高血压及其辨证分型与骨质疏松的相关性研究

【作者】 贺琳；

【导师】 黄力；

【作者基本信息】 北京中医药大学 ， 中西医结合临床， 2008， 硕士

【摘要】 目的研究高血压病和骨质疏松症的相关性及其机理,并运用中医理论探讨其内在联系,为中西医结合防治高血压病和骨质疏松症提供临床及理论依据。方法采用横断面调查方法,收集来自2005年8月～2008年1月在中日友好医院骨密度室行骨密度检测的病人共计479例,分为高血压组和非高血压组,其中高血压组272例,非高血压组207例,并将高血压组病人辨证分为肝火亢盛、阴虚阳亢、阴阳两虚、痰湿壅盛四型。采用双能X线骨密度检测仪分别测定病人的腰椎、股骨颈、Ward三角区、股骨粗隆四个部位的骨密度,分析两组间骨密度及高血压病各证型间有无差异,并采用多元Logistic回归方法分析骨密度变化相关影响因素。另外,对其中105例(高血压组82例,非高血压组23例)分别测定血骨碱性磷酸酶(BALP)、骨钙素(BGP)、Ⅰ型胶原交联氨基末端肽(NTX)和胰岛素样生长因子-1(IGF-1)等骨代谢指标。结果①高血压组Ward三角区骨密度明显低于非高血压组(P＜0.01),高血压组骨密度减低的发生率较无高血压组明显增加(P＜0.01);②绝经后女性高血压组Ward三角区的骨密度明显低于非高血压组,有显著差异(P＜0.05),而在绝经期前女性亚组和男性患者亚组中,高血压与非高血压患者各部位骨密度均无显著性差异(P＞0.05);③高血压组阴阳两虚证型各部位骨密度均明显低于其他三种证型同部位骨密度,将年龄作为协方差分析,有极显著差异(P＜0.01);④在骨密度减低患者中,合并高血压病的比例明显增高;⑤多元Logistic回归分析结果显示,高血压病、糖尿病和年龄是骨密度减低的重要影响因素,以高血压病最为明显(回归系数0.69,P＜0.01),有高血压病骨密度减低与无高血压病骨密度减低的比数比为1.99;⑥高血压组与非高血压组骨代谢指标未见明显差别;高血压组各证型之间骨代谢指标比较亦无显著差异,但阴阳两虚型NTX、BALP较阴虚阳亢型有减低趋势(P=0.07和P=0.09)结论①高血压病是骨密度减低的重要影响因素,高血压病患者较非高血压病者更易发生骨密度减低,导致骨质疏松症,在绝经后女性尤为明显;②高血压病中医辨证不同证型之间骨密度有一定差异,其中辨证属阴阳两虚型者骨密度减低更为明显,提示肾虚可能是高血压病与骨质疏松症共同的发病机制;提示我们临床对高血压病患者应关注其骨密度变化,对于骨密度减低患者也应注意其血压的改变。尤其对阴阳两虚型高血压患者,骨密度检查有助于早期发现该类患者的骨密度变化,而对阴阳两虚型骨密度减低患者也应严格监控其血压的变化。在此基础上,及早采用补益肝肾、滋阴潜阳、阴阳双补等干预方法,有可能延缓骨质疏松症的发生;③本研究中高血压病和非高血压病患者以及高血压病各中医证型之间骨形成与骨吸收指标无显著差别,考虑与样本数较小有关。更多还原

【Abstract】 Objective To investigate the correlation between primary hypertension(HT) and osteoporosis(OP) as well as its mechanism,discuss the underlying relationship with theory of traditional Chinese medicine(TCM),thus provide clinical and theoretical basis for prevention and treatment of HT and OP with integrative western and Chinese Medicine.Method Cross-sectional study was applied to collected 479 cases receiving bone densitometry in Bone Density Lab of China-Japan Friendship Hospital from Aug 2005 to Jan 2008.The subjects were divided into 272 cases in HT group and 207 cases in non-HT group.The HT patients were made a differentiation diagnosis of four TCM-syndrome types:Overabundant liver-fire,asthenic yin causing predominant yang, deficiency of both yin and yang,excessiveness of phlegm-dampness.Bone Mineral Density(BMD) of lumber spine,femoral neck,Ward triangular area and Greater trochanter of femur were determined using dual-energy x-ray absorptiometry and the BMD between HT and non-HT groups and among TCM-syndrome types were compared. The influential factors of BMD changes were analyzed by multivariate logistic regression method.In addition,bone metabolic parameters including serum bone alkaline phosphatase(BALP),bone gla protein(BGP),N-Telopeptide of TypeⅠcollagen and insulin-like growth factor-1(IGF-1) were measured.Result(1)The BMD of Ward triangular area in the HT group was significantly lower than that in the non-HT group(P＜0.01),the incidence of decreased BMD in the HT group was much higher than that in the non-HT group(P＜0.01);(2)In postmenopausal female subgroup,the BMD of Ward triangular area in HT patients was significantly lower than that in patients without HT(P＜0.05),while there were no differences in BMD of any locations between HT and no-HT patients in both non-postmenopausal female and male subgroups(P＞0.05).(3)As for the TCM-syndrome type of deficiency of both yin and yang,the BMD in the four locations were all much lower than that of the corresponding location in the other three TCM-syndrome types,taking the age as a covariate(P＜0.01). (4)Multivariate logistic regression analysis showed that HT,diabetes and age were significant influencing factors for reducing BMD,especially HT with regression coefficient of 0.69 and odds ratio of 1.99(P＜0.01);(5) There was no significant difference for any bone metabolic parameters between HT and non-HT groups and among TCM-syndrome types in HT patients,and just shy of significant difference for NTX and BALP in TCM-syndrome type of deficiency of both yin and yang,which was lower than that in TCM-syndrome type of asthenic yin causing predominant yang(P=0.07 and P=0.09 respectively).Conclusion(1)HT was an significant influential factor for decreased BMD.HT patients are more prone to suffer from reduced BMD and even OP as compared with non-HT patients,especially in postmenopausal female patients;(2)The BMD in TCM-syndrome type of deficiency of both yin and yang was much lower than that in patients of the other three TCM-syndrome types,indicating kidney deficiency might be the common pathogenesis underlying HT and OP;More attention should be paid to BMD changes for HT patients in clinical practice,especially for those HT patients with TCM-syndrome type of deficiency of both yin and yang.Bone densitometry is helpful for early detecting BMD changes in HT patients,based on which,OP might be delayed by early intervention of tonifying liver and kidney,nourishinig Yin to suppress Yang and tonifying both Yin and Yang;(3) There was no significant difference for any bone metabolic parameters between HT and non-HT groups and among TCM-syndrome types in HT patients,which might be due to small sample.更多还原