[1]邓森,蔡桦.阿法骨化醇联合补中益气汤口服治疗老年股骨颈骨折股骨头置换术后肌减少症脾胃虚弱证的临床研究[J].中医正骨,2018,30(11):28-31.
　DENG Sen,CAI Hua.Oral applications of alfacalcidol and Buzhong Yiqi Tang(补中益气汤)for treatment of spleen-stomach-deficiency-type sarcopenia appeared after femoral head replacement in aged patients with femoral neck fractures:a clinical study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(11):28-31.
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阿法骨化醇联合补中益气汤口服治疗老年股骨颈骨折股骨头置换术后肌减少症脾胃虚弱证的临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期数:
2018年11期
页码:
28-31
栏目:
临床研究
出版日期:
2018-11-20

文章信息/Info

Title:
Oral applications of alfacalcidol and Buzhong Yiqi Tang(补中益气汤)for treatment of spleen-stomach-deficiency-type sarcopenia appeared after femoral head replacement in aged patients with femoral neck fractures:a clinical study
作者:
邓森1; 蔡桦2
(1.广东省高州市中医院,广东 高州 525200; 2.广州中医药大学附属骨伤科医院,广东 广州 510240)
Author(s):
DENG Sen1; CAI Hua2
1.Gaozhou Hospital of Traditional Chinese Medicine,Gaozhou 525200,Guangdong,China 2.The Orthopedic Hospital Affiliated to Guangzhou University of Chinese Medicine,Guangzhou 510240,Guangdong,China
关键词:
股骨颈骨折;  关节成形术; 置换; 髋;  肌减少症;  补中益气汤;  痿证;  维生素D;  老年人;  临床试验
Keywords:
femoral neck fractures;  arthroplasty; replacement; hip;  sarcopenia;  Buzhong Yiqi Tang;  flaccidity syndrome;  vitamin D;  aged;  clinical trial
摘要:
目的:观察阿法骨化醇联合补中益气汤口服治疗老年股骨颈骨折股骨头置换术后肌减少症脾胃虚弱证的临床疗效。方法:将80例老年股骨颈骨折股骨头置换术后肌减少症脾胃虚弱证患者随机分为2组,阿法骨化醇组40例、联合治疗组40例。阿法骨化醇组术后1 d口服阿法骨化醇片,每日0.5 μg,连续服用60 d; 联合治疗组术后1 d在阿法骨化醇组的治疗基础上口服补中益气汤,每日1剂,早晚各温服200 mL,连续服用60 d。分别于治疗前、治疗30 d后、治疗60 d后测定患者的握力,并采用简易躯体能力测试(short physical performance battery,SPPB)量表评价临床综合疗效。结果:握力测试结果,时间因素和分组因素存在交互效应(F=13.453,P=0.006); 2组患者握力总体比较,组间差异有统计学意义,即存在分组效应(F=17.537,P=0.000); 治疗前后不同时间点握力的差异有统计学意义,即存在时间效应(F=23.812,P=0.000); 2组患者握力随时间变化均呈增高趋势,但2组的增高趋势不完全一致[(19.13±3.21)kg,(20.71±2.18)kg,(21.91±3.16)kg,F=16.634,P=0.000;(18.72±4.15)kg,(22.04±3.56)kg,(23.51±3.82)kg,F=51.427,P=0.000]; 治疗前,2组患者握力的组间差异无统计学意义(t=0.341,P=0.367); 治疗30 d、60 d后,联合治疗组的握力均大于阿法骨化醇组(t=2.252,P=0.013; t=2.631,P=0.005)。2组患者治疗60 d后的SPPB评分均较治疗30 d后增高[(6.63±1.85)分,(7.91±2.26)分,t=1.871,P=0.033;(7.85±2.17)分,(9.23±2.25)分,t=2.930,P=0.002],治疗30 d、60 d后联合治疗组的SPPB评分均高于阿法骨化醇组(t=1.927,P=0.029; t=6.620,P=0.000)。结论:阿法骨化醇联合补中益气汤口服治疗老年股骨颈骨折股骨头置换术后肌减少症脾胃虚弱证,可以改善肌肉功能、提高肌力,且效果优于单纯口服阿法骨化醇治疗。
Abstract:
Objective:To observe the clinical curative effects of oral applications of alfacalcidol and Buzhong Yiqi Tang(补中益气汤,BZYQT)for treatment of spleen-stomach-deficiency-type sarcopenia appeared after femoral head replacement in aged patients with femoral neck fractures.Methods:Eighty aged patients with spleen-stomach-deficiency-type sarcopenia appeared after femoral head replacement for treatment of femoral neck fractures were randomly divided into monotherapy group and combination therapy group,40 cases in each group.The patients in the 2 groups were treated with oral application of alfacalcidol since postoperative day 1,0.5 μg a day for consecutive 60 days,moreover,the patients in combination therapy group were treated with oral application of warm BZYQT,200 mL at a time,one dose a day, in the morning and evening respectively for consecutive 60 days.The grip strengths of patients in the 2 groups were measured before the treatment and after 30- and 60-day treatment respectively,and the clinical comprehensive curative effects were evaluated by using short physical performance battery(SPPB)scale.Results:The grip strength test results showed that there was interaction between time factor and group factor(F=13.453,P=0.006).There was statistical difference in grip strength between the 2 groups in general,in other words,there was group effect(F=17.537,P=0.000).There was statistical difference in grip strength between different timepoints before and after the treatment,in other words,there was time effect(F=23.812,P=0.000).The grip strength presented a time-dependent increasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the increasing trend of grip strength(19.13+/-3.21,20.71+/-2.18,21.91+/-3.16 kg,F=16.634,P=0.000; 18.72+/-4.15,22.04+/-3.56,23.51+/-3.82 kg,F=51.427,P=0.000).There was no statistical difference in grip strength between the 2 groups before treatment(t=0.341,P=0.367).The grip strengths were greater in combination therapy group compared to monotherapy group after 30- and 60-day treatment(t=2.252,P=0.013; t=2.631,P=0.005).The SPPB scores measured after 60-day treatment were higher than that measured after 30-day treatment in both of the 2 groups(6.63+/-1.85 vs 7.91+/-2.26 points,t=1.871,P=0.033; 7.85+/-2.17 vs 9.23+/-2.25 points,t=2.930,P=0.002),and the SPPB scores were higher in combination therapy group compared to monotherapy group after 30- and 60-day treatment(t=1.927,P=0.029; t=6.620,P=0.000).Conclusion:Oral applications of alfacalcidol and BZYQT can improve muscle function and muscle strength in treatment of spleen-stomach-deficiency-type sarcopenia appeared after femoral head replacement in aged patients with femoral neck fractures,and its curative effect is better than that of monotherapy of oral application of alfacalcidol.

