参苓白术散合龟鹿二仙汤加减对原发性骨质疏松症脾肾两虚证患者骨代谢及炎症反应的影响

Title:

Effects of Shenling-Baizhu Powder combined with modified Guilu-Erxian Decoction on bone metabolism and inflammation response in osteoporosis patients

作者:

张寒 王洪海 徐荣林

安徽省天长市中医院骨科 239300

Author(s):

Zhang Han;  Wang Honghai;  Xu Ronglin

Department of Orthopedics, Tianchang Hospital of Traditional Chinese Medicine, Anhui Province, Tianchang 239300, China

关键词:

骨质疏松症; 脾肾两虚证; 参苓白术散; 龟鹿二仙汤; 骨代谢; 炎症反应

Keywords:

Osteoporosis;  Spleen-kidney deficiency;  Shenling-Baizhu Powder ;  Guilu-Erxian Decoction;  Bone metabolism;  Inflammatory response

DOI:

10.3760/cma.j.cn115398-202 10728-00245

摘要:

目的 探讨参苓白术散合龟鹿二仙汤加减对原发性骨质疏松症脾肾两虚证患者骨代谢及炎症反应的影响。方法 将符合入选标准的2018年6月－2019年10月本院82例原发性骨质疏松症脾肾两虚证患者采用随机数字表法分为2组，每组41例。对照组口服碳酸钙D3片与阿仑膦酸钠，观察组在对照组基础上服用参苓白术散合龟鹿二仙汤加减。2组均治疗6个月。分别于治疗前后进行中医症状评分，采用双能X线骨密度分析仪检测腰椎L2～4及股骨颈和桡骨远端1/3处骨密度值，采用电化学发光分析仪检测血清抗酒石酸酸性磷酸酶-5b(TRACP-5b)、Ⅰ型胶原C端肽(CTX-Ⅰ)水平，采用放射免疫法检测骨钙素(BGP)水平，采用全自动生化分析仪检测IL-6、IL-10、TNF-、CRP水平。观察治疗期间的不良反应，评价临床疗效。结果 观察组总有效率为95.1%(39/41)、对照组为78.0%(32/41)，2组比较差异有统计学意义(χ2＝5.145，P＝0.023)。观察组治疗后腰背疼痛、胫膝酸软、肢体倦怠、神疲乏力、头晕耳鸣、夜尿频数、纳少便溏、面色不华评分均低于对照组(t值分别为14.268、10.732、20.720、7.564、9.055、15.975、10.826、6.552，P值均＜0.001)。治疗后，观察组腰椎L2～4[(0.89±0.06)g/cm3比(0.81±0.04)g/cm3，t＝7.104]、股骨颈[(0.80±0.08)g/cm3比(0.72±0.06)g/cm3，t＝5.122]、桡骨远端1/3处[(0.65±0.12)g/cm3比(0.56±0.14)g/cm3，t＝3.125]骨密度值高于对照组(P＜0.01)。治疗后，观察组血清BGP及IL-10水平高于对照组(t值分别为3.875、3.714，P＜0.01)，TRACP-5b、CTX-Ⅰ水平及IL-6、TNF-、CRP水平低于对照组(t值分别为3.169、5.849、9.412、4.606、5.430，P值均＜0.01)。结论 参苓白术散合龟鹿二仙汤加减可有效改善原发性骨质疏松症脾肾两虚证患者临床症状，增加骨密度，调节骨代谢，减轻炎症反应，提高临床疗效。

Abstract:

Objective To explore the effects of Shenling-Baizhu Powder combined with modified Guilu-Erxian Decoction on bone metabolism and inflammation response in osteoporosis patients. Methods A total of 82 patients with osteoporosis of spleen-kidney deficiency, meeting the inclusion criteria in the hospital, were enrolled between June 2018 and October 2019. They were divided into observation group and control group by random number table method, 41 in each group. The control group was treated with oral calcium carbonate D3 tablets and alendronate sodium, while the observation group was treated with Shenling-Baizhu Powder combined with modified Guilu-Erxian Decoction on basis of control group. Both groups were treated for 6 months. Before and after treatment, scores of TCM symptoms were conducted. The bone mineral density (BMD) values of lumbar vertebra L 2-4, femoral neck and distal radius1/3 site were detected by dual-energy X-ray BMD analyzer. The levels of serum tartrate-resistant acid phosphatase 5b (TRACP 5b) and type I C-terminal cross linked peptide (CTX-I) were detected by electrochemiluminescence analyzer. The level of bone gla protein (BGP) was detected by radioimmunoassay. The levels of interleukin 6 (IL-6), interleukin 10 (IL-10), tumor necrosis factor α (TNF-α) and C-reactive protein (CRP) were detected by full-automatic biochemical analyzer. The adverse events during treatment were observed. And clinical curative effect was evaluated. Results The differences in response rate between observation group and control group was statistically significant [95.1% (39/41) vs. 78. 0% (32/41); χ2=5.145, P=0.023]. After treatment, scores of clinical symptoms (pain in back and loin, soreness and weakness of waist and knees, limb fatigue, debilitation, dizziness and tinnitus, frequent nocturia, loose stools, poor complexion) in observation group were significantly lower than those in the control group (t=14.268, 10.732, 20.720, 7.564, 9.055, 15.975, 10.826, 6.552, all Ps<0.001). After treatment, BMD values of lumbar vertebra L2-4 (0.89 ± 0.06 g/cm 3 vs. 0.81 ± 0.04 g/cm 3, t=7.104), femoral neck (0.80 ± 0.08 g/cm3 vs. 0.72 ± 0.06 g/cm 3, t=5.122) and distal radius 1/3 site (0.65 ± 0.12 g/cm3 vs. 0.56 ± 0.14 g/cm 3, t=3.125) in observation group were significantly greater than those in the control group (P<0.01). After treatment, levels of serum BGP and IL-10 in observation group were significantly higher than those in the control group ( t=3.875, 3.714, P<0.01), while levels of TRACP-5b, CTX-I, IL-6, TNF-α and CRP were significantly lower than those in the control group (t=3.169, 5.849, 9.412, 4.606, 5.430, all Ps<0.001). Conclusion Shenling-Baizhu Powder combined with modified Guilu-Erxian Decoction can improve clinical symptoms in patients with primary osteoporosis of spleen-kidney deficiency, increase BMD, regulate bone metabolism, alleviate inflammatory response and improve clinical curative effect.