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[1]劉魏,童培建,肖魯偉,等.益骨湯口服聯(lián)合太極拳鍛煉治療老年性骨質(zhì)疏松癥腎陽(yáng)虛證[J].中醫(yī)正骨,2018,30(11):6-12.
　LIU Wei,TONG Peijian,XIAO Luwei,et al.Oral application of Yigu Tang(益骨湯)combined with shadow boxing exercises for treatment of osteoporosis with kidney-yang deficiency syndrome in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(11):6-12.
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益骨湯口服聯(lián)合太極拳鍛煉治療老年性骨質(zhì)疏松癥腎陽(yáng)虛證()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期數(shù):
2018年11期
頁(yè)碼:
6-12
欄目:
臨床研究
出版日期:
2018-11-20

文章信息/Info

Title:
Oral application of Yigu Tang(益骨湯)combined with shadow boxing exercises for treatment of osteoporosis with kidney-yang deficiency syndrome in the aged
作者:
劉魏1; 童培建2; 肖魯偉2; 何幫劍2
(1.浙江省德清縣中醫(yī)院,浙江 德清 313200; 2.浙江中醫(yī)藥大學(xué)附屬第一醫(yī)院,浙江 杭州 310006)
Author(s):
LIU Wei1; TONG Peijian2; XIAO Luwei2; HE Bangjian2
1.Traditional Chinese Medical Hospital of Deqing county,Deqing 310053,Zhejiang,China 2.The First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310006,Zhejiang,China
關(guān)鍵詞:
骨質(zhì)疏松;  腎陽(yáng)虛;  益骨湯;  太極拳;  生長(zhǎng)激素;  胰島素樣生長(zhǎng)因子1;  骨密度;  阿侖膦酸鈉;  臨床試驗(yàn)
Keywords:
osteoporosis;  kidney-yang deficiency;  Yigu Tang;  shadow boxing;  growth hormone;  insulin-like growth factor I;  bone density;  alendronate sodium;  clinical trial
摘要:
目的:觀察益骨湯口服聯(lián)合太極拳鍛煉治療老年性骨質(zhì)疏松癥腎陽(yáng)虛證的臨床療效,并分析其作用機(jī)制。方法:將80例老年性骨質(zhì)疏松癥腎陽(yáng)虛證患者隨機(jī)分為2組,每組40例,分別采用益骨湯口服聯(lián)合太極拳鍛煉治療和鈣劑聯(lián)合阿侖膦酸鈉口服治療。益骨湯水煎服,每日1劑,分2次服用,連續(xù)服用6個(gè)月; 太極拳每日早晚鍛煉1次,每次15～20 min,連續(xù)6個(gè)月; 碳酸鈣D3咀嚼片(Ⅱ)每日口服1次,每次1片,連續(xù)服用6個(gè)月; 阿侖膦酸鈉每周口服1片,連續(xù)服用6個(gè)月。分別于治療前和治療開(kāi)始后1個(gè)月、3個(gè)月、6個(gè)月,比較2組患者腰背部疼痛視覺(jué)模擬量表(visual analogue scale,VAS)評(píng)分、臨床癥狀評(píng)分以及生長(zhǎng)激素(growth hormone,GH)、胰島素樣生長(zhǎng)因子-Ⅰ(insulin-like growth factors-Ⅰ,IGF-Ⅰ)血清含量; 并于治療前和治療開(kāi)始后6個(gè)月,比較2組患者腰椎骨密度。結(jié)果:①腰背部疼痛VAS評(píng)分。時(shí)間因素和分組因素存在交互效應(yīng)(F=36.390,P=0.000); 2組患者腰背部疼痛VAS評(píng)分總體比較,差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=7.257,P=0.000); 治療前后不同時(shí)間點(diǎn)腰背部疼痛VAS評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=2 717.259,P=0.000); 2組患者腰背疼痛VAS評(píng)分均呈下降趨勢(shì),但2組的下降趨勢(shì)不完全一致[(6.87±0.34)分,(4.68±0.43)分,(3.45±0.39)分,(1.59±0.36)分,F=1 282.371,P=0.000;(6.79±0.36)分,(5.47±0.27)分,(4.24±0.31)分,(2.54±0.34)分,F=1 547.065,P=0.000]; 治療前,2組患者腰背部疼痛VAS評(píng)分比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-0.946,P=0.347); 治療開(kāi)始后 1 個(gè)月、3 個(gè)月和6個(gè)月,益骨湯聯(lián)合太極拳組VAS評(píng)分均低于鈣劑聯(lián)合阿侖膦酸鈉組(t=10.029,P=0.000; t=9.925,P=0.000; t=12.148,P=0.000)。②臨床癥狀評(píng)分。