本文關(guān)鍵詞：強(qiáng)直性脊柱炎患者骨代謝水平與中醫(yī)證型的相關(guān)性研究　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 強(qiáng)直性脊柱炎 骨代謝 骨密度 疾病活動(dòng)度 辨證分型

【摘要】：目的:強(qiáng)直性脊柱炎(Ankylosing Spondylitis,AS)是一種主要累及中軸關(guān)節(jié),尤其是腰椎、骶髂關(guān)節(jié)的慢性脊柱關(guān)節(jié)炎性疾病。現(xiàn)代研究表明,部分患者有骨量減少、骨代謝水平異常的情況,提示存在骨折風(fēng)險(xiǎn)。本研究立足于觀察AS患者中醫(yī)證型與骨代謝、骨密度水平之間的相關(guān)性,AS患者中醫(yī)證型與疾病活動(dòng)度之間的相關(guān)性,以及AS患者疾病活動(dòng)度與骨代謝、骨密度水平之間的相關(guān)性,為進(jìn)一步行中西醫(yī)結(jié)合治療,有效防治骨質(zhì)疏松,降低AS患者骨折風(fēng)險(xiǎn)提供一定的依據(jù)。方法:依據(jù)納入標(biāo)準(zhǔn),收集中國(guó)人民解放軍陸軍總醫(yī)院風(fēng)濕免疫科2016年7月到11月住院及門診AS患者126例,記錄其一般臨床相關(guān)數(shù)據(jù)包括:性別、年齡、病程長(zhǎng)短等。應(yīng)用雙能X線吸收法測(cè)量其骨密度水平,并記錄右側(cè)股骨頸Z值及腰椎L1-L4的Z值。依憑中國(guó)人民解放軍陸軍總醫(yī)院檢驗(yàn)科實(shí)驗(yàn)室,檢測(cè)并記錄患者骨鈣素(Bone Gla Protein,BGP)、I型原膠原N-端前肽(Procollagen type I N-terminal propeptide,PINP)、甲狀旁腺素(Parathyroid Hormone,PTH)、血鈣(Serum Calcium,Ca)、堿性磷酸酶(Alkaline Phosphatase,ALP)、紅細(xì)胞沉降率(Erythrocyte Sedimentation Rate,ESR)、C 反應(yīng)蛋白(C-reactive Protein,CRP)水平。收集相關(guān)病情活動(dòng)數(shù)據(jù),通過(guò)ASDAS法(ASAS-endorsed disease activity score,ASDAS)計(jì)算患疾病活動(dòng)度評(píng)分。依據(jù)《中藥新藥臨床研究指導(dǎo)原則(最新)》,對(duì)處于病情活動(dòng)期的AS患者進(jìn)行科學(xué)的中醫(yī)辨證分型,共分為:濕熱痹阻證、寒濕痹阻證、瘀血痹阻證、肝腎虧虛證、腎陽(yáng)虧虛證5個(gè)證型組。應(yīng)用SPSS19.0軟件對(duì)收集的AS患者中醫(yī)證型、骨密度及骨代謝水平、疾病活動(dòng)度ASDAS評(píng)分三者的數(shù)據(jù)結(jié)果進(jìn)行統(tǒng)計(jì)分析,主要研究上述三者之間的相關(guān)性聯(lián)系。結(jié)果:共收集AS患者126例,男性111例,女性15例,男女比例為7.4:1,骨量異常者78例,占總?cè)藬?shù)的61.9%�；颊吖晒穷i及L1-L4腰椎的骨密度Z值:1.均與Ca水平呈正相關(guān);2.與ALP、PTH相關(guān)性尚不能認(rèn)為有統(tǒng)計(jì)學(xué)意義(P0.05);3.股骨頸Z值與BGP相關(guān)性均尚不能認(rèn)為有統(tǒng)計(jì)學(xué)意義(P0.05)、與PINP水平呈負(fù)相關(guān),腰椎Z值與BGP、PINP呈負(fù)相關(guān);4.均與CRP、ESR呈負(fù)相關(guān);5.與ASDAS-CRP、ASDAS-ESR的相關(guān)性尚不能認(rèn)為有統(tǒng)計(jì)學(xué)意義(P0.05)。中醫(yī)五個(gè)證型組的骨密度和骨代謝水平方面:與其他三組相比,腎陽(yáng)虧虛證組和肝腎不足證組骨密度水平較低,Ca水平偏低,PINP和BGP水平較高。中醫(yī)五個(gè)證型組的炎癥因子和疾病活動(dòng)度方面:腎陽(yáng)虧虛證組在ESR和CRP方面均最高;瘀血痹阻證AS患者病情活動(dòng)較為突出。結(jié)論:1.本次研究中骨密度水平減低的AS患者,Ca水平降低,BGP、PINP增加,此兩者參與的骨生成水平提高,ALP和PTH參與的骨代謝環(huán)節(jié)可能并無(wú)異常。炎癥因子活動(dòng)與AS患者骨密度減低相關(guān),但疾病活動(dòng)情況與骨密度水平尚未發(fā)現(xiàn)有相關(guān)性。應(yīng)是有更加劇烈的骨破壞因素打破了骨生成與骨吸收之間的動(dòng)態(tài)平衡,造成AS患者骨代謝紊亂,骨密度減低。2.本次研究中腎陽(yáng)虧虛證組和肝腎不足證組骨密度水平均明顯低于其他三組,骨代謝異常較其他三組更為明顯,要明確檢查,及早防治骨量減少、骨質(zhì)疏松。
[Abstract]:Objective: ankylosing spondylitis (Ankylosing Spondylitis AS) is a major involvement of axial joints, especially the lumbar spine, sacroiliac joint chronic spinal arthritis disease. Modern research shows that some patients with osteopenia, bone metabolism abnormalities, suggesting that in fracture risk. This research is based on the observation of AS patients TCM syndrome type and the correlation between bone metabolism, bone mineral density level, the correlation between AS patients with TCM syndrome type and disease activity, and disease activity in patients with AS and bone metabolism, the correlation between bone mineral density level, combined with western medicine for further treatment, effective prevention and treatment of osteoporosis in patients with AS, reduce the risk of fractures provide certain basis. Methods: according to the inclusion criteria, collected China people's Liberation Army General Hospital Department of Rheumatology in July 2016 to November 126 cases of inpatient and outpatient AS patients, record the general clinical correlation Including: gender, age, according to the length of the course. The level of bone mineral density measurement of dual energy X-ray absorptiometry application, and record the right femoral neck and lumbar spine Z value