t-score ≤-2.5 SD) between stage Ⅳ PBC patients, and two groups of age- and sex-matched controls: one with hepatitis C virus (HCV)-related cirrhosis, and the other one consisting of a group of healthy subjects from the general population; (2) to identify the main risk factors for the development of bone loss.METHODS: Thirty-five stage Ⅳ PBC patients (mean age 52.5±10 years), 49 females with HCV-related cirrhosis (mean age 52.9±5.8 years) and 33 healthy females (mean age 51.8+2.22 years) were enrolled in the study. Bone metabolism was evaluated by measuring serum calcium corrected for serum albumin (Ca corr.), 25-hydroxy vitamin D (25-OH vit D), parathyroid hormone, osteocalcin.Bone mineral density (BMD) was assessed at the lumbar spine by dual-photon X-ray absorptiometry.RESULTS: Osteoporosis was present in 5/35 PBC patients (14.2%) and in 7/49 HCV-related cirrhotic patients (14.3%),without any statistical difference between the two groups.Among healthy control subjects, none had osteoporosis.No difference was found between the three groups in serum parameters of bone metabolism. Univariate analysis showed that menopausal state and low BMI were significantly correlated with osteoporosis. Multivariate regression analysis showed that menopausal status, BMI ＜23, and old age were independent variables significantly correlated with osteoporosis.CONCLUSION: PBC in itself has no negative influence on BMD. End-stage liver disease patients carry a disease-specific risk for osteoporosis, but have an effective risk of bone loss in relation to individual potential risk for each patient. A practical message should be taken into account, that is, every effort should be made to prevent osteoporosis when a patient has simple osteopenia, or if it is a woman in or near menopausal age.

Observation on Effect of Gennlanchun (更年春) In Preventing Experimental Primary Osteoporosis

Objective: To evaluate the efficacy of Genni-anchun (GNC) in preventing primary osteoporosis. Methods: Fifty female SD rats of 10 - 12 months old were randomly divided into five groups. Except those in the sham operation group, animals were ovariectomized bilaterally. The gastric perfusion was started immediately after operation, with normal saline to the sham operation group and model group; GNC to high dose (2 ml) and low dos (1 ml) GNC groups and Nilestriol to the NE group, every day for 3 months. Animals were sacrificed at the end of experiment, their vertebra and

INFLUENCE OF DIFFERENT INTERVALS OF ACUPUNCTURE TREATMENT ON BONE INTENSITY IN PRIMARY OSTEOPOROSIS PATIENTS

Objective: To observe the influence of different intervals of acupuncture treatment on bone intensity in primary osteoporosis subjects. Methods: A total of 45 cases of primary osteoporosis female patients were randomly divided into 1 treatment/week (1-T/W), 2 treatments/week (2-T/W) and 3 treatments/week (3-T/W) groups, with 15 cases being in each group. Guanyuan (CV 4), Zusanli (ST 36), Sanyinjiao (SP 6), Shenshu (BL 23), Taixi (KI 3) and Pishu (BL 20) were used and stimulated with reinforcing needling manipulation. For patients with deficiency syndrome of kidney-yang, thermal acupuncture was applied to Shenshu (BL 23), and for patients with spleen-deficiency syndrome, thermal acupuncture applied to Zusanli (ST 36). Results: After 6 months’ treatment, in 1-T/W group, no apparent change of bone intensity was observed, while in 2-T/W and 3-T/W groups, the bone intensity was increased significantly (P<0.05, 0.01). Conclusion: Acupuncture plus moxibustion treatment twice or 3 times every week can obviously improve the bone intensity.