時(shí)間因素和分組因素存在交互效應(yīng)(F=44.886,P=0.000); 2 組患者臨床癥狀評(píng)分總體比較,差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=10.506,P=0.000); 治療前后不同時(shí)間點(diǎn)臨床癥狀評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=1 281.241,P=0.000); 2組患者臨床癥狀評(píng)分均呈下降趨勢(shì),但2組的下降趨勢(shì)不完全一致[(19.86±1.83)分,(15.66±0.52)分,(12.19±0.68)分,(9.61±0.87)分,F=673.543,P=0.000;(19.89±1.11)分,(17.45±0.68)分,(15.49±0.52)分,(12.68±0.69)分,F=687.054,P=0.000]; 治療前,2組患者臨床癥狀評(píng)分比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=0.081,P=0.936); 治療開(kāi)始后1個(gè)月、3個(gè)月和6個(gè)月,益骨湯聯(lián)合太極拳組臨床癥狀評(píng)分均低于鈣劑聯(lián)合阿侖膦酸鈉組(t=13.036,P=0.000; t=24.324,P=0.000; t=17.380,P=0.000)。③腰椎骨密度。治療前,2組患者腰椎骨密度比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-0.777,P=0.439); 治療開(kāi)始后6個(gè)月,2組患者腰椎骨密度均高于治療前[(0.63±0.12)g·cm-2,(0.86±0.25)g·cm-2,t=-5.246,P=0.000;(0.61±0.11)g·cm-2,(0.74±0.18)g·cm-2,t=-3.897,P=0.000],益骨湯聯(lián)合太極拳組腰椎骨密度高于鈣劑聯(lián)合阿侖膦酸鈉組(t=-2.464,P=0.016)。④GH血清含量。時(shí)間因素和分組因素存在交互效應(yīng)(F=69.456,P=0.000); 2組患者GH血清含量總體比較,差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=-5.959,P=0.000); 治療前后不同時(shí)間點(diǎn)GH血清含量的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=790.502,P=0.000); 2組患者GH血清含量均呈升高趨勢(shì),但2組的升高趨勢(shì)不完全一致[(0.79±0.44)ug·L-1,(2.51±0.77)ug·L-1,(4.10±0.88)ug·L-1,(5.59±1.08)ug·L-1,F=494.694,P=0.000;(0.78±0.47)ug·L-1,(1.44±0.64)ug·L-1,(2.69±0.81)ug·L-1,(3.99±1.03)ug·L-1,F=332.258,P=0.000]; 治療前,2組患者GH血清含量比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-0.068,P=0.946); 治療開(kāi)始后1個(gè)月、3個(gè)月和6個(gè)月,益骨湯聯(lián)合太極拳組GH血清含量均高于鈣劑聯(lián)合阿侖膦酸鈉組(t=-6.742,P=0.000; t=-7.433,P=0.000; t=-6.751,P=0.000)。⑤IGF-Ⅰ血清含量。時(shí)間因素和分組因素存在交互效應(yīng)(F=10.313,P=0.000); 2組患者IGF-Ⅰ血清含量總體比較,差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=-4.466,P=0.000); 治療前后不同時(shí)間點(diǎn)IGF-Ⅰ血清含量的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=380.659,P=0.000); 2組患者IGF-Ⅰ血清含量均呈上升趨勢(shì),但2組的上升趨勢(shì)不完全一致[(178.95±7.59)ug·L-1,(233.96±20.58)ug·L-1,(255.18±22.49)ug·L-1,(296.82±28.29)ug·L-1,F=231.799,P=0.000;(177.12±10.19)ug·L-1,(210.39±17.67)ug·L-1,(232.54±21.01)ug·L-12,(264.98±32.57)ug·L-1,F=163.707,P=0.000]; 治療前,2組患者IGF-Ⅰ血清含量比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-0.907,P=0.367); 治療開(kāi)始后1個(gè)月、3個(gè)月和6個(gè)月,益骨湯聯(lián)合太極拳組IGF-Ⅰ血清含量均高于鈣劑聯(lián)合阿侖膦酸鈉組(t=-5.495,P=0.000; t=-4.652,P=0.000; t=-4.668,P=0.000)。結(jié)論:益骨湯口服聯(lián)合太極拳鍛煉與鈣劑聯(lián)合阿侖膦酸鈉口服治療老年性骨質(zhì)疏松癥腎陽(yáng)虛證,均能在一定程度上緩解腰背部疼痛、改善患者的臨床癥狀和提高患者骨密度,但前者的臨床療效優(yōu)于后者,其作用機(jī)制可能與其能提高患者血清GH、IGF-Ⅰ含量有關(guān)。
Abstract:
Objective:To observe the clinical curative effects of oral application of Yigu Tang(益骨湯,YGT)combined with shadow boxing exercises for treatment of osteoporosis with kidney-yang deficiency syndrome in the aged,and to analyze its mechanism of action.Methods:Eighty aged patients with kidney-yang deficiency type osteoporosis were randomly divided into 2 groups,40 cases in each group,and were treated with combination therapy of oral application of YGT and shadow boxing exercises(group A)and combination therapy of oral application of calcium agents and alendronate sodium(group B)respectively.The YGT were taken one dose a day in the morning and evening respectively for consecutive 6 months.The shadow boxing exercises were performed in the morning