原发性骨质疏松症“本痿标痹”的核心病机研究  

Research on the Key Pathogenesis of Primary Osteoporosis “Deficiency in Origin and Excess in Superficiality”

作　　者：帅波[1] 沈霖[1] 杨艳萍[1] 马陈[1] 周丕琪[1] 朱锐[1] 徐晓娟[1] 吕林[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院中西医结合骨科,武汉430022

出　　处：《中国中医骨伤科杂志》2015年第5期9-12,共4页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：国家自然科学基金(81473492;81403257)

摘　　要：目的：探讨患者中医证候与血清骨转换标志物β-CTX,N-MID和T-PINP水平、血清IL-6、TNF-a含量及疼痛分级的相关性,揭示其＂本痿标痹＂的核心病机。方法：选取我院门诊2012年1月-2013年12月180例原发性骨质疏松患者,根据主诉疼痛分级法将疼痛分为0~2级,按中医辨证分为虚痿证和本虚标实（痹）证两大类,用放免法检测血清β-CTX,N-MID和T-PINP水平,Elisa法检测患者血清中IL-6、TNF-a的含量,分析中医证候与骨转换标志物水平,血清中IL-6、TNF-a水平及疼痛程度的相关性。结果：中医证候与疼痛程度密切相关,其中疼痛0级患者95%属中医虚证,疼痛1级及2级患者全属中医本虚标实证。且疼痛2级患者血清β-CTX水平及IL-6、TNF-a含量明显高于疼痛0级及疼痛1级患者（P〈0.05）,但在疼痛0级及疼痛1级骨质疏松症患者中无统计学差异（P〉0.05）。相关性分析显示疼痛分级与骨转换标志物β-CTX及血清IL-6、TNF-a含量存在正相关（r=0.23,r=0.22,r=0.34,P〈0.01）,中医本痿标痹证候亦与骨转换标志物β-CTX及血清IL-6、TNF-a含量存在正相关（r=0.36,r=0.52,r=0.46,P〈0.01）。结论：原发性骨质疏松症患者血清骨转换标志物β-CTX和血清IL-6、TNF-a与痹痛程度及中医＂本痿标痹＂证候密切相关,可作为病情进展评价及疗效判定的指标,为阐述＂本痿标痹＂的病机提供部分临床依据。Objective：To propose and explore the pathogenesis of the primary osteoporosis is＂deficiency in origin and excess in superficiality＂,and to detect the correlation in TCM syndrome,serum levels of β-CTX,N-MID,T-PINP,IL-6,TNF-αand the degrees of pain.Methods：All 180 cases of primary osteoporosis patients were divided into three grading groups according to a report pain grading method,and two TCM syndrome groups（deficiency in origin group,deficiency in origin and excess in superficiality group）according to TCM syndrome differentiation from January 2012 to December 2013.The serum β-CTX,N-MID and TPINP levels were detected by radioimmunoassay method,and the contents of serum IL-6 and TNF-αwere detected by enzymelinked immunosorbent assay method.The correlation in TCM syndrome,serum levels of β-CTX,N-MID,T-PINP,IL-6,TNF-αand the degrees of pain were analyzed.Results：The TCM syndromes were closely related to the degrees of pain.The 95% patients of pain degree 0 group were deficiency in origin syndrome,and the patients of pain degree 1 and 2 groups were all deficiency in origin and excess in superficiality syndrome.The serum levels of β-CTX,IL-6 and TNF-αin pain degree 2 group were significantly higher than that of pain degree 0 and 1 groups（P〈0.05）,but there was no statistical difference between pain degree 0 and 1 groups（P〉0.05）.There was a positive correlation between pain degrees and serum levels of β-CTX,IL-6 and TNF-α（r=0.23,r=0.22,r=0.34,P〈0.01）.And there also was a positive correlation between TCM syndromes and serum levels of β-CTX,IL-6 and TNF-α（r=0.36,r=0.52,r=0.46,P〈0.01）.Conclusion：The serum levels of β-CTX,IL-6 and TNF-αin primary osteoporosis are closely related to degrees of pain and TCM syndromes,which can used as indexes as evaluating and judging the curative effects.This study provides partial clinical basis for elaboration the pathogenesis of＂deficiency in origin and excess in superficiality＂in the primary osteoporosis patients.

关 键 词：骨质疏松症 本痿标痹 骨代谢标志物 疼痛 病机 

分 类 号：R274.39[医药卫生—中医骨伤科学]