【摘要】 目的:探讨自拟壮骨方治疗绝经后骨质疏松症的疗效及作用机制。方法:将纳入研究的240例绝经后骨质疏松症患者随机分为2组,每组120例。治疗组采用口服自拟壮骨方治疗,对照组采用口服尼尔雌醇片治疗。比较2组患者的骨密度及血清中钙、磷、碱性磷酸酶、雌二醇的水平,同时比较2组患者治疗后的疼痛改善情况。结果:1骨密度。治疗前2组患者腰椎和股骨颈骨密度比较,组间差异均无统计学意义[(0.73±0.26)g·cm-2,(0.71±0.29)g·cm-2,t=3.296,P=0.110;(0.84±0.03)g·cm-2,(0.85±0.02)g·cm-2,t=3.114,P=0.201]。治疗组治疗前后腰椎骨密度的差值大于对照组[(0.20±0.15)g·cm-2,(0.18±0.12)g·cm-2,t=4.012,P=0.021];2组患者股骨颈骨密度的差值比较,差异无统计学意义[(0.60±0.24)g·cm-2,(0.16±0.14)g·cm-2,t=1.062,P=0.080]。2血生化指标。治疗前2组患者血清中钙、磷、碱性磷酸酶、雌二醇浓度比较,组间差异均无统计学意义[(2.24±0.16)mmol·L-1,(2.22±0.14)mmol·L-1,t=5.659,P=0.431;(1.19±0.21)mmol·L-1,(1.18±0.22)mmol·L-1,t=3.314,P=0.158;(109.50±13.41)U·L-1,(108.71±20.42)U·L-1,t=1.354,P=0.762;(40.86±18.26)pmol·L-1,(41.14±19.04)pmol·L-1,t=1.918,P=0.656]。治疗组血清中钙和磷浓度治疗前后的差值均大于对照组[(1.61±0.46)mmol·L-1,(0.31±0.25)mmol·L-1,t=5.618,P=0.000;(0.60±0.24)mmol·L-1,(0.30±0.14)mmol·L-1,t=7.012,P=0.000];碱性磷酸酶和雌二醇浓度治疗前后的差值与对照组比较,差异均无统计学意义[(20.21±12.16)U·L-1,(16.11±10.12)U·L-1,t=1.368,P=0.612;(19.26±10.23)pmol·L-1,(16.76±9.67)pmol·L-1,t=1.386,P=0.748]。3疼痛改善情况。治疗组显效74例、有效35例、无效11例,对照组显效71例、有效34例、无效15例。治疗结束后2组患者疼痛改善情况比较,差异无统计学意义(Z=-0.547,P=0.584)。结论:自拟壮骨方具有类雌激素样作用,可通过提高雌激素水平,改善骨代谢,增加骨密度,减轻绝经后骨质疏松症患者的疼痛症状。更多还原

【Abstract】 Objective: To study the curative effect and mechanism of action of self-made ZHUANGGU decoction in treatment of postmenopausal osteoporosis( PMO). Methods: Two hundred and forty patients with PMO were randomly divided into 2 groups,120 cases in each group. The patients in the treatment group was treated with oral application of self-made ZHUANGGU decoction,while others in the control group was treated with nilestriol tablet. Bone mineral density( BMD) and serum level of Ca,P,alkaline phosphatase( ALP) and estradiol( E2) were compared between the 2 groups. Meanwhile,the posttreatment pain degree was compared between the2 groups.Results:There was no statistical difference in BMD of lumbar spine and femoral neck between the 2 groups before the treatment( 0. 73 +/- 0. 26 vs 0. 71 +/- 0. 29 g /cm( 2),t = 3. 296,P = 0. 110; 0. 84 +/- 0. 03 vs 0. 85 +/- 0. 02 g /cm( 2),t = 3. 114,P = 0. 201). After the treatment,the lumbar spine BMD change of treatment group was greater than that of control group( 0. 20 +/- 0. 15 vs 0. 18 +/- 0. 12 g /cm( 2),t = 4. 012,P = 0. 021),and there was no statistical difference in the femoral neck BMD change between the 2 groups( 0. 60 +/- 0. 24 vs 0. 16 +/- 0. 14 g /cm( 2),t = 1. 062,P = 0. 080). There was no statistical difference in serum level of Ca,P,ALP an E2 between the 2 groups before the treatment( 2.24 +/-0.16 vs2.22 +/-0.14 mmol/L,t =5.659,P =0.431;1.19 +/-0.21 vs1.18 +/-0.22 mmol/L,t =3.314,P =0.158;109.50 +/-13. 41 vs 108. 71 +/- 20. 42 U /L,t = 1. 354,P = 0. 762; 40. 86 +/- 18. 26 vs 41. 14 +/- 19. 04 pmol·L- 1,t =1.918,P =0.656). After the treatmeng,the change of serum level of Ca and P of treatment group was greater than that of control group( 1. 61 +/- 0. 46 vs 0. 31 +/-0. 25 mmol /L,t = 5. 618,P = 0. 000; 0. 60 +/- 0. 24 vs 0. 30 +/- 0. 14 mmol /L,t = 7. 012,P = 0. 000),while there was no statistical difference in the change of serum level of ALP and E2 between the 2 groups( 20. 21 +/- 12. 16 vs 16. 11 +/- 10. 12 U /L,t = 1. 368,P = 0. 612;19. 26 +/- 10. 23 vs 16. 76 +/- 9. 67 pmol /L,t = 1. 386,P = 0. 748). Seventy- four patients obtained an excellent result,35 good and 11 poor in the treatment group; while 71 patients obtained an excellent result,34 good and 15 poor in the control group. There was no statistical difference in the degree of pain relief between 2 groups after the treatment( Z =- 0. 547,P = 0. 584). Conclusion: Self-made ZHUANGGU decoction has estrogen- like effects,so it can effectively reduce the pain symptoms of the patients with PMO through increasing estrogen levels and improving bone metabolism and increasing BMD.更多还原