【摘要】：目的與背景：從中醫(yī)角度，圍絕經(jīng)期女性氣血不足，周身臟腑經(jīng)絡(luò)因氣虛、血虛而失養(yǎng)，，導(dǎo)致血行遲緩，脈道枯萎，血液淤積現(xiàn)象，出現(xiàn)“血瘀”證。西醫(yī)認(rèn)為，絕經(jīng)期女性因卵巢功能的退化，體內(nèi)雌激素水平下降，表現(xiàn)出一系列內(nèi)分泌障礙性疾病，影響脂類代謝，導(dǎo)致血管內(nèi)皮細(xì)胞破壞，激活血小板凝血系統(tǒng)及各種細(xì)胞因子的活性，導(dǎo)致紅細(xì)胞聚集、血流緩慢、血粘度增加，形成“血瘀”。絕經(jīng)后骨質(zhì)疏松是絕經(jīng)期女性常見的代謝性骨病，主要是因為雌激素缺乏，導(dǎo)致成骨細(xì)胞和破骨細(xì)胞活性下降，骨吸收與骨重建失衡所致。歷代醫(yī)家認(rèn)為，女性絕經(jīng)后腎元虛衰，進(jìn)而導(dǎo)致氣血衰弱，不能營養(yǎng)筋骨，導(dǎo)致骨枯髓減，引發(fā)“骨瘺”，認(rèn)為“腎虛血瘀”是導(dǎo)致骨質(zhì)疏松的主要病機(jī)。由此我們推斷，雌激素水平下降是導(dǎo)致圍絕經(jīng)期女性出現(xiàn)“血瘀證”，進(jìn)而腎精虧虛引起骨代謝障礙，最終導(dǎo)致骨質(zhì)疏松發(fā)生。本研究主要目的是探討圍絕經(jīng)期女性雌激素水平下降導(dǎo)致血瘀證病理變化的原因，及腎虛血瘀證引起骨量減少進(jìn)而導(dǎo)致骨質(zhì)疏松癥的發(fā)病機(jī)制。 方法：選取圍絕經(jīng)期女性83例，年齡41-60歲，按年齡每10歲一組分為41-50歲組34例和51-60歲組49例，分別檢測兩組患者雌二醇水平（E2）、血液流變學(xué)指標(biāo)、骨代謝指標(biāo)水平，骨代謝指標(biāo)包括I型羧基末端肽（CTX）、氨基酸中段骨鈣素（NMID）、I型前膠原氨基端前肽（PINP），同時將兩組患者中醫(yī)臨床證候量化評分，比較各組患者雌激素水平、骨代謝指標(biāo)、“血瘀”量化評分及血液流變學(xué)指標(biāo)的差異，評價雌二醇水平與“血瘀”證及骨代謝的相關(guān)性。 結(jié)果：1、兩組患者雌二醇水平及骨代謝指標(biāo)比較：隨著年齡的增長女性雌二醇水平呈下降趨勢，骨代謝指標(biāo)CTX、PINP水平呈升高趨勢，NMID水平呈下降趨勢，兩組E2、NMID、PINP、CTX比較差異有統(tǒng)計學(xué)意義（P＜0.05）。2、兩組患者血瘀量化評分及血流變指標(biāo)比較：隨著女性雌二醇水平的下降，血瘀量化評分呈上升趨勢，兩年齡段女性血瘀量化評分比較差異顯著（P＜0.05），51-60歲年齡段女性血流變大部分指標(biāo)顯著高于41-50歲年齡段的女性（P＜0.05），提示圍絕經(jīng)期女性存在凝、黏、濃、聚等血瘀的病理基礎(chǔ)，并且年齡越大的患者血瘀程度越嚴(yán)重。3、雌二醇和骨代謝指標(biāo)與血瘀量化評分、血流變指標(biāo)間的相關(guān)性：（1） E2與CTX、NMID、PINP、血瘀量化評分、全血高切粘度、全血低切粘度、全血中切粘度、全血高切還原粘度、全血中切還原粘度、全血低切還原粘度、紅細(xì)胞剛性指數(shù)呈負(fù)相關(guān)，與紅細(xì)胞電泳時間呈正相關(guān)；說明隨著年齡的癥狀，E2水平降低，導(dǎo)致骨代謝發(fā)生變化和血流動力學(xué)發(fā)生改變，呈現(xiàn)血瘀的病理改變。（2）血瘀量化評分與全血粘度高切、全血粘度中切、全血粘度低切、全血高切還原粘度呈正相關(guān)，提示圍絕經(jīng)期女性血液流變學(xué)改變存在血瘀證表現(xiàn)。（3）CTX與血瘀量化評分正相關(guān)，與紅細(xì)胞電泳時間負(fù)相關(guān)， NMID和PINP指標(biāo)與血瘀量化評分、全血高切粘度、全血低切粘度、全血中切粘度存在正相關(guān)，提示圍絕經(jīng)期女性血瘀證與骨合成速度相關(guān)，血瘀越嚴(yán)重成骨細(xì)胞活性越強(qiáng)，骨更新的速率越快，骨轉(zhuǎn)換越高，說明血瘀的病理改變導(dǎo)致骨代謝異常。 結(jié)論：圍絕經(jīng)期女性雌二醇水平與血瘀證、標(biāo)志骨形成的指標(biāo)NMID、PINP和標(biāo)志骨吸收的指標(biāo)CTX成負(fù)相關(guān)性，提示圍絕經(jīng)期女性雌激素水平與骨代謝和腎精虧虛密切相關(guān)，雌激素水平下降導(dǎo)致血液流變學(xué)指標(biāo)的變化，引起“血瘀”的癥候，從而引起骨代謝異常，骨吸收增加明顯，骨形成相對減少，進(jìn)而導(dǎo)致骨質(zhì)疏松。因此，“腎虛血瘀”是導(dǎo)致骨質(zhì)疏松的主要病機(jī)。
[Abstract]:Objective and BACKGROUND: From the perspective of traditional Chinese medicine, perimenopausal women with insufficient Qi and blood, the body viscera and meridians due to Qi deficiency, blood deficiency and loss of nourishment, resulting in blood flow retardation, atrophy, blood stasis, the emergence of "blood stasis" syndrome. Diseases affect lipid metabolism, cause vascular endothelial cell destruction, activate platelet coagulation system and various cytokine activities, lead to red blood cell aggregation, slow blood flow, increased blood viscosity, the formation of "blood stasis." Postmenopausal osteoporosis is a common metabolic osteopathy in menopausal women, mainly due to estrogen deficiency, resulting in osteoblasts. It is believed that the decrease of estrogen level is the main pathogenesis of osteoporosis. The purpose of this study was to investigate the pathogenesis of osteoporosis caused by the decrease of estrogen level in perimenopausal women and the pathological changes of blood stasis syndrome.
