通补并用法对原发性骨质疏松症生存质量的影响

【作者】 马元；

【导师】 姜良铎；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2007， 博士

【摘要】 骨质疏松症是当今世界范围内严重危害公众健康,尤其是中老年人的一种常见病、多发病。伴随人口寿命的提高和社会老龄化的进程,骨质疏松症的防治已经引起世界各国医务人员的极大关注。随着社会发展及生物医学模式的转变,人们对健康的认识逐步完善,生存质量作为一种重要的医学评价标准已被广泛应用。国内生存质量的研究近几年刚刚起步。中医学重视患者躯体感觉、生理活动、心理状态和社会活动的综合评估,重视患者生存质量的观察与提高,提高生存质量是中医药临床治疗的一大特色。中医学理论的“整体观念”与生存质量具有相似的内涵,将生存质量纳入中医辨证及疗效评价体系,使之更加客观化、科学化,对于中医药的发展具有重要意义。本研究在既往的前期研究中,通过临床观察和理论研究,根据“肾主骨”,“脾胃为后天之本”,“不通则痛”等中医理论,总结了原发性骨质疏松症的病因病机、证治规律,提出原发性骨质疏松症以脾肾两虚,胃肠郁滞,气血失和为病机,治疗以通补并用论治骨质疏松症,治以补益脾肾,通腑降浊,调和气血。临床研究1:课题探讨原发性骨质疏松症患者生存质量及其与中医证型的关系。采用健康状况调查表(SF-36)测查骨质疏松症患者生存质量并与非骨质疏松症受试者对照,同时调查中医证型。结果骨质疏松症患者生存质量各维度的评分显著低于非骨质疏松症。生存质量有的维度受不同的中医证型影响,提示生存质量与中医证型有关。临床研究2:课题探讨通补并用法对原发性骨质疏松症患者生存质量的影响及临床疗效。采用SF-36量表调查生存质量,并测量腰椎及股骨的骨密度及调查患者的中医症状。经过三个月一疗程治疗后,SF-36量表调查显示,治疗组患者治疗后生存质量各维度评分及总分均有上升,其中躯体角色、机体疼痛、总体健康、社会功能、精力、情感角色、心理健康7个维度及总分的评分变化自身比较具有统计学意义。治疗组与对照组疗后组间比较,治疗组患者在生存质量的躯体功能、躯体角色、机体疼痛、社会功能、精力、心理健康6个维度及总分方面均优于对照组,而在总体健康、情感角色方面未表现出显著性差异。治疗组患者治疗后中医症状积分明显降低,中医证候总有效率优于对照组。治疗组患者股骨骨密度升高有统计学意义。本研究提示了通补并用法治疗原发性骨质疏松具有确切的疗效,并明显改善患者生存质量。本课题的创新之处在于,探讨生存质量和中医学的关系及生存质量评价在骨质疏松症的应用,认为生存质量能客观的反映中医特色,提出了将生存质量引入骨质疏松症中医疗效评价体系的观点。观察骨质疏松症患者的生存质量及其与中医证型的关系,骨质疏松症患者生存质量显著降低,生存质量有的维度受不同中医证型的影响;从临床观察和生存质量评价探讨了通补并用法对原发性骨质疏松症的影响,通补并用治疗可提高骨质疏松症患者的骨密度,改善症状并能改善生存质量,对于中医治疗骨质疏松症的深入研究及临床评价具有一定意义。更多还原

