本文關(guān)鍵詞：基于“腎主骨”理論探討穴位針灸對(duì)腎陰虧虛型骨質(zhì)疏松患者骨代謝及生活質(zhì)量的影響　出處：《南京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 針灸 骨質(zhì)疏松癥 骨代謝 疼痛 生活質(zhì)量

【摘要】：[目的]通過(guò)對(duì)骨質(zhì)疏松的病人行針灸治療,觀察其骨密度、骨代謝指標(biāo)變化及疼痛、生活質(zhì)量和中醫(yī)證候的改善等,探索印證針灸療法是否可以對(duì)骨質(zhì)疏松癥產(chǎn)生治療作用,為該療法找尋科學(xué)依據(jù)。[方法]采用隨機(jī)對(duì)照研究方法,方案經(jīng)倫理委員會(huì)審核通過(guò)。招募符合納入標(biāo)準(zhǔn),并簽署知情同意書的受試者60名。依據(jù)隨機(jī)序號(hào)入組,設(shè)立基礎(chǔ)治療下的試驗(yàn)與空白對(duì)照,試驗(yàn)組口服鈣爾奇D600mg/日,依據(jù)補(bǔ)腎填髓選穴針刺治療,對(duì)照組僅給予口服鈣爾奇D600mg/日。試驗(yàn)周期3個(gè)月。觀察指標(biāo)包括:雙能X線骨密度測(cè)定和血清骨代謝指標(biāo)PINP\CTX\OP值測(cè)定(試驗(yàn)前后);視覺(jué)疼痛評(píng)分、生活質(zhì)量量表評(píng)分和中醫(yī)證候改善評(píng)分(試驗(yàn)前及試驗(yàn)開(kāi)始后每1、2、3月末)。[結(jié)果]本研究入組60例絕經(jīng)后骨質(zhì)疏松婦女受試者,完成試驗(yàn)48例。其中針灸組23例,對(duì)照組25例,不符合納入標(biāo)準(zhǔn)被剔除5例,未完成治療失聯(lián)7例。治療前兩組觀察指標(biāo)基線值比較無(wú)顯著差異,具有可比性。通過(guò)正態(tài)性檢驗(yàn),分別使用t檢驗(yàn)和非參數(shù)檢驗(yàn)對(duì)治療后得出結(jié)論:1、腰椎骨密度、股骨頸骨密度、全髖骨密度進(jìn)行數(shù)據(jù)統(tǒng)計(jì)分析,腰椎骨密度針灸組治療后為0.88590±10920,對(duì)照組治療后為0.8754±0.22384;股骨頸骨密度針灸組治療后為0.7413±0.09068,對(duì)照組治療后為0.7612±0.09043;全髖骨密度針灸組治療后為0.7921 ±0.07705,對(duì)照組治療后為0.8096±0.09850。結(jié)果顯示兩組經(jīng)過(guò)治療后針灸組和對(duì)照組骨密度指標(biāo)無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。2、骨代謝指標(biāo)中,PINP針灸組治療后為52.2146± 19.45078,對(duì)照組治療后52.7904±23.15097;CTX針灸組治療后為458.5417±201.57402,對(duì)照組治療后為457.2083±211.93415;0C針灸組治療后為20.4992±5.17352,對(duì)照組治療后為20.9108±7.71508。通過(guò)正態(tài)性檢驗(yàn),使用t檢驗(yàn)對(duì)PINP、CTX、0P進(jìn)行數(shù)據(jù)統(tǒng)計(jì)分析,結(jié)果顯示兩組經(jīng)過(guò)治療后針灸組和對(duì)照組上述各項(xiàng)指標(biāo)仍然無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。3、治療1月后針灸組疼痛評(píng)分為5.1667±0.70196,對(duì)照組評(píng)分為5.7917±0.72106;治療2月后針灸組疼痛評(píng)分為4.7083±0.55003,對(duì)照組評(píng)分為5.7083±0.85867;治療3月后針灸組疼痛評(píng)分為4.2917±0.55003,對(duì)照組評(píng)分為5.6250±0.85867;經(jīng)過(guò)重復(fù)測(cè)量方差分析檢驗(yàn),兩組組內(nèi)分別比較治療后VAS評(píng)分比前一個(gè)月均有好轉(zhuǎn)(F=26.788,P=0.0000.05),針灸組及對(duì)照組治療后的每個(gè)月的時(shí)間節(jié)點(diǎn)進(jìn)行比較發(fā)現(xiàn)兩組間VAS評(píng)分有統(tǒng)計(jì)學(xué)差異(F=18.252,P=0.0000.05)。