健脾补肾方对脾肾阳虚型亚临床甲减伴骨质疏松患者的临床疗效
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摘要
目的观察健脾补肾方对亚临床甲减伴骨质疏松(脾肾阳虚型)患者的临床疗效和不良反应等。方法将2015年1月—2017年1月于绍兴市中医院就诊的120例脾肾阳虚型亚临床甲减伴骨质疏松患者按照随机数字表均分为2组。对照组予改善甲状腺功能和抗骨质疏松等对症治疗,研究组在对照组基础上加用健脾补肾方。治疗1年后,观察2组甲状腺功能、骨代谢、细胞因子、骨密度、证候积分、疗效和不良反应等。结果治疗后研究组TSH[(3.01±0.42)m U/L]、PTH[(18.75±4.39) ng/L]、骨代谢[BGP(12.92±4.39) ng/m L、PINP(240.79±9.38)μg/L、CTX(0.23±0.01) mmol/L)]、细胞因子[IL-10(2.63±1.07) pg/m L、IL-6(85.71±9.25) pg/m L]、治疗前后症状积分差[(21.45±4.33)分]、疗效(84.0%)改善优于对照组,差异具有统计学意义(均P<0.05)。结论甲状腺功能是影响骨代谢的重要因素,亚临床甲减可引起骨量丢失,降低骨密度。健脾补肾方协助西医治疗可改善亚临床甲减伴骨质疏松(脾肾阳虚型)患者甲状腺功能、抑制骨吸收、促进骨形成、提高骨密度,改善临床症状,提高疗效。
Objective To observe the clinical observation of Jianpibushen formula in subclinical hypothyroidism(SCH)associated with osteoporosis(OP) patients of spleen kidney yang deficiency.Methods From January 2015 to January2017,120 SCH with OP patients were randomly divided into the research group and the control group according to the random number table.The control group were given the conventional radiation of improving the thyroid gland and osteoporosis treatment.While the research group were given Jianpibushen formula on the basis of the control group.After one year treatment,thyroid function,bone metabolism,cytokine,bone mineral density(BMD),symptom score,curative effect and adverse reaction were compared between the two groups.Results After treatment,TSH [(3.01 ± 0.42)m U/L],PTH:[(18.75 ± 4.39) ng/L],bone metabolism [BGP:(12.92 ± 4.39) ng/m L,PINP:(240.79 ± 9.38)μg/L,CTX(0.23 ± 0.01) mmol/L],cytokine [IL-10:(2.63 ± 1.07) pg/m L,IL-6:(85.71 ± 9.25) pg/m L],symptom score[(21.45 ± 4.33) scores],and curative effect(84.0%) in the research group were significantly better than those in the control group.The differences were statistically significant(all P < 0.05).Conclusion Thyroid function was an important factor on affecting bone metabolism.SCH can cause bone loss and reduce the BMD.Combing the Jianpibushen formula with the conventional treatment of SCH with OP patients of spleen kidney yang deficiency had satisfaction curative effect.It can significantly improve the thyroid function,promoting the bone formation,decreasing the bone resorption,increasing the BMD,and improving clinical symptoms and curative effect.
Objective To observe the clinical observation of Jianpibushen formula in subclinical hypothyroidism(SCH)associated with osteoporosis(OP) patients of spleen kidney yang deficiency.Methods From January 2015 to January2017,120 SCH with OP patients were randomly divided into the research group and the control group according to the random number table.The control group were given the conventional radiation of improving the thyroid gland and osteoporosis treatment.While the research group were given Jianpibushen formula on the basis of the control group.After one year treatment,thyroid function,bone metabolism,cytokine,bone mineral density(BMD),symptom score,curative effect and adverse reaction were compared between the two groups.Results After treatment,TSH [(3.01 ± 0.42)m U/L],PTH:[(18.75 ± 4.39) ng/L],bone metabolism [BGP:(12.92 ± 4.39) ng/m L,PINP:(240.79 ± 9.38)μg/L,CTX(0.23 ± 0.01) mmol/L],cytokine [IL-10:(2.63 ± 1.07) pg/m L,IL-6:(85.71 ± 9.25) pg/m L],symptom score[(21.45 ± 4.33) scores],and curative effect(84.0%) in the research group were significantly better than those in the control group.The differences were statistically significant(all P < 0.05).Conclusion Thyroid function was an important factor on affecting bone metabolism.SCH can cause bone loss and reduce the BMD.Combing the Jianpibushen formula with the conventional treatment of SCH with OP patients of spleen kidney yang deficiency had satisfaction curative effect.It can significantly improve the thyroid function,promoting the bone formation,decreasing the bone resorption,increasing the BMD,and improving clinical symptoms and curative effect.
引文
[1]刘丽娟,杜煜,黄伟,等.绝经前后亚临床甲减患者骨密度变化的临床分析[J].标记免疫分析与临床,2017,24(1):67-69.
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[3]徐晓棠,张巧红,蒋锦文.亚临床甲减对女性的性激素水平影响与分析[J].医学理论与实践,2016,29(9):1226-1227.
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[5]王佳丹,张巧,时立新,等.亚临床甲状腺功能减退症居民血清25羟维生素D水平及心血管危险因素的变化情况[J].中国全科医学,2016,19(22):2671-2675.
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[8]刘颖,王楠,高蕾.血清TPOAb检测在亚临床甲状腺功能减退患者诊治中的应用[J].中国临床研究,2018,31(1):91-94.
