广东省中老年女性骨质疏松症患者骨密度、中医证型及其影响因素调查分析
|
摘要
目的对广东省中老年女性骨质疏松症患者骨密度、中医证型及其影响因素做横断面研究并探讨分析其关系。方法对广东省内各地(广州市、中山市、佛山市、惠州市、台山市等)医院1 453名骨质疏松症患者进行问卷调查,对所收集的资料采用SPSS统计软件进行统计分析,分析骨密度、中医证型及其影响因素(年龄、绝经年龄/年限,既往骨折史,髋部骨密度,治疗时间等)。结果最终筛选出符合标准的样本共373例,年龄介于48～95岁之间,平均年龄73.56±9.32岁,其中脾肾阳虚证130例,占34.85%,肝肾阴虚证161例,占43.16%,气滞血瘀证75例,占20.11%,其他证型7例,占1.88%。各年龄段、不同绝经年龄组间、不同绝经年限组间的患者骨密度比较差异有统计学意义(P<0.05),是否有既往骨折史和父母是否发生过髋骨骨折的骨密度比较有明显差异(P<0.05),脾肾阳虚证的患者髋部骨密度明显高于肝肾阴虚证(P<0.05),治疗时间大于6个月的患者活动度改善情况和一般情况优于治疗时间少于6个月的(P<0.05),脾肾阳虚证、肝肾阴虚证的患者接受治疗半年以上的治疗效果明显优于不超过半年的,结果具有统计学意义(P<0.05)。结论广东省中老年女性骨质疏松症各年龄段的骨密度有一定的差异性,绝经年龄、绝经年限、既往骨折史、父母髋骨骨折史与骨密度有一定相关性,不同中医证型的患者接受治疗的时间不同其效果亦有差别。
Objective To investigate the relationship among bone mineral density(BMD), TCM syndromes, and the influential factors in middle-aged and elderly women with osteoporosis in Guangdong province. Methods A total of 1453 osteoporosis patients were inquired with age, menopause age, menopausal period, history of fracture, BMD of hip and lumbar vertebrae, et al. The data were analyzed using software SPSS 20.0 editions. Results A total of 373 samples were obtained, aging from 48 to 95 years old, with the average of 73.56±9.32 years old. Among those, 130 cases were with spleen and kidney yang deficiency syndrome(34.85%), 161 cases with Yin deficiency of liver and kidney syndrome(43.16%), 75 cases with Qi stagnation and blood stasis syndrome(20.11%), and 7 cases with other syndromes(1.88%). BMD was significantly different among difference age groups, menopause age groups, and menopausal period groups(P<0.05). BMD was significantly different between the patients having and having not the history of fracture, and between having and having not parental fractures(P<0.05). BMD of patient with spleen and kidney Yang deficiency syndrome was higher than that of patients with Yin deficiency of liver and kidney syndrome(P<0.05). The patients who had been treated for more than 6 months recovered better than those treated less than 6 months in terms of improvement of joint movement. The efficacy was better in patients with Yin deficiency of liver and kidney syndrome or spleen and kidney Yang deficiency syndrome who received treatment for more than half a year. Conclusion There is a certain difference in BMD among middle-aged and elderly women with osteoporosis in Guangdong. Age, menopause age, menopausal period, and patients with fracture history or parent history of fracture are influential factors of BMD. The efficacy is various in patients with different TCM syndrome or with different treatment time.
