中西医结合治疗绝经后妇女骨质疏松症临床疗效及安全性观察

薛金　薛丽莉　陈慧瑶

【摘要】 目的：探討中西医结合治疗绝经后骨质疏松症（postmenopausal osteoporosis，PMOP）的效果及安全性。方法：选取2015年1月-2017年8月本院收治的PMOP患者108例。按照随机数字表法将其分为观察组和对照组，各54例。对照组给予阿仑膦酸钠片和碳酸钙D3片，观察组在对照组基础上给予补肾壮骨汤治疗，均连续治疗3个月。比较两组治疗前后的中医症候积分、骨密度、骨代谢指标（BAP、BGP、TRAcp-5b）、雌二醇（E2）水平及临床疗效、不良反应。结果：观察组总有效率为96.30%，高于对照组的79.63%（字2=7.083，P=0.008）；治疗后，两组患者腰脊疼痛、腰膝酸软、下肢疼痛、下肢痿弱、步履维艰、目眩积分均低于治疗前，且观察组均低于对照组，比较差异均有统计学意义（P<0.05）；治疗后，两组患者BAP、BGP、TRAcp-5b水平均低于治疗前，且观察组均低于对照组，比较差异均有统计学意义（P<0.05）；治疗后，两组患者L2～4（前后位）、股骨颈、Wards三角、大粗隆的骨密度及E2水平均高于治疗前，且观察组均高于对照组，比较差异均有统计学意义（P<0.05）。两组患者不良反应总发生率比较，差异无统计学意义（P>0.05）。结论：补肾壮骨汤与阿仑膦酸钠联合治疗PMOP效果显著提高，可改善患者临床症状，提高患者雌激素水平和骨密度，降低骨代谢，且安全性高，值得推广。

【关键词】 补肾壮骨汤； 阿仑膦酸钠； 骨质疏松症； 绝经后妇女

Clinical Observation on the Efficacy and Safety of Integrated Traditional Chinese and Western Medicine in Treatment of Postmenopausal Osteoporosis/XUE Jin，XUE Lili，CHEN Huiyao.//Medical Innovation of China，2018，15（14）：011-015

【Abstract】 Objective：To explore the efficacy and safety of integrated traditional Chinese and western medicine in treatment of postmenopausal osteoporosis（PMOP）.Method：A total of 108 patients with PMOP admitted in our hospital from January 2015 to August 2017 were selected.According to the random number table method，they were divided into observation group and control group，54 cases in each group.The control group was treated with Alendronate Sodium Tablets and Calcium Carbonate D3 Tablets，and observation group was given Bushen Zhuanggu Decoction on the basis of control group，they were treated for 3 months continuously.The TCM symptom score，bone mineral density，bone metabolism index（BAP，BGP，TRAcp-5b），estradiol（E2） before and after treatment，clinical efficacy and adverse reactions between two groups were compared.Result：The total effective rate of observation group was 96.30%，which was higher than 79.63% of control group（字2=7.083，P=0.008）.After treatment，the scores of lumbar spine pain，low back and knee soft，lower limbs pain，lower limbs flaccid，difficulty and dizziness in two groups were lower than those before treatment，and observation group were all lower than those of control group，the differences were statistically significant（P<0.05）.After treatment，the levels of BAP，BGP and TRAcp-5b in two groups were all lower than those before treatment，and observation group were all lower than those of control group，the differences were statistically significant（P<0.05）.After treatment，the bone mineral density of L2-4（anterior and posterior），femoral neck，Wards triangle and big trochanter and E2 level in two groups were all higher than those before treatment，and observation group were all higher than those of control group，the differences were statistically significant（P<0.05）.The total incidence of adverse reactions in two groups was compared，the difference was not statistically significant（P>0.05）.Conclusion：Bushen Zhuanggu Decoction combined with Alendronate in treatment of PMOP has significantly improved the curative effect，can improve clinical symptoms，improve estrogen level and bone mineral density，reduce bone metabolism，and is safe，which is worth promoting.

【Key words】 Bushen Zhuanggu Decoction； Alendronate； Osteoporosis； Postmenopausal women

First-authors address：Foshan First Peoples Hospital Tongji Rehabilitation Hospital，Foshan 528000，China

doi：10.3969/j.issn.1674-4985.2018.14.003

骨质疏松症（osteoporosis，OP）患者骨量明显减少，骨呈现微观结构退化且脆性增强，增加骨折的发生率，是一种全身性的骨骼疾病，绝经后骨质疏松症（postmenopausal osteoporosis，PMOP）是OP的一种特殊类型，患病对象特指绝经后的妇女，全身性单位体积内骨骼量减少明显，骨密度呈现不同程度下降，微结构出现退化，患者表现为腰腿疼痛、脊椎变形，并且骨折的发生率增加[1-2]。临床上对于PMOP的发病原因尚未明确，多数学者认为PMOP发生的重要原因是绝经后卵巢功能衰竭致使雌激素严重缺乏[3-4]，增加骨的吸收，破坏骨形成与吸收之间的平衡，是原发性OP[5]。……