Primary Hyperparathyroidia at the Abass Ndao Hospital Center: About 29 Cases

Introduction: In Senegal, there is very little data on primary hyperparathyroidism despite an overall upward epidemiological trend. The objective was to describe its epidemiological, clinical, therapeutic and evolutionary aspects. Materials and Methods: This was a cross-sectional, descriptive study, conducted over 5 years (from January 01, 2018 to December 31, 2022) at the National Abass Ndao Hospital Center and including all confirmed cases of primary hyperparathyroidism. Results: Twenty-nine patients were included with a female predominance (86.20%) and an average age of 48.10 ± 18.93 years. The discovery of hyperparathyroidism was fortuitous in 79.31% of cases. The main clinical manifestations were osteoarticular (62%) and urinary (34.5%). On average, serum calcium measured was 109.2 ± 7.92 mg/l, corrected serum calcium 111.3 ± 6.25 mg/l, urinary calcium 421.9 ± 96.45 mg/24h and parathormone at 145 ± 159.71 pg/ml. Among the patients, 25 had hypercalcemia (86.2%) and all had 24-hour hypercalciuria. The diagnosis was retained in view of the elevated parathyroid hormone (PTH) values in all patients. Cervical ultrasound objectified a parathyroid adenoma in 27.58% of cases and 12 patients or 46.2% had presented a scintigraphy in favor of a parathyroid adenoma. We found 01 cases of multiple endocrine neoplasia type 2. Bone densitometry performed in 10 patients found osteoporosis in 60% of cases (6 patients) and osteopenia in 40% of cases (4 patients). Surgical treatment was performed in 12 patients (41.4%). The histology of the surgical specimens was in favor of a parathyroid adenoma in all cases. Among the operated patients, the evolution was marked by a cure rate of 100%. Conclusion: The symptomatology of primary hyperparathyroidism remains mainly osteoarticular and urinary. Surgery has proven its effectiveness in our series. We insist on the systematic dosage of calcemia especially in women over 50 years and the promotion of morphological explorations.

肌-骨交互视阈下传统功法防治原发性骨质疏松症的思路探讨

原发性骨质疏松症(POP)具有高患病率、高致残率的特点,严重影响老年人的健康和生命质量,寻求有效的防治手段具有现实意义。以肌-骨交互作用为切入点,肌骨交互机制作为传统功法防治POP的新靶点,探讨传统功法防治POP的研究思路,太极拳调养气息,强壮肌肉筋骨;五禽戏调腑通络,提高腰椎稳定性;易筋经动静结合,降低跌倒风险;八段锦形气意同调,补肾强筋壮骨。传统功法一方面可提高骨密度、增强骨强度,另一方面提高肌肉质量和力量,加强机械作用传导促进骨代谢,双向调控肌肉-骨骼并形成闭合式循环回路。

中医体质类型与原发性骨质疏松症的相关性分析

目的:探讨中医体质类型与原发性骨质疏松症的相关性。方法:通过分层抽样的方式,抽取2022年1月—2023年1月期间福建省第二人民医院骨科收治的60例老年女性绝经后骨质疏松症患者为研究主体,纳入骨质疏松症组,另将同期来我院行健康体检的60例骨密度正常者纳入对照组,通过问卷调查的方式,了解其中医体质类型,并通过Logtisic回归分析中医体质类型与原发性骨质疏松症的相关性。结果:骨质疏松症组气郁质、气虚质及血瘀质显著高于对照组(P<0.05);Logtisic回归分析显示,气郁质、气虚质及血瘀质是老年女性绝经后骨质疏松症发生的危险体质。结论:老年女性绝经后骨质疏松症患者以血瘀质、气郁质为主,二者存在密切关联,因此要重视患者体质分析,尽早辨识,尽早干预偏颇体质,以更好地预防骨质疏松症发生发展。

老年原发性骨质疏松症患者接受双膦酸盐治疗的临床效果分析

目的:探讨双膦酸盐治疗老年原发性骨质疏松症的效果。方法:选取2020年10月—2023年12月中山市中医院收治的老年原发性骨质疏松症患者200例为研究对象,随机分为对照组与观察组,各100例。对照组应用唑来膦酸治疗,观察组应用双膦酸盐(阿伦膦酸钠)治疗。比较两组患者不良反应、生活质量、治疗效果。结果:治疗3、7 d后,观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05);治疗后,两组心理、躯体、认知及社会功能评分均高于治疗前,观察组高于对照组,差异有统计学意义(P<0.05);观察组总有效率高于对照组,差异有统计学意义(P=0.018)。结论:双膦酸盐(阿伦膦酸钠)治疗老年原发性骨质疏松症的效果理想,可有效提高患者生活质量,减少不良反应发生。