and evening respectively,15-20 minutes at a time for consecutive 6 months.The Caltrate D tablets were taken once a day,1 tablet at a time for consecutive 6 months.The alendronate sodium tablets were taken once a week,1 tablet at a time for consecutive 6 months.The low back pain visual analogue scale(VAS)scores,the clinical symptom scores and the serum contents of growth hormone(GH)and insulin-like growth factors-Ⅰ(IGF-Ⅰ)were measured and compared between the 2 groups before treatment and at 1,3 and 6 months after the beginning of the treatment respectively,and the lumbar bone mineral density(BMD)was measured and compared between the 2 groups before treatment and at 6 months after the beginning of the treatment.Results:There was interaction between time factor and group factor in low back pain VAS scores(F=36.390,P=0.000).There was statistical difference in low back pain VAS scores between the 2 groups,in other words,there was group effect(F=7.257,P=0.000).There was statistical difference in low back pain VAS scores between different timepoints before and after the treatment,in other words,there was time effect(F=2 717.259,P=0.000).The low back pain VAS scores presented a time-dependent decreasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the decreasing trend of low back pain VAS scores(6.87+/-0.34,4.68+/-0.43,3.45+/-0.39,1.59+/-0.36 points,F=1 282.371,P=0.000; 6.79+/-0.36,5.47+/-0.27,4.24+/-0.31,2.54+/-0.34 points,F=1 547.065,P=0.000).There was no statistical difference in low back pain VAS scores between the 2 groups before treatment(t=-0.946,P=0.347).The low back pain VAS scores were lower in group A compared to group B at 1,3 and 6 months after the beginning of the treatment(t=10.029,P=0.000; t=9.925,P=0.000; t=12.148,P=0.000).There was interaction between time factor and group factor in clinical symptom scores(F=44.886,P=0.000).There was statistical difference in clinical symptom scores between the 2 groups in general,in other words,there was group effect(F=10.506,P=0.000).There was statistical difference in clinical symptom scores between different timepoints before and after the treatment,in other words,there was time effect(F=1 281.241,P=0.000).The clinical symptom scores presented a time-dependent decreasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the decreasing trend of clinical symptom scores(19.86+/-1.83,15.66+/-0.52,12.19+/-0.68,9.61+/-0.87 points,F=673.543,P=0.000; 19.89+/-1.11,17.45+/-0.68,15.49+/-0.52,12.68+/-0.69 points,F=687.054,P=0.000).There was no statistical difference in clinical symptom scores between the 2 groups before treatment(t=0.081,P=0.936).The clinical symptom scores were lower in group A compared to group B at 1,3 and 6 months after the beginning of the treatment(t=13.036,P=0.000; t=24.324,P=0.000; t=17.380,P=0.000).There was no statistical difference in lumbar BMD between the 2 groups before treatment(t=-0.777,P=0.439).The lumbar BMD was higher at 6 