Objective To investigate the relationship among bone mineral density(BMD), TCM syndromes, and the influential factors in middle-aged and elderly women with osteoporosis in Guangdong province. Methods A total of 1453 osteoporosis patients were inquired with age, menopause age, menopausal period, history of fracture, BMD of hip and lumbar vertebrae, et al. The data were analyzed using software SPSS 20.0 editions. Results A total of 373 samples were obtained, aging from 48 to 95 years old, with the average of 73.56±9.32 years old. Among those, 130 cases were with spleen and kidney yang deficiency syndrome(34.85%), 161 cases with Yin deficiency of liver and kidney syndrome(43.16%), 75 cases with Qi stagnation and blood stasis syndrome(20.11%), and 7 cases with other syndromes(1.88%). BMD was significantly different among difference age groups, menopause age groups, and menopausal period groups(P<0.05). BMD was significantly different between the patients having and having not the history of fracture, and between having and having not parental fractures(P<0.05). BMD of patient with spleen and kidney Yang deficiency syndrome was higher than that of patients with Yin deficiency of liver and kidney syndrome(P<0.05). The patients who had been treated for more than 6 months recovered better than those treated less than 6 months in terms of improvement of joint movement. The efficacy was better in patients with Yin deficiency of liver and kidney syndrome or spleen and kidney Yang deficiency syndrome who received treatment for more than half a year. Conclusion There is a certain difference in BMD among middle-aged and elderly women with osteoporosis in Guangdong. Age, menopause age, menopausal period, and patients with fracture history or parent history of fracture are influential factors of BMD. The efficacy is various in patients with different TCM syndrome or with different treatment time.
引文
[1] Cunningham T D,Di Pace B S, et al.Self-Reported Sleep Duration Associated with Osteoporosis? Data from a 4-Year Aggregated Analysis from the National Health and Nutrition Examination Survey[J].Journal of the American Geriatrics Society,2015,63(7):1401-1406.
[2] 章振林,金小岚,夏维波.原发性骨质疏松症诊疗指南(2017版)[J].中华骨质疏松和骨矿盐疾病杂志,2017,5(10):411-412.
[3] 刘庆思, 庄洪, 黄宏兴. 骨质疏松症中西医结合治疗[M]. 2006:204-206.
[4] 黄宏兴,吴青,李跃华,等.肌肉、骨骼与骨质疏松专家共识[J].中国骨质疏松杂志,2016,22(10):1221-1229+1236.
[5] 黄宏兴,邓伟民,万雷,等.原发性骨质疏松症辨证分型的聚类分析研究[J].世界中西医结合杂志,2014,9(9):959-961+964.
[6] 刘辉文,廖二元,戴如春,等.两种双能X线吸收法骨密度仪测量骨块模型的精密度和灵敏度比较[J].中国骨质疏松杂志,2003,9(3):19-24.
[7] 高柳. 晚期糖基化终产物及其受体在2型糖尿病性骨质疏松症中的作用[D].河北医科大学,2014.
[8] 秦林林,陈金标,张卫,等.双能X射线骨密度仪测定技术研究[J].原子能科学技术,1996,30(3):230-235.
[9] 秦莹,尚家芸,唐成志,等.DXA仪测量骨密度的质量控制及效果评价[J].中华骨质疏松和骨矿盐疾病杂志,2014,7(1):55-61.
[10] 李树法,向菲,张韬威,等.细化年龄分组在人群峰值骨量和骨质疏松症诊断中的价值[J].中国老年学杂志,2008,28(1):45-47.
[11] Yoshimura N,Muraki S,Nakamura K,et al.Epidemiology of the locomotive syndrome:the research on osteoarthritis/osteoporosis against disability study 2005-2015[J].Modern rheumatology,2017,27(1):1-7.
[12] 林晓生,王海燕,肖庆华,等.717名围绝经期妇女骨量丢失情况的流行病学调查[J].中国骨质疏松杂志,2017,23(3):363-367.
[13] 栾雪芳,赵新爽,崔文豪,等.社区中老年人骨质疏松认知水平及影响因素分析[J].河南科技大学学报:医学版,2017,35(3):226-229.
[14] 李军,祝勇刚,薛宝宝,等.老年骨折患者对骨质疏松知识认知程度及健康教育需求调查分析[J].解放军预防医学杂志,2017,35(8):986-988.
