目的:研究温肾宣痹汤联合阿法骨化醇及碳酸钙治疗老年骨质疏松症的临床效果.方法:选择2020年1月-2022年12月苏州大学附属常州老年病医院(常州市第七人民医院)收治的82例老年骨质疏松症患者,随机分为三组.西药组采用阿法骨化醇及碳酸钙,中药组采用温肾宣痹汤,联合组采用温肾宣痹汤联合阿法骨化醇及碳酸钙治疗.检测三组的血清碱性磷酸酶(Alkaline Phosphatase,ALP)、护骨素(Osteoprotegerin,OPG)、Ⅰ型胶原羧基端肽β特殊序列(β-C-terminal cross-linking telopeptide of type Ⅰ collagen,β-CTx)、骨钙素(Bone Gla Protein,BGP)、内皮素(Endothelin-1,ET-1)、基质金属蛋白酶(Matrix Metallopep-tidase,MMP)-9和胰岛素样生长因子-1(Insulin-like Growth Factor-1,IGF-1)水平.结果:联合组的有效率明显更高(P＜0.05);治疗前,三组腰椎L1～4 及股骨颈的骨密度差异无统计学意义(P＞0.05);治疗后,三组腰椎L1～4 及股骨颈的骨密度明显升高(P＜0.05),且联合组更高(P＜0.05).治疗前,三组的血清ALP、OPG、β-CTx和BGP水平差异无统计学意义(P＞0.05);治疗后,三组的血清ALP、OPG、β-CTx和BGP水平均明显改善(P＜0.05),且联合组的血清ALP、OPG、β-CTx和BGP水平明显优于西药组和中药组(P＜0.05).治疗前,三组的血清ET-1、MMP-9和IGF-1水平差异无统计学意义(P＞0.05);治疗后,三组的血清ET-1、MMP-9和IGF-1水平均明显改善(P＜0.05),且联合组的血清ET-1、MMP-9和IGF-1水平明显优于西药组和中药组(P＜0.05).结论:温肾宣痹汤联合阿法骨化醇及碳酸钙对老年骨质疏松症有显著的效果,提高L1～4 及股骨颈的骨密度,有效改善ALP、OPG、β-CTx和BGP等骨代谢指标,并且可能从降低血清ET-1和MMP-9水平,升高IGF-1水平方面治疗骨质疏松,值得推广.
Clinical study of Wenshen Xuanbi decoction combined with alfacalcalcitol and calcium carbonate in the treatment of senile osteoporosis
Objective:To study the clinical effect of Wenshen Xuanbi decoction(温肾宣痹汤)combined with alfacalcalcitol and calcium carbonate on senile osteoporosis.Methods:A total of 82 elderly patients with osteoporosis admitted to Changzhou Geriatric Hospital Affiliated to Soochow University from January 2020 to December 2022 were randomly divided into three groups.The western medicine group was treated with alfacalcitol and calcium carbonate,the Chinese medicine group was treated with Wenshen Xuanbi decoction,and the combination group was treated with Wenshen Xuanbi decoction combined with alfacalcitol and calcium carbonate.Serum levels of al-kaline phosphatase(ALP),osteophosphate(OPG),carboxy-terminal peptide B special sequence of type Ⅰ collagen(β-CTx),osteocalcin(BGP),endothelin(ET-1),matrix metalloproteinase-9(MMP-9)and insulin-like growth factor-1(IGF-1)were detected in the three groups.Results:The effective rate of the combination group was significantly higher(P<0.05).Before treatment,BMD of lumbar L1-4 and femoral neck were not sig-nificantly different among the three groups(P>0.05).After treatment,the bone mineral density of lumbar vertebrae L1-4 and neck of femur in the three groups increased significantly(P<0.05),and that of the combination group was higher(P<0.05).Before treatment,there was no significant difference in serum ALP,OPG,β-CTx and BGP levels of the three groups(P>0.05),but after treatment,serum ALP,OPG,β-CTx and BGP lev-els of the three groups were significantly improved(P<0.05).The serum levels of ALP,OPG,β-CTx and BGP in the combination group were significantly higher than those in western medicine group and Chinese medicine group(P<0.05).Before treatment,there was no significant difference in the serum ET-1,MMP-9 and IGF-1 levels of the three groups(P>0.05),but after treatment,serum ET-1,MMP-9 and IGF-1 levels of the three groups were significantly improved(P<0.05).The levels of ET-1,MMP-9 and IGF-1 in the combination group were significantly higher than those in western medicine group and Chinese medicine group(P<0.05).Conclusion:Wenshen Xuanbi decoction combined with alfacalcalcitol and calcium carbonate can significantly improve bone mineral density of L1-4 and femoral neck,effectively promote bone metabolic indexes such as ALP,OPG,β-CTx and BGP,and may reduce serum ET-1 and MMP-9 levels,and increase IGF-1 levels to treat osteoporosis,which is worthy of promotion.
万方数据
维普
