糖尿病性骨质疏松的中医药防治
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摘要
随着糖尿病的发病率逐年增加,直接导致糖尿病性骨质疏松的发病率也随之上升,并且本病容易引起骨折等不良后果,严重影响患者生命质量,并带来巨大经济负担。目前DOP的治疗,主要以抗骨质疏松药物治疗为主,然而此类药物治疗效果仍存在争议,且价格昂贵,有些患者对其不良反应不能耐受。目前急需对糖尿病骨质疏松的发生机制进行研究,并寻找更经济有效的治疗方法。由此,中药的抗骨质疏松作用逐渐受到重视。中医药治疗糖尿病的大量实验和临床研究,肯定了中医药的疗效,中药或中西药结合已经在临床上非常普遍应用。现从糖尿病骨质疏松的病因病机、辨证论治、动物实验及临床研究等方面的研究进展进行综述。
Annual increase of the morbidity of diabetes directly leads to the increase of incidence of diabetic osteoporosis.And it is likely to cause fractures and other adverse consequences,seriously affecting the quality of life of patients,and bringing a huge financial burden to the family and society.Currently,the treatment of diabetic osteoporosis mainly relies on the anti-osteoporosis drugs,but the effect of such drugs is still controversial.They are expensive,even worse,some patients cannot tolerate side effects from anti-osteoporosis drugs.To sum up,there is an urgent requirement to study the mechanism of diabetic osteoporosis and to find more economical and effective way for curing diabetic osteoporosis.As a result,the anti-osteoporosis effect of traditional Chinese medicine has been paid more and more attention.A large number of experimental and clinical researches affirmed the efficacy of Chinese medicine.Traditional Chinese medicine or combined therapy of Chinese and Western medicine has been widely used in clinical practices.Now,we will review the etiology and pathogenesis,the syndrome differentiation,modern researches,clinical researches and other aspects of the relevant researches of diabetic osteoporosis from the perspective of traditional Chinese medicine.
Annual increase of the morbidity of diabetes directly leads to the increase of incidence of diabetic osteoporosis.And it is likely to cause fractures and other adverse consequences,seriously affecting the quality of life of patients,and bringing a huge financial burden to the family and society.Currently,the treatment of diabetic osteoporosis mainly relies on the anti-osteoporosis drugs,but the effect of such drugs is still controversial.They are expensive,even worse,some patients cannot tolerate side effects from anti-osteoporosis drugs.To sum up,there is an urgent requirement to study the mechanism of diabetic osteoporosis and to find more economical and effective way for curing diabetic osteoporosis.As a result,the anti-osteoporosis effect of traditional Chinese medicine has been paid more and more attention.A large number of experimental and clinical researches affirmed the efficacy of Chinese medicine.Traditional Chinese medicine or combined therapy of Chinese and Western medicine has been widely used in clinical practices.Now,we will review the etiology and pathogenesis,the syndrome differentiation,modern researches,clinical researches and other aspects of the relevant researches of diabetic osteoporosis from the perspective of traditional Chinese medicine.
引文
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[2]Kharal M,Al-Hajjaj A,Al-Ammri M,et al.Meeting the American Diabetic Association standards of diabetic care[J].Saudi J Kidney Dis Transpl,2010,21(4):678-685.
[3]Azuma K.Therapeutic considerations on secondary osteoporosis caused by diabetes mellitus[J].Clin Calcium,2009,19(9):1345-1352.
[4]Hofbauer LC,Brueck CC,Singh SK,et al.Osteoporosis in patients with diabetes mellitus[J].J Bone Miner Res,2007,22(9):1317-1328.
[5]Schwartz AV.Efficacy of Osteoporosis Therapies in Diabetic Patients[J].Calcif Tissue Int,2017,100(2):165-173.
[6]朱丽华,张贤.糖尿病骨质疏松中医病机探析[J].中国中医骨伤科杂志,2011,19(2):57-58.
[7]徐桂琴,王树芬,邹建华.古代文献对骨质疏松症病因病机的认识[J].中医杂志,2008,49(6):568-569.
[8]王世伟,高旸,刘文波,等.肾主骨与骨质疏松症[J].中国中医骨伤科杂志,2011,19(8):76-78.
[9]黄菊,舒仪琼.温阳滋阴固肾法治疗糖尿病性骨质疏松症的研究进展[J].湖南中医药杂志,2015,31(6):176-178.
[10]张磊,谷燕,董砚虎.糖尿病骨质疏松的细胞及分子机制研究进展[J].中国骨质疏松杂志,2013,19(11):1190-1194.
[11]陶乐维.糖尿病性骨质疏松症中医研究现状[J].四川中医,2013,31(2):129-131.
[12]巩振东,李翠娟,张喜德.中医药防治糖尿病性骨质疏松症的研究思路探讨[J].陕西中医学院学报,2012,35(6):10-11.
