补肾活血通络汤治疗糖皮质激素致骨质疏松症临床观察

Clinical Observation on Bushen Huoxue Tongluo Decoction in Treatment of Glucocorticoid-induced Osteoporosis

摘要:

目的：观察补肾活血通络汤治疗糖皮质激素致骨质疏松症（GIOP）的效果，并探讨其作用机制。方法：将120例GIOP患者随机分为观察组和对照组，各60例。观察组给予强的松激素和补肾活血汤，对照组给予糖皮质激素和骨化三醇胶囊和碳酸钙D3片，治疗6个月。评价两组患者的疗效，治疗前后中医证候积分，血钙、血磷、尿钙、尿磷、血清碱性磷酸酶（ALP），血清骨钙素（BGP）和血甲状腺旁激素（PTH）水平，骨密度（BMD）值和不良反应。结果：观察组显效率（53.3%）高于对照组（30.0%）（P<0.05），两组总有效率无明显差异。与治疗前比较，两组患者治疗后中医证候总积分降低，血钙、血磷升高，BMD值增加，均有统计学差异（P<0.05）。与对照组比较，观察组治疗后腰膝酸软、腰背疼痛、下肢疼痛、步履艰难症状和总积分明显下降（P<0.05），PTH水平明显降低，BMD值明显升高（P<0.05）。观察组不良反应发生率为0%，对照组为10.0%，观察组低于对照组（P<0.05）。结论：补肾活血通络汤治疗GIOP的效果好，能减轻激素和副作用，降低骨折的发生率，安全性良好。

Abstract:

Objective: To observe the clinical efficacy of Bushen Huoxue Tongluo decoction in treatment of glucocorticoid-induced osteoporosis (GIOP), and investigate its mechanism of action. Method: The 120 cases of GIOP patients were randomly divided into observation group and control group, 60 cases in each group. Patients in observation group took prednisone hormone and Bushen Huoxue decoction, and patients in control group received glucocorticoid, calcitriol capsules and calcium carbonate D3 tablets for 6 months. Before and after treatment, the two groups were evaluated by traditional Chinese medicine (TCM) syndrome scores, curative effects, levels of blood calcium, blood phosphorus, urinary calcium, urinary phosphorus, serum alkaline phosphatase (ALP), serum bone gla protein (BGP) and blood parathyroid hormone (PTH), bone mineral density (BMD) value and adverse reactions. Result: The markedly effective rate was 53.3% in observation group, higher than 30.0% in control group (P<0.05), and there was no difference in total effective rate between two groups. As compared with before treatment, total TCM syndrome scores were decreased in two groups; levels of blood calcium and phosphorus were increased, and BMD values were increased, with significant difference (P<0.05). As compared with control group, soreness and weakness of waist and knees, low back pain symptoms, leg pain, walking hardship symptom and total scores were decreased significantly after treatment in observation group (P<0.05), levels of serum PTH were decreased and BMD values were increased (P<0.05). The incidence of adverse effects was 0 in observation group, and 10% in control group (P<0.05). Conclusion: Bushen Huoxue Tongluo decoction has satisfactory efficacy for GIOP, which can reduce the levels of hormones, side effects and the incidence of fractures, with high safety.