中药复方治疗原发性骨质疏松用药规律及作用机制分析

背景:中药复方治疗原发性骨质疏松有着较久的历史,并且疗效确切,但其用药规律及作用机制尚不明确。目的:利用数据挖掘与网络药理学的方法学,探究现代中医家治疗原发性骨质疏松的用药规律、分子层面的作用机制并一定程度的加以验证。方法:将中国知网、万方、维普、PubMed等数据库收录的相关文献作为数据来源,使用Microsoft EXCEL 2019、IBM SPSS 25.0等软件统计和提取相关资料。将数据统计得到的高频药物进行关联规则分析和聚类分析,综合两者结果得到中药复方治疗原发性骨质疏松的核心药物组合,利用网络药理学阐释此组合发挥治疗作用的机制并借助分子对接加以验证。结果与结论:最终纳入151篇文献,筛选出方剂207首,涉及中药285味。①通过上述两种分析综合得到重要药物组合10组,其中置信度和提升度最高的核心药物组合为“骨碎补-杜仲-当归”,其组合治疗原发性骨质疏松的关键成分为槲皮素、山奈酚、柚皮素等,核心靶点为SRC原癌基因(SRC proto-oncogene)、磷脂酰肌醇-3-激酶调节亚单位1(PIK3R1)、RELA原癌基因(RELA)等,主要通路为癌症信号通路、JAK-STAT信号通路、VEGF信号通路、核因子κB信号通路等。②将关键活性成分与核心靶点进行分子对接,两者展示出较好的结合性。③中药复方治疗原发性骨质疏松核心药物组合可利用其多种活性成分,通过多条信号通路、作用于多个靶点发挥疗效,可为后续治疗原发性骨质疏松新药的研发提供理论基础。

原发性干燥综合征合并骨质疏松的危险因素

原发性干燥综合征(primary Sjögren’s syndrome,pSS)是一种好发于中老年女性,以口干、眼干、疲劳、关节疼痛为主要临床特点的系统性自身免疫性疾病。研究表明约1/3的pSS患者合并骨质疏松(osteoporosis,OP),出现腰背疼痛,甚至骨折,严重影响pSS患者生活质量。pSS和OP的共同危险因素除年龄与性别外,还包括持续存在的炎症状态、免疫紊乱、肠道菌群失调、低维生素D水平、血脂异常和肌少症等,而pSS合并症(如肾小管性酸中毒、原发性胆汁性胆管炎、自身免疫性甲状腺疾病)以及pSS治疗药物(如糖皮质激素、甲氨蝶呤、环磷酰胺)是pSS合并OP特有的危险因素。在临床工作中应加强对pSS患者的宣教及健康引导,加强OP筛查等骨骼健康的管理。早期识别OP并及时进行干预治疗对改善pSS患者骨代谢及生活质量起着重要作用。

原发性骨质疏松潜在生物标志物的生物信息学分析

背景:原发性骨质疏松症的发病率高,但发病机制尚不完全清楚,目前尚缺乏有效的早期筛查指标和治疗方案。目的:通过综合生物信息学分析,进一步探索原发性骨质疏松症的发生机制。方法:原发性骨质疏松症数据来自公共基因表达数据库,筛选差异基因分别进行GO功能和KEGG通路富集分析。此外,将差异基因进行蛋白质-蛋白质相互作用网络确定原发性骨质疏松症相关核心基因,并通过最小绝对收缩和选择运算算法来识别并验证原发性骨质疏松症相关的生物标志物,并分别进行免疫细胞相关分析、基因富集分析以及药物标靶网络分析。最后将生物标志物行qPCR实验验证。结果与结论:①该研究中共获得126个差异基因以及前列腺素、表皮生长因子受体、丝裂原活化蛋白激酶3、转化生长因子B1和视网膜母细胞瘤基因1等5个生物标志物。②GO分析表明差异基因主要富集在细胞对氧化应激的反应以及自噬的调节等方面;KEGG分析显示主要集中在自噬以及细胞衰老等通路当中。③生物标志物的免疫分析发现,前列腺素,视网膜母细胞瘤基因1、丝裂原活化蛋白激酶3与免疫细胞密切相关。④基因富集分析表明,生物标志物与免疫相关途径有关。⑤药物标靶网络分析显示5个生物标志物与原发性骨质疏松症药物相关。⑥qPCR结果表明,前列腺素、表皮生长因子受体、丝裂原活化蛋白激酶3和转化生长因子B1在原发性骨质疏松症样本中,与对照样本相比表达显著上升(P<0.001),而视网膜母细胞瘤基因1在原发性骨质疏松症样本中,与对照样本相比表达显著下降(P<0.001)。⑦总之,该研究筛选并验证了5个原发性骨质疏松潜在生物标志物,为进一步深入探究原发性骨质疏松症的发病机制、早期筛查诊断及靶向治疗提供了参考依据。