参考文献/References:


[1] 姚波,金建明,霍文璟,等.老年人下肢伸膝肌力对平衡功能的影响[J].中华物理医学与康复杂志,2006,28(7):466-467.
[2] 周海滨,雷林,冯浓萍,等.社区老年骨质疏松患者跌倒的危险因素研究[J].中国慢性病预防与控制,2016,24(5):351-353.
[3] CHEN LK,LIU LK,WOO J,et al.Sarcopenia in Asia:consensus report of the Asian Working Group for Sarco-penia[J].J Am Med Dir Assoc,2014,15(2):95-101.
[4] 国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:23-24.
[5] JANG YC,LUSTGARTEN MS,LIU Y,et al.Increased superoxide in vivo accelerates age-associated muscle atrophy through mitochondrial dysfunction and neuromuscular junction degeneration[J].FASEB J,2010,24(5):1376-1390.
[6] CHANG CD,WU JS,MHUIRCHEARTAIGH JN,et al.Effect of sarcopenia on clinical and surgical outcome in elderly patients with proximal femur fractures[J].Skeletal Radiol,2018,47(6):771-777.
[7] MURTON AJ.Muscle protein turnover in the elderly and its potential contribution to the development of sarcopenia[J].Proc Nutr Soc,2015,74(4):387-396.
[8] LAURETANI F,BANDINELLI S,BARTALI B,et al.Axonal degeneration affects muscle density in older men and women[J].Neurobiol Aging,2006,27(8):1145-1154.
[9] WU CH,YANG KC,CHANG HH,et al.Sarcopenia is related to increased risk for low bone mineral density[J].J Clin Densitom,2013,16(1):98-103.
[10] SCHRAGER MA,METTER EJ,SIMONSICK E,et al.Sarcopenic obesity and inflammation in the InCHIANTI study[J].J Appl Physiol(1985),2007,102(3):919-925.
[11] 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.
[12] 谢鸣.方剂学[M].北京:人民卫生出版社,2002:188-189.
[13] 张广霞,刘碧原,张媛凤,等.脾虚证大鼠骨骼肌变化及中医补脾类方的作用比较[J].北京中医药大学学报,2016,39(9):739-743.
[14] 李涛,杨春霞,张立新.补中益气汤对A型肉毒毒素中毒大鼠神经肌肉接头功能的影响[J].中国中西医结合杂志,2005,25(S1):9-11.
[15] 马清华,张竞.补中益气汤加减对老年性骨质疏松(脾肾两虚证)的临床疗效分析[J].中医药临床杂志,2017,29(4):551-553.
[16] 王志旺,孙少伯,王永辉,等.当归挥发油对哮喘大鼠的平喘作用及其对IL-4、IFN-γ的影响[J].免疫学杂志,2013,29(5):391-394.
[17] 官福兰,王汝俊,王建华.陈皮及橙皮甙对小鼠胃排空、小肠推进功能的影响[J].中药药理与临床,2002,18(3):7-9.
[18] 蒋志,陈其城,曹立幸,等.槟榔及其活性物质的研究进展[J].中国中药杂志,2013,38(11):1684-1687.

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更新日期/Last Update: 2018-11-30