强直性脊柱炎患者骨密度、骨代谢指标与中医辨证分型的关系  

The relationships among bone mineral density,bone metabolic parameters,and syndrome differentiation typing in Chinese medicine in ankylosing spondylitis patients

作　　者：孔维萍[1] 阎小萍[1] 张卫[1] 陶庆文[1] 路平[1] 

机构地区：[1]中日友好医院中医风湿病科,北京100029

出　　处：《中国骨质疏松杂志》2011年第4期328-332,共5页Chinese Journal of Osteoporosis

摘　　要：目的检测1051例强直性脊柱炎(AS)骨密度(BMD)、骨代谢指标,探讨其与五种中医辨证分型的关系。方法酶联免疫法、放射免疫法检测1051例AS患者及260例同期健康体检者血清骨钙素、骨碱性磷酸酶、Ⅰ型胶原羧基端延长肽、Ⅰ型胶原交联C末端肽及尿脱氧吡啶啉水平。双能X线法检测对照组与AS组腰椎、股骨颈、股骨粗隆BMD。并检测AS组ESR、CRP水平。探讨不同证型AS患者上述指标的异同。结果五个证型患者的腰椎BMD均显著降低,除湿热伤肾证的股骨颈BMD与对照组相比无明显减低外,其余四个证型的股骨颈、股骨粗隆BMD及湿热伤肾证的股骨粗隆BMD均较对照组显著降低。AS患者邪郁化热证、湿热伤肾证的ESR、CRP高于其他证型,尤高于肾虚督寒、邪及肝肺证。肾虚督寒、邪及肝肺、邪痹肢节证的骨生成指标低于湿热伤肾、邪郁化热证。湿热伤肾、邪郁化热证的骨吸收指标高于其他证型。与对照组比较各证型骨吸收水平均显著增高。结论 AS患者的BMD的降低,是骨质受损的外在表现,与肾督亏虚密切相关。五个证型均存在着肾虚督亏骨质受损的表现,并存在着正气的偏虚、邪气的偏盛。但湿热伤肾、邪郁化热证的邪气更盛,治疗应更注重于驱邪;肾虚督寒、邪及肝肺、邪痹肢节证的正气更虚,治疗应更偏重于扶正。Objective Bone mineral density （BMD） and bone metabolic parameters were measured in 1051 ankylosing spondylitis （AS） patients. The relationships among these and 5 syndrome differentiation types of Chinese medicine were explored. Methods Serum osteocalcin, bone specific alkaline phosphatase, C- telopeptide of type I collagen, and pyridinoline cross-linked carboxy-terminal telopeptiele of type I collagen were determined using ELISA and immunoradiological methods in 1051 AS patients and 260 healthy people. BMDs of the lumbar spine, femoral neck, and the femoral tuberosity in both AS group and control group were measured using DXEA. ESR and CRP levels were also measured in AS group. The difference of the parameters in patients of varied syndrome differentiation types was explored. Results BMD of the lumbar spine in patients of all 5 syndrome differentiation types was significantly decreased. Except in damp heat and impairment of kidney type, BMDs of the femoral neck and the femoral rough in all other syndrome types, and the femoral tuberosity in damp heat and impairment of kidney type, were significantly decreased compared to the control. ESR and CRP levels in AS group of stagnant pathogen and heat-transmission and damp heat and impairment of kidney syndromes were higher than other syndromes, especially higher than nephrasthenia cold syndrome and pathogens impairing liver and lung syndrome. Bone formation parameters of nephrasthenia cold syndrome, pathogens impairing liver and lung syndrome, and exogenous deafness of extremities syndrome were lower than those of damp heat and impairment of kidney and stagnant pathogen and heat-transmission syndromes. Bone resorption parameters of damp heat and impairment of kidney and stagnant pathogen and heat-transmission syndromes were higher than those of other syndromes. Bone resorption parameters of all syndromes were significantly higher than those of control group. Conclusion The decrease of BMD in AS patients was the superior appearance of bone damage which was close

关 键 词：强直性脊柱炎 骨密度 骨代谢 辨证分型 

分 类 号：R681[医药卫生—骨科学]