[1]刘魏,童培建,肖鲁伟,等.益骨汤口服联合太极拳锻炼治疗老年性骨质疏松症肾阳虚证[J].中医正骨,2018,30(11):6-12.
　LIU Wei,TONG Peijian,XIAO Luwei,et al.Oral application of Yigu Tang(益骨汤)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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益骨汤口服联合太极拳锻炼治疗老年性骨质疏松症肾阳虚证()
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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:
6-12
栏目:
临床研究
出版日期:
2018-11-20

文章信息/Info

Title:
Oral application of Yigu Tang(益骨汤)combined with shadow boxing exercises for treatment of osteoporosis with kidney-yang deficiency syndrome in the aged
作者:
刘魏1; 童培建2; 肖鲁伟2; 何帮剑2
(1.浙江省德清县中医院,浙江 德清 313200; 2.浙江中医药大学附属第一医院,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
关键词:
骨质疏松;  肾阳虚;  益骨汤;  太极拳;  生长激素;  胰岛素样生长因子1;  骨密度;  阿仑膦酸钠;  临床试验
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:观察益骨汤口服联合太极拳锻炼治疗老年性骨质疏松症肾阳虚证的临床疗效,并分析其作用机制。方法:将80例老年性骨质疏松症肾阳虚证患者随机分为2组,每组40例,分别采用益骨汤口服联合太极拳锻炼治疗和钙剂联合阿仑膦酸钠口服治疗。益骨汤水煎服,每日1剂,分2次服用,连续服用6个月; 太极拳每日早晚锻炼1次,每次15～20 min,连续6个月; 碳酸钙D3咀嚼片(Ⅱ)每日口服1次,每次1片,连续服用6个月; 阿仑膦酸钠每周口服1片,连续服用6个月。分别于治疗前和治疗开始后1个月、3个月、6个月,比较2组患者腰背部疼痛视觉模拟量表(visual analogue scale,VAS)评分、临床症状评分以及生长激素(growth hormone,GH)、胰岛素样生长因子-Ⅰ(insulin-like growth factors-Ⅰ,IGF-Ⅰ)血清含量; 并于治疗前和治疗开始后6个月,比较2组患者腰椎骨密度。结果:①腰背部疼痛VAS评分。时间因素和分组因素存在交互效应(F=36.390,P=0.000); 2组患者腰背部疼痛VAS评分总体比较,差异有统计学意义,即存在分组效应(F=7.257,P=0.000); 治疗前后不同时间点腰背部疼痛VAS评分的差异有统计学意义,即存在时间效应(F=2 717.259,P=0.000); 2组患者腰背疼痛VAS评分均呈下降趋势,但2组的下降趋势不完全一致[(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]; 治疗前,2组患者腰背部疼痛VAS评分比较,差异无统计学意义(t=-0.946,P=0.347); 治疗开始后 1 个月、3 个月和6个月,益骨汤联合太极拳组VAS评分均低于钙剂联合阿仑膦酸钠组(t=10.029,P=0.000; t=9.925,P=0.000; t=12.148,P=0.000)。②临床症状评分。时间因素和分组因素存在交互效应(F=44.886,P=0.000); 2 组患者临床症状评分总体比较,差异有统计学意义,即存在分组效应(F=10.506,P=0.000); 治疗前后不同时间点临床症状评分的差异有统计学意义,即存在时间效应(F=1 281.241,P=0.000); 2组患者临床症状评分均呈下降趋势,但2组的下降趋势不完全一致[(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]; 治疗前,2组患者临床症状评分比较,差异无统计学意义(t=0.081,P=0.936); 治疗开始后1个月、3个月和6个月,益骨汤联合太极拳组临床症状评分均低于钙剂联合阿仑膦酸钠组(t=13.036,P=0.000; t=24.324,P=0.000; t=17.380,P=0.000)。③腰椎骨密度。治疗前,2组患者腰椎骨密度比较,差异无统计学意义(t=-0.777,P=0.439); 治疗开始后6个月,2组患者腰椎骨密度均高于治疗前[(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],益骨汤联合太极拳组腰椎骨密度高于钙剂联合阿仑膦酸钠组(t=-2.464,P=0.016)。④GH血清含量。时间因素和分组因素存在交互效应(F=69.456,P=0.000); 2组患者GH血清含量总体比较,差异有统计学意义,即存在分组效应(F=-5.959,P=0.000); 治疗前后不同时间点GH血清含量的差异有统计学意义,即存在时间效应(F=790.502,P=0.000); 2组患者GH血清含量均呈升高趋势,但2组的升高趋势不完全一致[(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]; 治疗前,2组患者GH血清含量比较,差异无统计学意义(t=-0.068,P=0.946); 治疗开始后1个月、3个月和6个月,益骨汤联合太极拳组GH血清含量均高于钙剂联合阿仑膦酸钠组(t=-6.742,P=0.000; t=-7.433,P=0.000; t=-6.751,P=0.000)。⑤IGF-Ⅰ血清含量。时间因素和分组因素存在交互效应(F=10.313,P=0.000); 2组患者IGF-Ⅰ血清含量总体比较,差异有统计学意义,即存在分组效应(F=-4.466,P=0.000); 治疗前后不同时间点IGF-Ⅰ血清含量的差异有统计学意义,即存在时间效应(F=380.659,P=0.000); 2组患者IGF-Ⅰ血清含量均呈上升趋势,但2组的上升趋势不完全一致[(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]; 治疗前,2组患者IGF-Ⅰ血清含量比较,差异无统计学意义(t=-0.907,P=0.367); 治疗开始后1个月、3个月和6个月,益骨汤联合太极拳组IGF-Ⅰ血清含量均高于钙剂联合阿仑膦酸钠组(t=-5.495,P=0.000; t=-4.652,P=0.000; t=-4.668,P=0.000)。结论:益骨汤口服联合太极拳锻炼与钙剂联合阿仑膦酸钠口服治疗老年性骨质疏松症肾阳虚证,均能在一定程度上缓解腰背部疼痛、改善患者的临床症状和提高患者骨密度,但前者的临床疗效优于后者,其作用机制可能与其能提高患者血清GH、IGF-Ⅰ含量有关。
Abstract:
Objective:To observe the clinical curative effects of oral application of Yigu Tang(益骨汤,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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备注/Memo

备注/Memo:
基金项目:浙江省中医药科技计划项目(2017ZA071)
通讯作者:何帮剑 E-mail:69554628 @qq.com
更新日期/Last Update: 2018-11-30