【作者】 周军；

【导师】 眭承志；

【作者基本信息】 福建中医学院 ， 中医骨伤科学， 2004， 硕士

【摘要】 目的：观察以活血通络立法的“骨脉通”方对血瘀型绝经后骨质疏松症的治疗作用，以阐明血瘀对绝经后骨质疏松症发病的影响，并从微循环及血液流变学角度探讨“骨脉通”方治疗绝经后骨质疏松症的作用机理。 方法：60例血瘀型绝经后骨质疏松症患者，随机分为两组，每组30例：治疗组（予活血通络中药“骨脉通”方）；对照组（予钙尔奇600片剂）。两组治疗前及治疗3个月、6个月后分别评定“血瘀”临床表现综合评分、甲襞微循环评分并测定血液流变学指标，组间及组内治疗前后对比，并分别与同期体检30例健康中年妇女对比；治疗前及治疗6个月后测定腰1-4椎体前后位骨矿物密度（BMD），组间及组内治疗前后对比。 结果：两组治疗前“血瘀”临床表现综合评分、甲襞微循环评分及血液流变学指标比较无显著性差异（P＞0.05），具有可比性，但各指标均较同期体检健康中年妇女高，并有显著性差异（P＜0.01）。治疗3个月后，治疗组“血瘀”临床表现综合评分、甲襞微循环评分及血液流变学指标均较治疗前降低，并有显著性差异（P＜0.01）：对照组“血瘀”临床表现综合评分较治疗前降低，并有显著性差异（P＜0.01），但甲襞微循环评分及血液流变学指标改变无统计学意义（P＞0.05）；两组间相比，治疗组“血瘀”临床表现综合评分、甲襞微循环评分及血液流变学指标均较对照组低，有显著性差异（P＜0.01）。治疗6个月后，治疗组“血瘀”临床表现综合评分、甲襞微循环评分及血液流变学指标均较治疗3个月后降低，并有显著性差异（P＜0.01）；而对照组该三项指标与治疗3个月后比较无显著性差异（P＞0.05）；两组间相比，治疗组该三项指标均较对照组低，并有显著性差异（P＜0.01）。两组治疗前BMD值、T值、Z值均无显著性差异（P＞0.05），具有可比性；治疗6个月后，两组BMD值、T值、Z值均较治疗前升高，其中治疗组L₂、L₃、L_1-4BMD值升高有显著性意义（P＜0.05）；对照组L₃、L_1-4BMD值升高有显著性意义(P（0.05）;组间比较，治疗组BMD值、T值及Z值均比对照组高，但无显著性意义（P>0.05）。结论:（l）血癖型绝经后骨质疏松症患者存在着微循环障碍及“粘、浓、凝、聚”的血液流变学变化;（2）“骨脉通”方治疗血癖型绝经后骨质疏松症不但可改善微循环及血液流变学，更可增加腰椎骨密度，其提高腰椎骨密度的作用与临床常用的复合钙剂相当，但与复合钙剂相比，“骨脉通”方能更加全面改善疼痛等临床表现，提高生活质量，对比研究，具有更好的临床疗效。其提高腰椎骨密度的作用，可能通过改善微循环及血液的“粘、浓、凝、聚”状态促进各种营养物质的吸收及利用而实现，亦有可能由其类雌激素样作用而实现，但其具体机理尚有待进一步研究。更多还原

【Abstract】 Objective: To observe the curative effects of "GuMaiTong" recipe that basic on Blood-Active Collateral-Dredge principle to the patients with Blood-Stasis type Postmenopausal Osteoporosis, elucidating the effect of Blood-Stasis to the attack of Postmenopausal Osteoporosis, and to discuss the mechanism that Postmenopausal Osteoporosis treated with "GuMaiTong" recipe from Hemorheology and Microcirculation.Methods: 60 Patients with Postmenopausal Osteoporosis, were divided into two group randomly,30 patients per group: treat group (treated with Blood-Active Collateral-Dredge "GuMaiTong" recipe), control group(treated with Caltrate600 chew tablet). Appraised the "Blood-Stasis" clinical appearance integrative scores, Nail fold Microcirculation scores, and determined hemorheological indexes before and after treated 3 months, 6months, then contrast intragroup and intergroup, and contrast to 30 healthy mid-age women who underwent checkup at the same time; determined anterior-posterior position lumbar 1-4 vertebra body bone mineral density(BMD) before and after treated 6 months, then contrast intragroup and intergroup.Results: There is no significant difference of the "Blood-Stasis" clinical appearance integrative scores, Nail fold Microcirculation scores and hemorheological indexes between treat group and control group pretreatment(P > 0.05), that means comparable; but they were all higher than healthy mid-age women who underwent checkup at the same time, with significant difference(P < 0.01). After 3 months’ treatment, the "Blood-Stasis" clinical appearance integrative scores, Nail fold Microcirculation scores and hemorheological indexesof treat group were lower than pretreatment, with significant difference(P < 0.01); the "Blood-Stasis" clinical appearance integrative scores of control group were lower than pretreatment, with significant difference(P < 0.01), but the change of Nail fold Microcirculation scores and hemorheological indexes had no statistical significance(P > 0.05); the "Blood-Stasis" clinical appearance integrative scores, Nail fold Microcirculation scores and hemorheological indexes of treat group were lower than those of control group, with significant difference(P < 0.01). After 6 months’ treatment, the "Blood-Stasis" clinical appearance integrative scores, Nail fold Microcirculation scores and hemorheological indexes of treat group were lower than treated 3 months, with significant difference(P < 0.01), the change of "Blood-Stasis" clinical appearance integrative scores, Nail fold Microcirculation scores and hemorheological indexes of control group had no significant difference than treated 3 months(P > 0.05), the "Blood-Stasis" clinical appearance integrative scores, Nail fold Microcirculation scores and hemorheological indexes of treat group were lower than those of control group, with significant difference(P < 0.05). There is no significant difference of BMD,T-score and Z-score between treat group and control group pretreatment(P > 0.05), that means comparable; After 6 months’ treatment, the BMD,T-score and Z-score of two group were higher than pretreatment, the change of L2 L3 L1-4BMD in treat group and L3 L1-4BMD in control group had significant difference(P < 0.05); but without significant difference between the two groups posttreatment(P > 0.05).Conclusions: (1)Patients with Blood-Stasis type Postmenopausal Osteoporosis have obstacle of microcirculation and hemorheological change of "sticky, dense, agglomerate, collective"; (2)Treated the patients with Blood-Stasis type Postmenopausal Osteoporosis by "GuMaiTong" recipe not only improve microcirculation and hemorheology, but increase lumbar vertebra body bone density, the effect of increase lumbar vertebra body bone density is equal to calcic medicament that in common clinical use, but "GuMaiTong" recipe can improve the clinical appearance such as pain and life quality more comprehensive than calcic medicament, comparative study indicated it has better clinical curative effect. It increase lumbar vertebra body bone density could be real更多还原