基于网络药理学的中药组方治疗骨质疏松症的用药规律研究

目的 分析国家专利中药组方治疗骨质疏松症的用药规律并进行网络药理学分析。方法 在国家知识产权局网站中检索治疗慢骨质疏松的中药组方,规范药名后进行中药频数分析、性味归经分析,组方规律分析,药物靶点频数分析,k-means降维PPI分析、GO-BP生物学功能富集分析和KEGGPathway分析。结果 共纳入112项专利中药组方,涉及156味中药,其中淫羊藿的使用频次最高。药性以温性、平性、寒常见;五味多为甘、苦、辛;归经多归属肝经、肾经、脾经。关联规则分析提示常用的药对组合为牡蛎—淫羊藿,三七—当归,黄芪—淫羊藿等。核心靶点主要是AR、ESR1、ESR2、NR1I2、SHBG、VDR、NR3C1,GABRA家族和GABRG家族等。k-mean聚类分析PPI互作网络可降维成4类,与临床分型密切相关。GO和KEGG-Pathway分析表明中药复方主要通过神经活性配体-受体相互作用,氯化物跨膜转运,类固醇激素生物合成,碳水化合物的消化和多种物质成瘾的信号通路,通过消化吸收,神经信号和递质传递,类固醇的代谢,氯离子的转运等功能发挥防治骨质疏松症的作用。结论 结果表明中药治疗原发性骨质疏松症有规律可循,为中药治疗骨质疏松提供了理论依据,为中药的临床研究和基础研究提供了新的思路。

维生素D及钙补充影响POP人群心脑血管类疾病发生的临床调查

目的探究维生素D(vitamin D,VD)及钙剂(calcium,Ca)补充对高血压或冠心病POP人群心脑血管类疾病发生的影响。方法将2018年10月至2019年9月在溧阳市人民医院心血管内科诊断为高血压伴原发性骨质疏松症(primary osteoporosis,POP)或冠心病伴POP并符合纳入标准的317例患者纳入研究,分为高血压组224例、冠心病组93例;并根据VD缺乏程度各自分为VD缺乏组(25(OH)D≤20 ng/mL)和极度缺乏组(25(OH)D≤10 ng/mL)。予VD缺乏组碳酸钙D3(钙尔奇D)1片,每天1次;予VD极度缺乏组碳酸钙D3(钙尔奇D)2片,每天1次。连续补充18个月。期间嘱患者记录心绞痛(包括心肌梗死)、动脉粥样硬化(除冠脉外新发)、下肢静脉血栓、脑梗发生并迫使其就医的发作次数和就医时的25(OH)D和血Ca水平,并记录各组发生心脑血管类疾病发生和未发生的总人数。比较各组内以上指标的差异。结果POP高血压组:VD极度缺乏组(19.0%)比VD缺乏组(7.5%)发生心脑血管类疾病的比例较高,P=0.018;2组VD及Ca呈现显著正相关,P<0.001。与VD缺乏组比较,VD极度缺乏组发生心绞痛时的血Ca及VD水平均较高,P<0.05。POP冠心病组:VD极度缺乏组(86.2%)比VD缺乏组(62.7%)发生心血管类疾病的比例较高,P=0.030;2组VD及Ca呈现显著的正相关,P<0.001。与VD缺乏组比较,VD极度缺乏组发生心绞痛时的血Ca及VD水平均较高,P<0.05和P<0.01;发生动脉粥样硬化时血Ca水平较高,P<0.05,而VD有升高趋势。结论对于高血压伴POP并VD极度缺乏的患者来说,适度增加VD并减少Ca补充较为适宜;而对于对应的冠心病患者来说,应当谨慎(一定程度减少)补充VD及Ca剂。