[13]李富震,姜德友,白玉宾,等.基于古今文献试论中医药治疗糖尿病骨质疏松症的思路[J].辽宁中医杂志,2015,42(1):50-51.
[14]唐建明.中医药治疗糖尿病骨质疏松的思路及方法[J].湖南中医杂志,2012,28(4):122-123.
[15]吴倩,方朝晖.中医药治疗糖尿病性骨质疏松症的思路与方法[J].中医药临床杂志,2014(6):627-629.
[16]曲岩,李敬林.从脾肾两虚论治糖尿病并发骨质疏松浅析[J].实用中医内科杂志,2011,25(4):60.
[17]范惠惠,倪海祥,魏佳平.糖尿病性骨质疏松症中医研究进展[J].浙江中西医结合杂志,2009,19(11):711-712.
[18]雷枭.糖尿病性骨质疏松中医证型研究[D].成都:成都中医药大学,2013.
[19]李真,魏玉玲.糖尿病骨质疏松症从痰瘀论治[J].中医药学报,2008,36(1):42-43.
[20]苏友新,郭进建,郑良朴,等.糖尿病性骨质疏松症的中医证候研究[J].福建中医学院学报,2002,12(1):26-29.
[21]夏木西卡玛尔,古丽娜尔.对老年性骨质疏松症的分析及预防[J].医学信息,2015,28(22):212.
[22]方朝晖,李家云,舒仪琼,等.消渴病合并骨病(糖尿病合并骨质疏松症)中医临床路径[J].中医药临床杂志,2013,25(9):835-837.
[23]何斌.中医辨证论治老年糖尿病并发骨质疏松症40例[J].福建中医药,2013,44(6):43.
[24]中华中医药学会糖尿病分会.糖尿病合并骨质疏松中医诊疗标准[J].世界中西医结合杂志,2011,6(3):265-269.
[25]张大威,程岩,张金超,等.淫羊藿苷对破骨细胞的分化及骨吸收功能的影响[J].中国药理学通报,2007,23(4):463-467.
[26]李青南,廖进民,吴铁,等.淫羊藿预防羟基脲致雄大鼠骨质疏松的定量研究[J].中国中医骨伤科杂志,1996,4(3):1-4.
[27]张秀珍,杨黎娟.淫羊藿甙对大鼠成骨细胞护骨素、RANKL表达的影响[J].中华内分泌代谢杂志,2006,22(3):222-225.
[28]杨肖红,张昆.淫羊藿对糖尿病骨质疏松患者骨保护素水平的影响[J].山东医药,2010,50(49):66-67.
[29]李永华,潘寒松,梁一民.葛根素注射液对高糖培养成骨细胞保护作用的研究[J].中国中医药科技,2012,19(4):318-319.
[30]杨勇晖,陈平洋.葛根素防治骨质疏松的研究进展[J].中国骨质疏松杂志,2015,21(3):376-378.
[31]张胜昌,王淑秋,赵爽.红景天苷对糖尿病并发骨质疏松大鼠瘦素表达的影响[J].中国病理生理杂志,2009,25(4):787-788.
[32]陶怡,沈涛,马晖.熟地黄及其不同配伍药对治疗糖尿病大鼠骨质疏松的药效比较[J].中国实验方剂学杂志,2012,18(8):249-251.
[33]张乃丹.基于分子对接的熟地防治糖尿病性骨质疏松症的有效成分和作用机制研究[D].上海:第二军医大学,2016.
[34]Choi C,Lee H,Lim H,et al.Effect of Rubus coreanus extracts on diabetic osteoporosis by simultaneous regulation of osteoblasts and osteoclasts[J].Menopause,2012,19(9):1043-1051.
[35]Qi W,Zhang Y,Yan YB,et al.The Protective Effect of Cordymin,a Peptide Purified from the Medicinal Mushroom Cordyceps sinensis,on Diabetic Osteopenia in Alloxan-Induced Diabetic Rats[J].Evid Based Complement Alternat Med,2013,2013:985636.
[36]Li XJ,Zhu Z,Han SL,et al.Bergapten exerts inhibitory effects on diabetes-related osteoporosis via the regulation of the PI3K/AKT,JNK/MAPK and NF-κB signaling pathways in osteoprotegerin knockout mice[J].Int J Mol Med,2016,38(6):1661-1672.
[37]商学征,许树青,周鹍,等.补肾通络治疗糖尿病骨质疏松临床观察[J].中国药师,2010,13(9):1329-1331.
[38]季兵,关健华,陈先明,等.补肾活血方治疗2型糖尿病骨质疏松的临床观察[J].中国医药指南,2012,10(17):3-4.
[39]巩振东,李翠娟.加味青娥丸治疗糖尿病性骨质疏松症临床研究[J].中国中医急症,2012,21(9):1391,1402.
