参苓白术散治疗肌少症患者的临床疗效观察  

Clinical effect of Senling Baizhu san on patients with sarcopenia

作　　者：王琴[1] 张彬 林萍[1] 任谦[1] 高康璐 孔程程 Wang Qin;Zhang Bin;Lin Ping;Ren Qian;Gao Kanglu;Kong Chengcheng(Department of Geriatrics,Hangzhou Third People's Hospital,Hangzhou 310009,Zhejiang,China)

机构地区：[1]杭州市第三人民医院老年科,浙江杭州310009

出　　处：《中华危重病急救医学》2021年第8期994-998,共5页Chinese Critical Care Medicine

基　　金：浙江省医药卫生科技计划项目(2019KY502);浙江省杭州市医药卫生科技计划项目(2018A29,2018Z05)。

摘　　要：目的观察参苓白术散治疗脾胃虚弱型肌少症的临床疗效。方法选择2018年1月至2020年3月杭州市第三人民医院老年科确诊为脾胃虚弱型肌少症的80例住院患者,按照随机数字表法将患者分为对照组和观察组,每组40例。所有患者均采用西医常规治疗,观察组在西医常规治疗基础上加用参苓白术散100 mL、每日2次,两组疗程均为12周。记录患者治疗前后握力、步行速度,计算四肢骨骼肌指数(ASMI);采用酶联免疫吸附试验(ELISA)检测血清沉默信息调节因子1(SIRT1)、生长分化因子-8(GDF-8)及胰岛素样生长因子-1(IGF-1)水平;采用实时荧光定量聚合酶链反应(RT-qPCR)检测血清腺苷酸活化蛋白激酶α(AMPK-α)mRNA表达。结果与治疗前比较,两组患者治疗后握力明显增强,ASMI明显增高,血清IGF-1、SIRT1水平及AMPK-αmRNA表达均明显升高,血清GDF-8水平显著下降,且观察组治疗后上述指标的变化均较对照组更加显著〔握力(kg):20.00(15.50,21.00)比18.20(14.93,19.50),ASMI(kg/m^(2)):5.80(5.25,6.00)比5.30(5.20,5.50),IGF-1(μg/L):246.00(229.00,259.50)比207.00(187.00,233.00),SIRT1(ng/L):649.2±38.3比624.6±38.6,AMPK-αmRNA(2^(-ΔΔCt)):0.30±0.03比0.27±0.03,GDF-8(μg/L):13.50(12.00,17.80)比15.60(14.08,19.98),均P<0.05〕。而两组治疗前后步行速度差异均无统计学意义〔对照组治疗前后为0.56(0.53,0.62)m/s、0.58(0.55,0.62)m/s,观察组治疗前后为:0.58(0.54,0.64)m/s、0.60(0.56,0.65)m/s,均P>0.05〕。Spearman相关性分析显示,IGF-1与SIRT1呈正相关(r=0.341,P=0.002),与步行速度呈正相关(r=0.250,P=0.026);ASMI与握力呈正相关(r=0.367,P=0.001)。结论在西医常规治疗基础上加用参苓白术散治疗脾胃虚弱型肌少症患者效果显著,可为肌少症的治疗提供新的中西医结合思路。Objective To observe the clinical effect of Senling Baizhu san(SLBZS)on patients with sarcopenia.Methods Eighty patients with spleen-stomach weakness sarcopenia admitted to the department of geriatrics of Hangzhou Third People's Hospital from January 2018 to March 2020 were enrolled.The patients were divided into control group and observation group by random number table method,40 cases in each group.All patients were treated with conventional Western medicine,and the observation group was treated with SLBZS 100 mL,twice a day,on the basis of conventional Western medicine.The course of the treatments was 12 weeks.Grip strength and walking speed were recorded before and after treatment,and appendicular skeletal mass index(ASMI)was calculated.The serum levels of silence infor-mation regulator 1(SIRT1),growth differentiation factor-8(GDF-8)and insulin-like rowth factor-1(IGF-1)were detected by enzyme linked immunosorbent assay(ELISA).The mRNA expression of AMP-activated protein kinase-α(AMPK-α)in serum was detected by real-time quantitative polymerase chain reaction(RT-qPCR).Results Compared with before treatment,grip strength,ASMI,IGF-1,SIRT1 and AMPK-αmRNA in both groups were significantly increased after treatment,while GDF-8 was significantly decreased.The changes of above indexes in the observation group were more significant than those in the control group after treatment[grip strength(kg):20.00(15.50,21.00)vs.18.20(14.93,19.50),ASMI(kg/m^(2)):5.80(5.25,6.00)vs.5.30(5.20,5.50),IGF-1(μg/L):246.00(229.00,259.50)vs.207.00(187.00,233.00),SIRT1(ng/L):649.2±38.3 vs.624.6±38.6,AMPK-αmRNA(2^(-ΔΔCt)):0.30±0.03 vs.0.27±0.03,GDF-8(μg/L):13.50(12.00,17.80)vs.15.60(14.08,19.98),all P<0.05].There was no significant difference in walking speed between the two groups before and after treatment[0.56(0.53,0.62)m/s and 0.58(0.55,0.62)m/s in the control group before and after treatment,0.58(0.54,0.64)m/s and 0.60(0.56,0.65)m/s in the observation group before and after treatment,both P>0.05].Spearman correlation analys

关 键 词：参苓白术散 肌少症 腺苷酸活化蛋白激酶 沉默信息调节因子1 

分 类 号：R685[医药卫生—骨科学]