L1-L4 Z value. China depend on the people's Liberation Army General Hospital clinical laboratories, detect and record the patients (Bone Gla Protein BGP, osteocalcin, I) procollagen terminal propeptide (N- Procollagen type I N-terminal propeptide, PINP), parathyroid hormone (Parathyroid Hormone, PTH), serum calcium (Serum Calcium, Ca), alkaline phosphatase (Alkaline Phosphatase, ALP), erythrocyte sedimentation rate (Erythrocyte Sedimentation, Rate, ESR), C reactive protein (C-reactive Protein, CRP) level collect the relevant data. The activity of disease, by the method of ASDAS (ASAS-endorsed disease activity score, ASDAS) calculate the disease activity score. On the basis of clinical research on new drugs of traditional Chinese medicine "guiding principle (the latest) >, in disease activity in AS TCM scientific classification, is divided into: dampness heat blockage syndrome, cold dampness syndrome, blood stasis syndrome, liver and kidney deficiency, kidney yang deficiency syndrome type 5 group. The application of SPSS19.0 software to collect the TCM syndrome in patients with type AS, bone mineral density and bone metabolism, disease activity score three ASDAS the results of statistical analysis, the correlation between the three main research subjects. Results: a total of 126 AS patients, 111 were male, 15 were female, male to female ratio was 7.4:1, 78 cases of abnormal bone mass, bone mineral density accounted for Z of the total number of 61.9%. patients with femoral neck and lumbar spine L1-L4 value: 1. and the Ca level was positively correlated with ALP; 2., PTH correlation is not considered statistically significant (P0.05); 3. femoral neck Z value and BGP correlation were not considered statistically significant (P0.05), and negatively correlated with the level of PINP, BGP and Z value of lumbar spine, PINP was negatively correlated with CRP; 4. 5., ESR was negatively correlated; With ASDAS-CRP, the correlation between ASDAS-ESR is not considered statistically significant (P0.05). Five TCM Syndromes of bone mineral density and bone metabolism: compared with the other three groups, kidney yang deficiency syndrome group and deficiency of liver and kidney. The BMD level is low, low levels of Ca, PINP and BGP five. Higher levels of TCM a group of syndromes of inflammation and disease activity: kidney yang deficiency syndrome group in ESR and CRP were the highest; blood stasis syndrome in patients with AS disease activity is more prominent. Conclusion: 1. the study of bone mineral density decreased level of AS patients, lower levels of Ca, BGP, PINP increased, the level of both bone formation participate in improving bone metabolism, ALP and PTH may participate in the process. No abnormal inflammatory factors in patients with AS activity and decreased bone density, but the disease activity and bone density level has not yet been found. The correlation should be more severe bone destruction factors break The bone formation and bone resorption caused by the dynamic balance between the AS patients, bone metabolism, bone mineral density decreased.2. in the research of kidney yang deficiency syndrome group and deficiency of liver and kidney. The BMD levels were significantly lower than those of the other three groups, abnormal bone metabolism is more obvious than the other three groups, to clear the check, reduce, as soon as possible prevention and treatment of bone osteoporosis.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R593.23
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本文編號(hào)：1400132