Methods: 83 perimenopausal women aged 41-60 years were divided into 41-50 age group (34 cases) and 51-60 age group (49 cases). The levels of estradiol (E2), hemorheology, bone metabolism, bone metabolism, including type I carboxyl terminal peptide (CTX), mid-amino acid osteocalcin (NMID) and type I procollagen were measured. Amino-terminal pro-peptide (PINP) was used to evaluate the correlation between estradiol level and blood stasis syndrome and bone metabolism.
Results: 1. Comparison of estradiol level and bone metabolism index between the two groups: with the increase of age, estradiol level of female showed a downward trend, bone metabolism index CTX, PINP level showed an upward trend, NMID level showed a downward trend, two groups of E2, NMID, PINP, CTX difference was statistically significant (P < 0.05). Variable index comparison: With the decrease of female estradiol level, the quantitative score of blood stasis showed an upward trend. There was a significant difference in the quantitative score of blood stasis between two years old women (P The pathological basis of blood stasis and the severity of blood stasis in older patients. 3. The correlation between estradiol and bone metabolism index and blood stasis quantitative score, hemorheology index: (1) E2 and CTX, NMID, PINP, blood stasis quantitative score, whole blood high shear viscosity, whole blood low shear viscosity, whole blood middle shear viscosity, whole blood high shear reduction viscosity, whole blood middle shear reduction viscosity Viscosity, whole blood low shear reduction viscosity, erythrocyte rigidity index was negatively correlated with erythrocyte electrophoresis time was positively correlated; indicating that with age symptoms, E2 level decreased, resulting in changes in bone metabolism and hemodynamics, showing pathological changes of blood stasis. (2) Blood stasis quantitative score and whole blood viscosity high shear, whole blood viscosity medium shear, whole blood viscosity, blood stasis. There was a positive correlation between blood viscosity and reduction viscosity at high shear, suggesting that there was blood stasis syndrome in perimenopausal women. (3) CTX was positively correlated with blood stasis quantitative score, and negatively correlated with erythrocyte electrophoresis time. NMID and PINP indexes were positively correlated with blood stasis quantitative score, whole blood high shear viscosity, whole blood low shear viscosity, and whole blood middle shear viscosity. It is suggested that the blood stasis syndrome in perimenopausal women is related to the rate of bone synthesis. The more serious the blood stasis, the stronger the activity of osteoblasts, the faster the rate of bone regeneration, and the higher the bone turnover, indicating that the pathological changes of blood stasis lead to abnormal bone metabolism.
Conclusion: The level of estradiol in perimenopausal women is negatively correlated with blood stasis syndrome, NMID, PINP and CTX, indicating that the level of estrogen in perimenopausal women is closely related to bone metabolism and deficiency of kidney essence. Therefore, kidney deficiency and blood stasis are the main pathogenesis of osteoporosis.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R711.51;R580

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