FRAX^(Ⓡ)探讨绝经后骨质疏松症中医证型与骨折风险的相关性研究  

Study of the relationship between the syndrome types of postmenopausal osteoporosis in traditional Chinese medicine and fracture risk based on FRAX^(Ⓡ)

作　　者：廖翼涛 张贤[1,2] 邱峰 刘小峰 李超[2] LIAO Yitao;ZHANG Xian;QIU Feng;LIU Xiaofeng;LI Chao(Nanjing University of Chinese Medicine,Nanjing 210038,China;Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine,Wuxi 214071,China;Wuxi Xinwu District Traditional Chinese Medicine Hospital,Wuxi 214145,China)

机构地区：[1]南京中医药大学,江苏南京210038 [2]南京中医药大学无锡附属医院,江苏无锡214071 [3]无锡市新吴区中医医院,江苏无锡214145

出　　处：《中国骨质疏松杂志》2023年第9期1315-1319,共5页Chinese Journal of Osteoporosis

基　　金：无锡市卫健委科研面上项目(M202114)。

摘　　要：目的运用FRAX^(Ⓡ)(fracture risk assessment tool,FRAX^(Ⓡ))评估不同证型骨质疏松症(osteoporosis,OP)患者骨折风险,从中医辨证角度探讨骨折高风险人群的临床特征,以期更好地预防骨折发生。方法选取2021年12月至2022年3月在南京中医药大学附属无锡中医医院骨伤科门诊纳入的绝经后骨质疏松症女性125例。依照中医辨证分型将患者分为脾肾阳虚、肝肾阴虚、肾阳虚以及血瘀气滞4组,采集所有受试者临床资料,运用FRAX^(Ⓡ)计算各组患者发生髋部骨折的发生概率(probability of hip fractures,PHF)以及主要骨质疏松性骨折概率(probability of major osteoporotic fractures,PMOF),分析骨质疏松症中医证型与骨折风险的相关性。结果与肝肾阴虚、肾阳虚以及血瘀气滞组相比,脾肾阳虚组BMI指数最低,差异具有统计学意义(P=0.020、P<0.001、P=0.040);与肝肾阴虚、肾阳虚以及血瘀气滞组相比,脾肾阳虚组骨密度T值最低,差异具有统计学意义(P=0.002、P<0.001、P=0.040);4组骨折率差异具有统计学意义(χ^(2)=11.23,P=0.010),脾肾阳虚组骨折率高于肝肾阴虚组,差异具有统计学意义(P=0.001);不代入骨密度T值各组PHF、PMOF差异无统计学意义(H=4.853,P=0.183;H=4.691,P=0.196);代入骨密度计算各组PHF,脾肾阳虚组PHF高于肝肾阴虚、肾阳虚组PHF,差异具有统计学意义(P=0.017、P<0.001);脾肾阳虚组PMOF高于肝肾阴虚、肾阳虚组PMOF,差异有统计学意义(P=0.025、P=0.001)。结论脾肾阳虚证OP患者骨折风险更高,将现代医学骨折风险评估工具FRAX与传统中医辨证内容相结合,有望OP患者能更早了解自身骨折风险从而更好地预防骨折发生。Objective To evaluate the fracture risk of osteoporosis(OP)in patients with different syndrome types in traditional Chinese medicine(TCM)by using fracture risk assessment tool(FRAX^(Ⓡ)),and to explore the clinical characteristics of people at high risk of fracture from the view of TCM,with the aim of improving the precision of osteoporotic fracture risk assessment.Methods During the period from December 2021 to March 2022,a group of 125 women who had developed postmenopausal osteoporosis were selected to participate in the outpatient program offered by the Department of Orthopedics and Traumatology at Wuxi Affiliated Hospital of NJUCM.The patients were divided into four groups according to differentiating from traditional Chinese medicine,spleen and kidney yang deficiency group,liver and kidney yin deficiency group,kidney yang deficiency group,and stasis and blood stagnation group.The clinical data of the subjects were collected.FRAX^(Ⓡ)was used to calculate the likelihood of hip fractures(PHF)and the likelihood of large osteoporotic fractures(PMOF)in each group.The relationship between the syndrome types of postmenopausal osteoporosis in traditional Chinese medicine and the fracture risk was analyzed.Results BMI was significantly lower in the group with spleen and kidney yang deficiency compared to that in the groups characterized by liver and kidney yin deficiency,kidney yang deficiency,and blood stasis and qi stagnation.(P=0.020,P<0.001,P=0.040).Additionally,compared with the groups characterized by liver and kidney yin deficiency,kidney yang deficiency,and blood stasis and qi stagnation,the group with spleen and kidney yang deficiency had the lowest T-score for bone mineral density,and the difference was statistically significant(P=0.002,P<0.001,P=0.040).The difference in fracture rates among the four groups was statistically significant(χ^(2)=11.23,P=0.010).The fracture rate in the spleen-kidney yang deficiency group was higher than that in the liver-kidney yin deficiency group(P=0.001).There was no sig

关 键 词：骨质疏松症 中医证型 FRAX 骨折风险 

分 类 号：R683[医药卫生—骨科学]