[40]熊和平,金连宁.补肾活血方治疗糖尿病骨质疏松29例[J].中国中医药现代远程教育,2014,12(14):54-55.
[41]王冠,王静怡,奚悦.三黄糖肾康对2型糖尿病大鼠骨组织肿瘤坏死因子-α、白细胞介素-6表达的影响[J].天津医药,2015,43(11):1292-1295.
[42]王静怡,奚悦.三黄糖肾康对2型糖尿病并发骨质疏松症大鼠瘦素表达的影响研究[J].中国全科医学,2015,(24):2966-2970,2975.
[43]许建国,梁娜,陈泽涛.补肾健脾活血汤对2型糖尿病骨质疏松大鼠骨代谢影响研究[J].山西中医,2015,31(5):48-49.
[44]李兆楠,裴瑞霞.六味地黄汤加味治疗2型糖尿病合并骨质疏松症60例[J].陕西中医,2015,36(9):1174-1175.
[45]王芳,高英,李卫民,等.黄芪散对糖尿病大鼠股骨和胫骨的作用研究[J].中国骨质疏松杂志,2016,22(3):278-282,287.
[46]粟麟,李双蕾,陈文辉,等.壮骨方对糖尿病大鼠骨质疏松的防治及其对血清IGF-1、TNF-α水平的影响[J].中国骨质疏松杂志,2016,22(4):428-432.
[47]吴宏梓,方洲,汪少波.中药治疗糖尿病性骨质疏松疗效与安全性的系统评价[J].中国骨质疏松杂志,2016,22(3):251-256.
[2]Kharal M,Al-Hajjaj A,Al-Ammri M,et al.Meeting the American Diabetic Association standards of diabetic care[J].Saudi J Kidney Dis Transpl,2010,21(4):678-685.
[3]Azuma K.Therapeutic considerations on secondary osteoporosis caused by diabetes mellitus[J].Clin Calcium,2009,19(9):1345-1352.
[4]Hofbauer LC,Brueck CC,Singh SK,et al.Osteoporosis in patients with diabetes mellitus[J].J Bone Miner Res,2007,22(9):1317-1328.
[5]Schwartz AV.Efficacy of Osteoporosis Therapies in Diabetic Patients[J].Calcif Tissue Int,2017,100(2):165-173.
[6]朱丽华,张贤.糖尿病骨质疏松中医病机探析[J].中国中医骨伤科杂志,2011,19(2):57-58.
[7]徐桂琴,王树芬,邹建华.古代文献对骨质疏松症病因病机的认识[J].中医杂志,2008,49(6):568-569.
[8]王世伟,高旸,刘文波,等.肾主骨与骨质疏松症[J].中国中医骨伤科杂志,2011,19(8):76-78.
[9]黄菊,舒仪琼.温阳滋阴固肾法治疗糖尿病性骨质疏松症的研究进展[J].湖南中医药杂志,2015,31(6):176-178.
[10]张磊,谷燕,董砚虎.糖尿病骨质疏松的细胞及分子机制研究进展[J].中国骨质疏松杂志,2013,19(11):1190-1194.
[11]陶乐维.糖尿病性骨质疏松症中医研究现状[J].四川中医,2013,31(2):129-131.
[12]巩振东,李翠娟,张喜德.中医药防治糖尿病性骨质疏松症的研究思路探讨[J].陕西中医学院学报,2012,35(6):10-11.
[13]李富震,姜德友,白玉宾,等.基于古今文献试论中医药治疗糖尿病骨质疏松症的思路[J].辽宁中医杂志,2015,42(1):50-51.
[14]唐建明.中医药治疗糖尿病骨质疏松的思路及方法[J].湖南中医杂志,2012,28(4):122-123.
[15]吴倩,方朝晖.中医药治疗糖尿病性骨质疏松症的思路与方法[J].中医药临床杂志,2014(6):627-629.
[16]曲岩,李敬林.从脾肾两虚论治糖尿病并发骨质疏松浅析[J].实用中医内科杂志,2011,25(4):60.
[17]范惠惠,倪海祥,魏佳平.糖尿病性骨质疏松症中医研究进展[J].浙江中西医结合杂志,2009,19(11):711-712.
[18]雷枭.糖尿病性骨质疏松中医证型研究[D].成都:成都中医药大学,2013.
[19]李真,魏玉玲.糖尿病骨质疏松症从痰瘀论治[J].中医药学报,2008,36(1):42-43.
[20]苏友新,郭进建,郑良朴,等.糖尿病性骨质疏松症的中医证候研究[J].福建中医学院学报,2002,12(1):26-29.
[21]夏木西卡玛尔,古丽娜尔.对老年性骨质疏松症的分析及预防[J].医学信息,2015,28(22):212.