[15] Franic D.Risk Factors for Osteoporosis in Postmenopausal Women - from The Point of View of Primary Care Gynecologist[J].ZdraVstveno varstvo,2018,57(1):33-38.
[16] Mohammadi F,Amirzadeh Iranagh J,Motalebi S A,et al.Reproductive factors influencing bone mineral density in postmenopausal women[J].Women & health,2018,(2):1-10.
[17] Liu S,Li J,Sheng Z,et al.Relationship between body composition and age,menopause and its effects on bone mineral density at segmental regions in Central Southern Chinese postmenopausal elderly women with and without osteoporosis[J].Archives of gerontology and geriatrics,2011,53(2):e192-7.
[18] Terzi H,Terzi R,Kale E.Effect of multiparity on bone mineral density,evaluated with bone turnover markers[J].Revista brasileira de reumatologia,2017,57(5):371-377.
[19] Dhiman P,Andersen S,Vestergaard P,et al.Does bone mineral density improve the predictive accuracy of fracture risk assessment? A prospective cohort study in Northern Denmark[J].BMJ open,2018,8(4):e018898.
[20] 胡海澜,凌龙,何敏辉,等.绝经后不同骨关节退行性疾病与骨质疏松程度的相关性研究[J].中国骨质疏松杂志,2017,23(5):623-626.
[21] Choi H S,Park J H,Kim S H,et al.Strong familial association of bone mineral density between parents and offspring:KNHANES 2008–2011[J].Osteoporosis International,2017,28(3):955-964.
[22] 许惠娟,陈娟,谢丽华,等.绝经后妇女骨质疏松症肾阳虚证的关联蛋白LTBP1的表达及其cDNA测序的研究[J].中国骨质疏松杂志,2015,21(8):905-909.
[23] 邓琳雯,母苓,刘艺.130例绝经后骨质疏松症中医证型分布规律[J].成都中医药大学学报,2016,39(2):76-78.DENG Linwen,MU Ling,LIU Yi.Distribution of TCM Syndromes in 130 Cases of Postmenopausal Osteoporosis[J].Journal of Chengdu University of TCM,2016,39(2):76-78.
[24] 许惠娟,李生强,陈娟,等.绝经后骨质疏松症不同年龄段中医证型分布特点[J].中国实验方剂学杂志,2017,23(12):157-161.
[25] Yusuf AA,Cummings SR,Watts NB,et al.Real-world effectiveness of osteoporosis therapies for fracture reduction in post-menopausal women[J].Archives of osteoporosis,2018,13(1):33.
[26] Albayrak I,Aydogmus M,Ozerbil OM.The association between bone mineral density,quality of life,quality of sleep and fatigue[J].Acta clinica Belgica,2016,71(2):92-98.
[2] 章振林,金小岚,夏维波.原发性骨质疏松症诊疗指南(2017版)[J].中华骨质疏松和骨矿盐疾病杂志,2017,5(10):411-412.
[3] 刘庆思, 庄洪, 黄宏兴. 骨质疏松症中西医结合治疗[M]. 2006:204-206.
[4] 黄宏兴,吴青,李跃华,等.肌肉、骨骼与骨质疏松专家共识[J].中国骨质疏松杂志,2016,22(10):1221-1229+1236.
[5] 黄宏兴,邓伟民,万雷,等.原发性骨质疏松症辨证分型的聚类分析研究[J].世界中西医结合杂志,2014,9(9):959-961+964.
[6] 刘辉文,廖二元,戴如春,等.两种双能X线吸收法骨密度仪测量骨块模型的精密度和灵敏度比较[J].中国骨质疏松杂志,2003,9(3):19-24.
[7] 高柳. 晚期糖基化终产物及其受体在2型糖尿病性骨质疏松症中的作用[D].河北医科大学,2014.
[8] 秦林林,陈金标,张卫,等.双能X射线骨密度仪测定技术研究[J].原子能科学技术,1996,30(3):230-235.