【Abstract】 Osteoporosis (OP) is a common disease and frequently occurring among population, especially does harm to aged people’s health. Along with the advance of life expectancy populate of people and aging sociality, the prevention and therapy of osteoporosis has attracted more attention of medical affairs perennials .With the development of social and the transitions of the health view and medical-model , the assessment of quality of life (QOL) in clinical trials has accepted by more and more medical affairs perennials. In our country , the study of QOL is starting. Compared with modern medicine science , traditional Chinese medicine (TCM)pay close attention to the view of person of their health among physical and mental health .TCM see the body as a whole , this opinion is as same as the idea of QOL .Bring the assessment of quality of life into the distinguishability and evaluation of traditional Chinese medicine ,we can make these more objective and scientific .It make important significance for the development of TCM.Based on the reviewing and summarizing the documents of the concerned theory , in the theoretical research, we explored the etiological , pathogenesis and regularity of diagnosis and treatment .The theory of traditional Chinese medicine revealed“kidney governs the bone”,“spleen is the root of later heaven”and“when there is stoppage ,there is pain”. The study indicated that the basical pathogenesis of POP was spleen-kidney vacuity detriment ,bowl-gastrointestinal depression and stagnation, and disharmony of qi and blood. By using theory of traditional Chinese medicine“tongbu bingyong”, the principles of therapy should be a comprehensive utilization of supplement the spleen and kidney , freeing the bowels and downbear turbidity , harmonie the qi and blood .Clinical study 1 :The study explored the relationship between the syndrome types differentiated by traditional Chinese medicine and the quality of life (QOL) in patients with osteoporosis (OP). The QOL in patients was investigated with Short Form-36 questionnaire (SF-36) , and compared with that of the non-OP people; the TCM syndrome type was differentiated at the same time by the outcomes of symptoms acquired from the questionnaire. The score of all the domains of QOL was respectively lower in the OP patients than that in the non-OP subjects. The score of some domains of QOL showed correlation with different TCM syndrome types. QOL of OP patients significantly decreased. The variation of syndrome types could significantly influence some domains of QOL.Clinical study 2 : The study observed the influence of traditional Chinese medicine to the quality of life in the primary osteoporosis (POP) patients . The study wanted to explore the therapeutics effects of traditional Chinese medicine (TCM) and pharmacy on primary osteoporosis (POP) to provide the reference for preventing chronic disease and improving the elder’s quality of life. The QOL in patients was investigated with Short Form-36 questionnaire (SF-36) , 80 patients with POP in community were bone-scanned in lumbar vertebrae and thoghbone to measure the bone mineral density(BMD). They had finished the SF-36 QOL survey questionnaire and TCM syndrome investigation . We randomly selected 40 of them for TCM treated group. The patients were observed for one treatment courses with QOL estimated by Short Form-36 questionnaire ,and referred to the traditional evaluating indexes of clinical efficiency. After three months of treatment,there was significantly difference between the two groups. QOL in the TCM treated group was improved after treatment with the improvement of scores in all domains , while it in domains of role -physical、bodily pain、general health、social functioning、vitality、role emotional and mental health ,there was statistical significance. ( P< 0.05). The score of QOL in six of the eight domains (physical functioning、role-physical、bodily pain、social functioning、vitality and mental health) were higher in the TCM treated group than those in the control group ( P < 0.05) , and no significant difference was shown between the domains of general health and role emotional of the two groups ( P > 0.05).All things we had done suggested that the“tongbu bingyong formula”can improve the bone mineral density and increase the quality of life in the primary osteoporosis (POP) patients. It might be one of the mechanisms for this therapy .It showed that more research into the therapy of TCM and quality of life are needed.The innovation of this study : The study explored the connotation of life quality and its interrelation with TCM , application of life quality at department of dermatology . The study indicated that the quality of life can objectively reflect the TCM characteristic and put forward the quality of life will be includedin the assessment system of TCM therapeutic effect of OP disease.The study explored the relationship between the syndrome types differentiated by traditional Chinese medicine and the quality of life (QOL) in patients with osteoporosis (OP). The quality of life (QOL) in patients with osteoporosis (OP) was lower than non-OP people . The score of some domains of QOL showed correlation with different TCM syndrome types.The study observed the influence of traditional Chinese medicine to the quality of life in the primary osteoporosis (POP) patients . The study explored the therapeutics effects of traditional Chinese medicine (TCM) the“tongbu bingyong formula”can improve the bone mineral density and increase the quality of life in the primary osteoporosis (POP) patients. They both have very importance sense in the investigation and evaluation of clinic in osteoporosis patient by the traditional Chinese medicine.更多还原