[22]方朝晖,李家云,舒仪琼,等.消渴病合并骨病(糖尿病合并骨质疏松症)中医临床路径[J].中医药临床杂志,2013,25(9):835-837.
[23]何斌.中医辨证论治老年糖尿病并发骨质疏松症40例[J].福建中医药,2013,44(6):43.
[24]中华中医药学会糖尿病分会.糖尿病合并骨质疏松中医诊疗标准[J].世界中西医结合杂志,2011,6(3):265-269.
[25]张大威,程岩,张金超,等.淫羊藿苷对破骨细胞的分化及骨吸收功能的影响[J].中国药理学通报,2007,23(4):463-467.
[26]李青南,廖进民,吴铁,等.淫羊藿预防羟基脲致雄大鼠骨质疏松的定量研究[J].中国中医骨伤科杂志,1996,4(3):1-4.
[27]张秀珍,杨黎娟.淫羊藿甙对大鼠成骨细胞护骨素、RANKL表达的影响[J].中华内分泌代谢杂志,2006,22(3):222-225.
[28]杨肖红,张昆.淫羊藿对糖尿病骨质疏松患者骨保护素水平的影响[J].山东医药,2010,50(49):66-67.
[29]李永华,潘寒松,梁一民.葛根素注射液对高糖培养成骨细胞保护作用的研究[J].中国中医药科技,2012,19(4):318-319.
[30]杨勇晖,陈平洋.葛根素防治骨质疏松的研究进展[J].中国骨质疏松杂志,2015,21(3):376-378.
[31]张胜昌,王淑秋,赵爽.红景天苷对糖尿病并发骨质疏松大鼠瘦素表达的影响[J].中国病理生理杂志,2009,25(4):787-788.
[32]陶怡,沈涛,马晖.熟地黄及其不同配伍药对治疗糖尿病大鼠骨质疏松的药效比较[J].中国实验方剂学杂志,2012,18(8):249-251.
[33]张乃丹.基于分子对接的熟地防治糖尿病性骨质疏松症的有效成分和作用机制研究[D].上海:第二军医大学,2016.
[34]Choi C,Lee H,Lim H,et al.Effect of Rubus coreanus extracts on diabetic osteoporosis by simultaneous regulation of osteoblasts and osteoclasts[J].Menopause,2012,19(9):1043-1051.
[35]Qi W,Zhang Y,Yan YB,et al.The Protective Effect of Cordymin,a Peptide Purified from the Medicinal Mushroom Cordyceps sinensis,on Diabetic Osteopenia in Alloxan-Induced Diabetic Rats[J].Evid Based Complement Alternat Med,2013,2013:985636.
[36]Li XJ,Zhu Z,Han SL,et al.Bergapten exerts inhibitory effects on diabetes-related osteoporosis via the regulation of the PI3K/AKT,JNK/MAPK and NF-κB signaling pathways in osteoprotegerin knockout mice[J].Int J Mol Med,2016,38(6):1661-1672.
[37]商学征,许树青,周鹍,等.补肾通络治疗糖尿病骨质疏松临床观察[J].中国药师,2010,13(9):1329-1331.
[38]季兵,关健华,陈先明,等.补肾活血方治疗2型糖尿病骨质疏松的临床观察[J].中国医药指南,2012,10(17):3-4.
[39]巩振东,李翠娟.加味青娥丸治疗糖尿病性骨质疏松症临床研究[J].中国中医急症,2012,21(9):1391,1402.
[40]熊和平,金连宁.补肾活血方治疗糖尿病骨质疏松29例[J].中国中医药现代远程教育,2014,12(14):54-55.
[41]王冠,王静怡,奚悦.三黄糖肾康对2型糖尿病大鼠骨组织肿瘤坏死因子-α、白细胞介素-6表达的影响[J].天津医药,2015,43(11):1292-1295.
[42]王静怡,奚悦.三黄糖肾康对2型糖尿病并发骨质疏松症大鼠瘦素表达的影响研究[J].中国全科医学,2015,(24):2966-2970,2975.
[43]许建国,梁娜,陈泽涛.补肾健脾活血汤对2型糖尿病骨质疏松大鼠骨代谢影响研究[J].山西中医,2015,31(5):48-49.
[44]李兆楠,裴瑞霞.六味地黄汤加味治疗2型糖尿病合并骨质疏松症60例[J].陕西中医,2015,36(9):1174-1175.
[45]王芳,高英,李卫民,等.黄芪散对糖尿病大鼠股骨和胫骨的作用研究[J].中国骨质疏松杂志,2016,22(3):278-282,287.
[46]粟麟,李双蕾,陈文辉,等.壮骨方对糖尿病大鼠骨质疏松的防治及其对血清IGF-1、TNF-α水平的影响[J].中国骨质疏松杂志,2016,22(4):428-432.
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