[9]李淑彦.亚临床甲状腺功能减退症的中医治疗思路[J].国际中医药杂志,2014,36(2):153-155.
[10]HARINARAYAN C V.Thyroid bone disease[J].Indian J Med Res,2012,135:9-11.
[11]KARSENTY G.The mutual dependence between bone and gonads[J].J Endocrinol,2012,213(2):107-114.
[12]BIONDI B,COOPER D S.The clinical significance of subclinical thyroid dysfunction[J].Endocr Rev,2008,29(1):76-131.
[13]张誉洋,何丽,王艺鹏.左甲状腺素钠对CHF伴亚临床甲减患者血清甲状腺激素和炎症因子水平及LVEF影响[J].陕西医学杂志,2018,47(1):69-71.
[14]王耀立,魏军平.亚临床甲状腺功能减退症中医研究进展[J].中国临床保健杂志,2016,19(3):334-336.
[15]韦丽红,张劼.2型糖尿病与促甲状腺激素及骨代谢关系的研究进展[J].医学综述,2017,23(14):2850-2854.
[16]靳云云,丁学硕.中老年女性亚甲减症与骨密度的相关性分析[J].标记免疫分析与临床,2018,25(4):454-456,486.
[17]禇青波.骨质疏松患者血清MMP相关指标及骨胶原指标的变化研究[J].陕西医学杂志,2017,46(5):619-620.
[18]赵豫梅,刘婷,李洁,等.绝经后2型糖尿病并发骨质疏松患者骨转换标志物的变化及相关因素[J].中华骨质疏松和骨矿盐疾病杂志,2016,9(1):27-31.
[19]张吟,许小凤.健脾补肾方对亚临床甲减孕鼠胎盘分泌功能及NF-κB/MMP-9通路的调控作用[J].南京中医药大学学报,2017,33(3):284-288.
[20]郑粤文,贾燕飞,罗瑞钦.金匮肾气丸对阳虚型亚临床甲减患者TPOAb-HPTA升调作用的研究[J].世界中西医结合杂志,2017,12(5):734-737.
[2]李恒,张利红,郝文庆,等.2型糖尿病合并亚临床甲状腺功能减退患者临床特点分析[J].陕西医学杂志,2018,47(4):461-463,481.
[3]徐晓棠,张巧红,蒋锦文.亚临床甲减对女性的性激素水平影响与分析[J].医学理论与实践,2016,29(9):1226-1227.
[4]刘竹林,李淑彦.基于“治未病”理论探讨亚临床甲状腺功能减退症的防治[J].中医药临床杂志,2017,29(12):2040-2044.
[5]王佳丹,张巧,时立新,等.亚临床甲状腺功能减退症居民血清25羟维生素D水平及心血管危险因素的变化情况[J].中国全科医学,2016,19(22):2671-2675.
[6]LEE J S,BUZKOVP,FINK H A,et al.Sub clinical thyroid dysfunction and incident hip fracture in older adults[J].Arch Intern Med,2010,170(21):1876-1883.
[7]梁利波,王佑娟,张玫,等.亚临床甲状腺功能减退症与骨密度及骨代谢指标的相关性研究[J].四川大学学报医学版,2014,45(1):66-69,83.
[8]刘颖,王楠,高蕾.血清TPOAb检测在亚临床甲状腺功能减退患者诊治中的应用[J].中国临床研究,2018,31(1):91-94.
[9]李淑彦.亚临床甲状腺功能减退症的中医治疗思路[J].国际中医药杂志,2014,36(2):153-155.
[10]HARINARAYAN C V.Thyroid bone disease[J].Indian J Med Res,2012,135:9-11.
[11]KARSENTY G.The mutual dependence between bone and gonads[J].J Endocrinol,2012,213(2):107-114.
[12]BIONDI B,COOPER D S.The clinical significance of subclinical thyroid dysfunction[J].Endocr Rev,2008,29(1):76-131.
[13]张誉洋,何丽,王艺鹏.左甲状腺素钠对CHF伴亚临床甲减患者血清甲状腺激素和炎症因子水平及LVEF影响[J].陕西医学杂志,2018,47(1):69-71.
[14]王耀立,魏军平.亚临床甲状腺功能减退症中医研究进展[J].中国临床保健杂志,2016,19(3):334-336.
[15]韦丽红,张劼.2型糖尿病与促甲状腺激素及骨代谢关系的研究进展[J].医学综述,2017,23(14):2850-2854.
[16]靳云云,丁学硕.中老年女性亚甲减症与骨密度的相关性分析[J].标记免疫分析与临床,2018,25(4):454-456,486.
[17]禇青波.骨质疏松患者血清MMP相关指标及骨胶原指标的变化研究[J].陕西医学杂志,2017,46(5):619-620.
[18]赵豫梅,刘婷,李洁,等.绝经后2型糖尿病并发骨质疏松患者骨转换标志物的变化及相关因素[J].中华骨质疏松和骨矿盐疾病杂志,2016,9(1):27-31.
[19]张吟,许小凤.健脾补肾方对亚临床甲减孕鼠胎盘分泌功能及NF-κB/MMP-9通路的调控作用[J].南京中医药大学学报,2017,33(3):284-288.
[20]郑粤文,贾燕飞,罗瑞钦.金匮肾气丸对阳虚型亚临床甲减患者TPOAb-HPTA升调作用的研究[J].世界中西医结合杂志,2017,12(5):734-737.