原发性骨质疏松症预测模型的建立与应用

目的构建原发性骨质疏松症(POP)的风险评分(RPOPS)模型,评价其预测POP的价值。方法选择2021年5月至2023年10月初次骨质疏松筛查者249例,根据骨密度(BMD)分为对照组(n=120)和骨质疏松组(n=129),并收集一般资料和外周血骨质疏松相关参数,包括中性粒细胞计数(N),淋巴细胞计数(L),中性粒细胞/淋巴细胞比值(NLR),血小板计数(P),血小板/淋巴细胞比值(PLR)和红细胞分布宽度(RDW),通过非参数检验、Spearman相关分析和多因素Logistic逐步回归分析预测POP的独立风险因素,构建POP的RPOPS预测模型,并绘制受试者操作特征曲线(ROC),评价RPOPS预测模型的诊断效能。结果两组除RDW、PLR比较差异无统计学意义(P>0.05),其余各指标比较差异均有统计学意义(P<0.001);相关性分析显示,N与NLR(r=0.585,P<0.001),L与NLR(r=-0.594,P<0.001);Logistic回归分析:年龄增长、BMI降低、PLT降低、NLR升高、t-PINP升高、性别是POP发生的独立危险因素(P<0.05);并建立模型RPOPS=-1.658+0.080×年龄+0.921×性别-0.220×BMI-0.008×PLT+1.053×NLR+0.045×t-PINP;HosmerLemeshow检验模型的拟合优度良好(P=0.53),RPOPS模型截断值为0.04时,其曲线下面积为0.905,预测敏感度和特异度分别为81.40%和84.20%。结论RPOPS模型的构建合理,简单易行,适宜基层医院预测和筛查POP。

基于结构方程模型的原发性骨质疏松症高危女性健康促进行为的影响因素分析

目的基于结构方程模型探讨原发性骨质疏松症高危女性健康促进行为的影响因素,为制订有效干预方案提供理论参考。方法2023年2-5月,采用便利抽样法选取衡阳市4所社区卫生服务中心的400名原发性骨质疏松症高危女性为研究对象,采用一般资料调查表、电子健康素养量表、领悟社会支持量表、骨质疏松症自我效能量表和健康促进生活方式量表Ⅱ对其进行调查,采用结构方程模型进行影响因素分析。结果工作状态、文化程度、疾病认知程度、领悟社会支持、自我效能直接影响健康促进行为(效应值分别为0.199、0.109、0.155、0.263、0.207);电子健康素养不仅直接影响,还可通过领悟社会支持和自我效能的部分中介作用影响健康促进行为(直接效应值为0.515,总中介效应值为0.231)。结论原发性骨质疏松症高危女性的健康促进行为受多种因素协同影响。社区医务人员应重点关注在职、文化程度与疾病认知程度较低者,可通过开展电子健康干预、调动社会支持系统、增强自我效能,以提升其健康促进行为水平。

中医体质与原发性骨质疏松症相关性Meta分析

目的:通过系统评价探讨原发性骨质疏松症患者与中医体质的相关性。方法:检索中国知网、万方、PubMed、SinoMed等中英文数据库中符合纳入标准的文献,检索时间为建库—2023年2月1日,并进行Meta分析。结果:最终纳入15项研究,合计样本量为10 050人。原发性骨质疏松症人群9种体质占比的Meta分析结果显示,阳虚质、气虚质、阴虚质、血瘀质的人数占比较高,分别为21%、17%、15%、11%;原发性骨质疏松症人群与一般人群主要体质占比的Meta分析结果显示,阳虚质、气虚质、阴虚质、血瘀质在原发性骨质疏松症人群的比例分别是一般人群的1.91倍、1.85倍、1.17倍、1.42倍。结论:原发性骨质疏松症人群中阳虚质、气虚质、阴虚质、血瘀质体质类型人数占比较高,阳虚质、气虚质、阴虚质、血瘀质是原发性骨质疏松症发病的危险因素。

基于中医传承辅助平台的中药内服治疗原发性骨质疏松症组方用药规律研究

目的:基于数据挖掘方法探讨中医药治疗原发性骨质疏松症的组方用药规律。方法:检索中国知网、维普、万方等中文数据库2006—2022年中药内服治疗原发性骨质疏松症的中药方剂,通过中医传承辅助平台系统软件(TCMISS)运用关联规则算法、复杂系统熵聚类方法,统计处方中药物的性味归经、使用频率、药物之间的关联规则、核心药物组合和高频中药组合。结果:纳入文献共计210篇,涉及224首方剂,168味中药。总结高频证候分型,居于前4位的分别是肾虚血瘀证、脾肾亏虚证、肝肾阴虚证、肾虚证。性味归经最多为温性药,五味频次最多为甘味药。药物归经前4位的是肝、肾、脾及心经。单味中药使用频次居于前10位的是熟地黄、淫羊藿、当归、杜仲、黄芪、骨碎补、补骨脂、山茱萸、山药、枸杞子。关联规则分析得到45个药对组合及44条关联规则。聚类分析得到20个药物核心组合,优化出10个新方组合。结论:原发性骨质疏松症病因以肾、脾亏虚为主,兼有血瘀,中医药治疗以补益肝肾、健脾益气、活血补血为主。