[9] 秦莹,尚家芸,唐成志,等.DXA仪测量骨密度的质量控制及效果评价[J].中华骨质疏松和骨矿盐疾病杂志,2014,7(1):55-61.
[10] 李树法,向菲,张韬威,等.细化年龄分组在人群峰值骨量和骨质疏松症诊断中的价值[J].中国老年学杂志,2008,28(1):45-47.
[11] Yoshimura N,Muraki S,Nakamura K,et al.Epidemiology of the locomotive syndrome:the research on osteoarthritis/osteoporosis against disability study 2005-2015[J].Modern rheumatology,2017,27(1):1-7.
[12] 林晓生,王海燕,肖庆华,等.717名围绝经期妇女骨量丢失情况的流行病学调查[J].中国骨质疏松杂志,2017,23(3):363-367.
[13] 栾雪芳,赵新爽,崔文豪,等.社区中老年人骨质疏松认知水平及影响因素分析[J].河南科技大学学报:医学版,2017,35(3):226-229.
[14] 李军,祝勇刚,薛宝宝,等.老年骨折患者对骨质疏松知识认知程度及健康教育需求调查分析[J].解放军预防医学杂志,2017,35(8):986-988.
[15] Franic D.Risk Factors for Osteoporosis in Postmenopausal Women - from The Point of View of Primary Care Gynecologist[J].ZdraVstveno varstvo,2018,57(1):33-38.
[16] Mohammadi F,Amirzadeh Iranagh J,Motalebi S A,et al.Reproductive factors influencing bone mineral density in postmenopausal women[J].Women & health,2018,(2):1-10.
[17] Liu S,Li J,Sheng Z,et al.Relationship between body composition and age,menopause and its effects on bone mineral density at segmental regions in Central Southern Chinese postmenopausal elderly women with and without osteoporosis[J].Archives of gerontology and geriatrics,2011,53(2):e192-7.
[18] Terzi H,Terzi R,Kale E.Effect of multiparity on bone mineral density,evaluated with bone turnover markers[J].Revista brasileira de reumatologia,2017,57(5):371-377.
[19] Dhiman P,Andersen S,Vestergaard P,et al.Does bone mineral density improve the predictive accuracy of fracture risk assessment? A prospective cohort study in Northern Denmark[J].BMJ open,2018,8(4):e018898.
[20] 胡海澜,凌龙,何敏辉,等.绝经后不同骨关节退行性疾病与骨质疏松程度的相关性研究[J].中国骨质疏松杂志,2017,23(5):623-626.
[21] Choi H S,Park J H,Kim S H,et al.Strong familial association of bone mineral density between parents and offspring:KNHANES 2008–2011[J].Osteoporosis International,2017,28(3):955-964.
[22] 许惠娟,陈娟,谢丽华,等.绝经后妇女骨质疏松症肾阳虚证的关联蛋白LTBP1的表达及其cDNA测序的研究[J].中国骨质疏松杂志,2015,21(8):905-909.
[23] 邓琳雯,母苓,刘艺.130例绝经后骨质疏松症中医证型分布规律[J].成都中医药大学学报,2016,39(2):76-78.DENG Linwen,MU Ling,LIU Yi.Distribution of TCM Syndromes in 130 Cases of Postmenopausal Osteoporosis[J].Journal of Chengdu University of TCM,2016,39(2):76-78.
[24] 许惠娟,李生强,陈娟,等.绝经后骨质疏松症不同年龄段中医证型分布特点[J].中国实验方剂学杂志,2017,23(12):157-161.
[25] Yusuf AA,Cummings SR,Watts NB,et al.Real-world effectiveness of osteoporosis therapies for fracture reduction in post-menopausal women[J].Archives of osteoporosis,2018,13(1):33.
[26] Albayrak I,Aydogmus M,Ozerbil OM.The association between bone mineral density,quality of life,quality of sleep and fatigue[J].Acta clinica Belgica,2016,71(2):92-98.