months after the beginning of the treatment compared to pretreatment in the 2 groups(0.63+/-0.12 vs 0.86+/-0.25 g/cm(-2),t=-5.246,P=0.000; 0.61+/-0.11 vs 0.74+/-0.18 g/cm(-2),t=-3.897,P=0.000),and was higher in group A compared to group B(t=-2.464,P=0.016).There was interaction between time factor and group factor in serum contents of GH(F=69.456,P=0.000).There was statistical difference in serum contents of GH between the 2 groups in general,in other words,there was group effect(F=-5.959,P=0.000).There was statistical difference in serum contents of GH between different timepoints before and after the treatment,in other words,there was time effect(F=790.502,P=0.000).The serum contents of GH presented a time-dependent increasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the increasing trend of serum contents of GH(0.79+/-0.44,2.51+/-0.77,4.10+/-0.88,5.59+/-1.08 ug/L,F=494.694,P=0.000; 0.78+/-0.47,1.44+/-0.64,2.69+/-0.81,3.99+/-1.03 ug/L,F=332.258,P=0.000).There was no statistical difference in serum contents of GH between the 2 groups before treatment(t=-0.068,P=0.946).The serum contents of GH were higher in group A compared to group B at 1,3 and 6 months after the beginning of the treatment(t=-6.742,P=0.000; t=-7.433,P=0.000; t=-6.751,P=0.000).There was interaction between time factor and group factor in serum contents of IGF-Ⅰ(F=10.313,P=0.000).There was statistical difference in serum contents of IGF-Ⅰ between the 2 groups in general,in other words,there was group effect(F=-4.466,P=0.000).There was statistical difference in serum contents of IGF-Ⅰ between different timepoints before and after the treatment,in other words,there was time effect(F=380.659,P=0.0000).The serum contents of IGF-Ⅰ presented a time-dependent increasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the increasing trend of serum contents of IGF-Ⅰ(178.95+/-7.59,233.96+/-20.58,255.18+/-22.49,296.82+/-28.29 ug/L,F=231.799,P=0.000; 177.12+/-10.19,210.39+/-17.67,232.54+/-21.01,264.98+/-32.57 ug/L,F=163.707,P=0.000).There was no statistical difference in serum contents of IGF-Ⅰ between the 2 groups before treatment(t=-0.907,P=0.367).The serum contents of IGF-Ⅰ were higher in group A compared to group B at 1,3 and 6 months after the beginning of the treatment(t=-5.495,P=0.000; t=-4.652,P=0.000; t=-4.668,P=0.000).Conclusion:Both combination therapy of oral application of YGT and shadow boxing exercises and combination therapy of oral application of calcium agents and alendronate sodium can relieve low back pain,improve patients' clinical symptoms and increase patients'BMD to some extent,however,the former surpasses the latter in clinical curative effects,and its mechanisms of action may be that it can increase the serum contents of GH and IGF-Ⅰ.

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備注/Memo

備注/Memo:
基金項(xiàng)目:浙江省中醫(yī)藥科技計(jì)劃項(xiàng)目(2017ZA071)
通訊作者:何幫劍 E-mail:69554628 @qq.com
更新日期/Last Update: 2018-11-30