中老年原发性骨质疏松症的中医证型分布规律及其与骨代谢指标的关系研究

目的 探讨中老年原发性骨质疏松症在临床上中医证型分布规律及其与骨代谢指标{甲状旁腺激素(PTH)、N中端骨钙素(N-MID)、25-羟基维生素D_3[25-(OH)D_3]、β胶原特殊序列(β-Crosslaps)}的关系。方法 回顾性分析165例中老年原发性骨质疏松症患者的临床资料,比较不同性别患者的年龄分布情况及中医证型分布情况,不同中医证型患者骨密度(T值)及骨代谢指标[25-(OH)D_3、N-MID、PTH、β-Crosslaps]。结果 男性患者与女性患者的年龄分布情况比较,无明显差异(P>0.05)。男性患者中各中医证型占比由高到低为肾阳虚证(42.6%)>血瘀气滞证(23.4%)>肝肾阴虚证(21.3%)>脾肾阳虚证(12.8%),女性患者中各中医证型占比由高到低为肝肾阴虚证(44.9%)>脾肾阳虚证(22.9%)>肾阳虚证(19.5%)>血瘀气滞证(12.7%),男性患者与女性患者的中医证型分布情况比较差异明显(P<0.05)。肾阳虚证、肝肾阴虚证、脾肾阳虚证、血瘀气滞证患者的T值分别为(-3.02±0.48)、(-2.9±0.47)、(-3.30±0.74)、(-2.72±0.18),25-(OH)D_3分别为(7.97±3.37)、(21.86±6.94)、(14.70±6.47)、(15.45±5.55)ng/ml;不同中医证型患者的T值、25-(OH)D_3水平比较差异具有统计学意义(P<0.05);不同中医证型患者的N-MID、β-Crosslaps、PTH水平比较无显著差异(P>0.05)。结论 中老年原发性骨质疏松症患者中医证型和性别分布具有差异性,且T值、25-(OH)D_3可以对中老年原发性骨质疏松症的中医证型判定及鉴别有辅助作用。

基于文献研究的原发性骨质疏松症中医证型及证素分布规律研究

目的:探讨原发性骨质疏松症患者的中医证候以及证素分布规律。方法:检索中国知网以及万方数据库中有关原发性骨质疏松症中医证型的相关文献,检索时间为数据库建立至2023年5月。应用Excel表提取原发性骨质疏松症患者的中医证型信息,将文献中证型的名称规范化处理,对中医证型进行证素提取,建立数据库,采用SPSS 27.0.1软件进行频数分析。结果:共纳入79篇符合标准的文献,病例18251例,经规范化处理后共纳入41种中医证型,16种证素,其中病位证素4种,病性证素12种。在总的证型分布中频率>3%的证型有8种,其中肝肾阴虚证居首位,4017例(22.05%),其余是脾肾阳虚证3236例(17.77%)、气滞血瘀证1733例(9.51%)、肾阳虚证1631例(8.95%)、肾虚血瘀证1433例(7.87%)、脾肾两虚证1087例(5.97%)、气虚血瘀证594例(3.26%)、脾肾气虚证549例(3.01%)。在总的证素分布中,病位证素分别是肾13700例(56.00%)、脾5720例(23.26%)、肝4454例(18.11%)、胃646例(2.63%);病性证素分别是阳虚5301例(27.92%)、阴虚4851例(25.55%)、血瘀4139例(21.80%)、气滞1759例(9.26%)、气虚1700例(8.95%)、精亏606例(3.19%),其余6个病性证素出现频率较小(频率均<3.00%)。结论:原发性骨质疏松症的病位主要分布在肾、脾、肝、胃,其证素分布虚实夹杂,虚证以阳虚、阴虚、气虚为主,实证则以血瘀、气滞为主,中医证型以肝肾阴虚证、脾肾阳虚证、气滞血瘀证、肾阳虚证最为常见。原发性骨质疏松症的病机、证候复杂多样,而中医证型有时难以完全体现患者的具体情况,证素的合理搭配能有效地应对复杂的病机及证候。