骨质疏松症患者25-(OH)VitD_(3)与中医辨证分型的相关性研究  

Study on the relationship between 25-hydroxyvitamin D_(3) and traditional Chinese medicine syndrome differentiation in patients with osteoporosis

作　　者：侍方[1] 陈佳[1] 高叶梅[1] SHI Fang;CHEN Jia;GAO Yemei(Department of Chinese Medicine,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院中医科,北京100035

出　　处：《长春中医药大学学报》2023年第8期881-884,共4页Journal of Changchun University of Chinese Medicine

基　　金：骨质疏松和骨矿盐疾病中青年医生优才培养计划暨白求恩·石药骨质疏松科研基金项目(G-X-2019-1107-5)。

摘　　要：目的讨论骨质疏松症患者血清25-羟维生素D_(3)[25-(OH)VitD_(3)]水平与中医证候辨证分型的关系。方法选择184例骨质疏松症患者,检测患者血清25-(OH)VitD_(3)水平,分析25-(OH)VitD_(3)水平与骨质疏松症各分型分布情况及相关性。结果184例低25-(OH)VitD_(3)水平骨质疏松患者共筛选出肾阳亏虚、肝肾阴虚、脾肾阳虚和血瘀气滞4种证候,按评估阳性占比高低依次为肝肾阴虚、肾阳亏虚、脾肾阳虚、血瘀气滞。4种证候评估阳性骨质疏松症患者在0~9.9 ng·mL^(-1)、10~14.9 ng·mL^(-1)、15~20 ng·mL^(-1)区间段均表现出明显差异(P<0.05)。Spearman相关性分析发现,25-(OH)VitD_(3)水平与肝肾阴虚呈负相关性(P<0.05),与其他3种证候间无明显相关性(P>0.05)。Logistic模型分析发现,仅有25-(OH)VitD_(3)水平是影响肝肾阴虚评估阳性的风险因素(OR=0.751,P=0.044,95%CI:0.569~0.992)。ROC曲线显示25-(OH)VitD_(3)水平评估肝肾阴虚阳性的曲线下面积为0.705、最佳截断值为16.95 ng·mL^(-1)、敏感度0.777、特异性0.667、95%CI:0.541~0.870。结论骨质疏松症患者机体25-(OH)VitD_(3)水平与中医证候中肝肾阴虚证关联性较强,可能是评估该证型的有效指标。Objective To discuss the relationship between serum 25-hydroxyvitamin D_(3)[25-(OH)VitD_(3)]level and traditional Chinese medicine(TCM)syndrome differentiation in patients with osteoporosis.Methods A total of 184 patients with osteoporosis were selected.The serum 25-(OH)VitD_(3)levels were detected,and the distribution and correlation between 25-(OH)VitD_(3)levels and various subtypes of osteoporosis were analyzed.Results 184 osteoporosis patients with low 25-(OH)VitD_(3)levels were screened for four syndromes,namely deficiency of kidney yang,yin deficiency of liver and kidney,yang deficiency of spleen and kidney,and blood stasis and qi stagnation.According to the proportion of positive evaluations,the order was yin deficiency of liver and kidney,deficiency of kidney yang,yang deficiency of spleen and kidney,and blood stasis and qi stagnation.There was significant difference in the range of 0-9.9 ng·mL^(-1),10-14.9 ng·mL^(-1),and 15-20 ng·mL^(-1)among patients with osteoporosis who were evaluated positive for the four syndromes(P<0.05).Spearman correlation analysis found that the level of 25-(OH)VitD_(3)was negatively correlated with yin deficiency of liver and kidney(P<0.05),and there was no significant correlation with the other three syndromes(P>0.05).Logistic model analysis found that only 25-(OH)VitD_(3)level was a risk factor affecting the positive assessment of yin deficiency of liver and kidney(OR=0.751,P=0.044,95%CI:0.569-0.992).The receiver operating characteristic(ROC)curve showed that the area under the curve for 25-(OH)VitD_(3)level to assess the positive of yin deficiency of liver and kidney was 0.705,the optimal cutoffvalue was 16.95 ng·mL^(-1),the sensitivity was 0.777,the specificity was 0.667,and the 95%CI was 0.541-0.870.Conclusion There is a strong correlation between the levels of 25-(OH)VitD_(3)in patients with osteoporosis and syndrome of yin deficiency of liver and kidney in traditional Chinese medicine syndromes,which may be an effective indicator for evaluating this syndrome type.

关 键 词：骨质疏松症 维生素D 中医证候 相关性 

分 类 号：R259[医药卫生—中西医结合]