葛根对原发性骨质疏松症患者临床症状及骨代谢生化指标影响的研究

【作者】 孙玉明；

【导师】 周福贻；

【作者基本信息】 南京中医药大学 ， 中医骨伤科学， 2006， 博士

【摘要】 葛根是中医传统的解表药，近年来研究证明葛根异黄酮具有明显的活血化瘀作用，已用于高血压、冠心病、糖尿病等疾病的治疗。近年后，国内不断有抗骨质疏松症中药面市，但均基于传统中医理论，采取补肾、健脾、活血化瘀等方法，但无论是中医文献，还是现代中医临床，未见把葛根运用于骨质疏松症的治疗。 本课题系统地回顾了骨质疏松症文献资料，总结了骨质疏松症的研究现状，对骨质疏松症的中医病因、病机、治法及中药治疗骨质疏松症的机理等方面进行了系统的归纳总结。通过文献研究，发现中药葛根有类雌激素样作用，其主要成分葛根异黄酮与己被证明具有抗骨质疏松症作用的大豆异黄酮在化学结构上比较相似，理论上对骨代谢可能有改善作用。国内已有实验室研究葛根异黄酮或其主要有效成分葛根素对骨代谢影响的报道，但尚无葛根治疗骨质疏松症的临床研究报道，本研究首先进行了葛根治疗骨质疏松症腰背疼痛等症状的临床研究，并进行了葛根对骨质疏松症患者骨代谢生化指标影响的有关研究。 临床研究在江苏省中医院骨伤科骨质疏松症专科门诊及病房收集病例，按随机原则分为葛根治疗组、阿法D₃对照组，分别给服葛根煎剂和阿法D₃，观察28天为一疗程，治疗前、治疗后分别对患者的VAS、活动能力、腰背疼痛等临床症状进行评分，治疗前和治疗后分别检测患者的骨代谢生化指标，经统计学分析进行临床疗效评估，并评估葛根对骨代谢生化指标的影响。 研究表明葛根能明显改善原发性骨质疏松症患者VAS、活动能力、腰背静息痛等方面的临床症状，其疗效优于阿法D₃。在骨代谢生化指标方面，葛根组病人的ALP、BGP、U-Ca、U-Cr、U-Hop、U-Ca／U-Cr、U-Hop／U-Cr等项目有所下降，其中BGP、U-Hop、U-Hop／U-Cr在治疗前后有显著性差异，表明葛根能降低骨质疏松症患者的骨转换率，抑制骨吸收，有类雌激素样作用。 本研究拓展了葛根临床应用范围，并对葛根治疗骨质疏松症的药理作用进行了探索，研究成果开辟了中药治疗骨质疏松症的新思路。更多还原

【Abstract】 Radix Puerariae is a traditional drug for relieving exterior syndrome in TCM. The recent research findings show that the isoflavone deriving from Radix Puerariae can noticeably activate blood circulation to dissipate blood stasis, and have been applied to the treatment on such diseases as high blood pressure, coronary artery disease, diabetes, and so on. In recent years, many Chinese patent medicines in china have come into market to cure osteoporosis, most of which were manufactured on the basis of theories of TCM, in which such methods were involved as invigorating the kidney and the spleen and activating blood circulation to dissipate blood stasis. But there exist no treatments in which Radix Puerariae was used to cure osteoporosis in either TCM literature or in modern TCM clinical practice.This dissertation systematically reviews TCM literature and documents, summarizes the present research status in treating osteoporosis, and its etiopathogenisis, pathogenesis, treatment and mechanism. The documents study shows that Radix Puerariae functions like estrogen, and isoflavone from Radix Puerariae is similar in chemical constitution to that from soybean, which has been proved to be effective in treating osteoporosis. There are reports on laboratory research on the impact of isoflavone from Radix Puerariae (or its main effective elements) on the bone metabolism, but there are no reports on clinical research up to now. And this research will be the first one on studying Radix Puerariae’s treatment on lumbar and back pain caused by osteoporosis, and performs relative research in its effect on the biochemical indicator of bone metabolism.The subjects were collected from the out-patient clinic(OPD) and ward in the discipline of osteoporosis, TCM hospital of Jiangsu province. And they were randomly divided into one experimental group and one controlled group, and decoction of powder Radix Puerariae and α-D3 were given respectively, and the observation lasted for 28 days. The subjects’ clinical symptom such as VAS, locomotor activity and lumbar and back pain were assessed before and after the treatment, and the biochemical indicator of bone metabolism was examined. Through statistical analysis, the effect asserted by Radix Puerariae can be evaluated.The study indicates that Radix Puerariae can markedly improve such clinical symptoms as VAS, locomotor activity and lumbar and back pain, and its efficiency is better than that of α-D3.更多还原