針灸組優(yōu)于對(duì)照組。4、治療1月后針灸組軀體健康總測(cè)量評(píng)分為44.7500±5.73509,對(duì)照組評(píng)分為44.3750±5.24042;治療2月后針灸組軀體健康總測(cè)量評(píng)分為48.1667±7.53927,對(duì)照組評(píng)分為44.3750±5.31183;治療3月后針灸組軀體健康總測(cè)量評(píng)分為58.4583± 10.99399,對(duì)照組評(píng)分為47.5000±5.80105;經(jīng)過(guò)重復(fù)測(cè)量方差分析檢驗(yàn),結(jié)果表明針灸組及對(duì)照組在治療后PCS每個(gè)月相比均有差異,治療后PCS評(píng)分比前一個(gè)月均有好轉(zhuǎn)(F=52.159,P=0.0000.05)。將針灸組及對(duì)照組治療后的每個(gè)月的時(shí)間節(jié)點(diǎn)進(jìn)行比較發(fā)現(xiàn)兩組間PCS評(píng)分有統(tǒng)計(jì)學(xué)意義(F=4.072,P=0.0490.05)。針灸組優(yōu)于對(duì)照組。5、治療1月后針灸組心理健康總測(cè)量評(píng)分為63.7083±7.07709,對(duì)照組評(píng)分為60.5417±7.07709;治療2月后針灸組心理健康總測(cè)量評(píng)分為66.7083±6.36894,對(duì)照組評(píng)分為60.4583±7.26504;治療3月后針灸組心理健康總測(cè)量評(píng)分為70.4583±5.91960,對(duì)照組評(píng)分為60.7083±6.60355;經(jīng)過(guò)重復(fù)測(cè)量方差分析檢驗(yàn),結(jié)果表明針灸組及對(duì)照組在治療后MCS每個(gè)月相比均有差異,治療后MCS評(píng)分比前一個(gè)月均有好轉(zhuǎn)(F=54.506,P=0.0000.05),針灸組及對(duì)照組治療后的每個(gè)月的時(shí)間節(jié)點(diǎn)進(jìn)行比較發(fā)現(xiàn)兩組間MCS評(píng)分有統(tǒng)計(jì)學(xué)差異(F=8.993,P=0.0040.05)。針灸組優(yōu)于對(duì)照組。6、治療1月后針灸組中醫(yī)證候評(píng)分為5.3333±0.96309,對(duì)照組評(píng)分為5.1667±0.96309;治療2月后針灸組中醫(yī)證候評(píng)分為4.7917±0.72106,對(duì)照組評(píng)分為5.5417±0.88363;治療3月后針灸組中醫(yī)證候評(píng)分為4.2500±0.94409,對(duì)照組評(píng)分為5.4167±0.97431;經(jīng)過(guò)重復(fù)測(cè)量方差分析檢驗(yàn),結(jié)果表明針灸組及對(duì)照組在治療后中醫(yī)證候評(píng)分每個(gè)月相比均有差異,治療后中醫(yī)證候評(píng)分比前一個(gè)月均有好轉(zhuǎn)(F=25.379,P=0.0000.05)。將針灸組及對(duì)照組治療后的每個(gè)月的時(shí)間節(jié)點(diǎn)進(jìn)行比較發(fā)現(xiàn)兩組間中醫(yī)證候評(píng)分有差異(F=3.250,p=0.0480.05)。針灸組優(yōu)于對(duì)照組。[結(jié)論]針灸治療能夠較好地改善患者疼痛癥狀,并提高患者生存質(zhì)量,可以作為骨質(zhì)疏松癥患者的基礎(chǔ)治療選擇。其作用機(jī)制還有待進(jìn)一步深入研究。本次研究反映的BMD\PINP\CTX\OP值治療前后無(wú)顯著差異,一方面可能與試驗(yàn)周期較短,尚不能產(chǎn)生骨質(zhì)量影像學(xué)的改變有關(guān);另一方面骨質(zhì)疏松代謝表現(xiàn)可以是高轉(zhuǎn)換型,也可以是低轉(zhuǎn)換型,本次研究未能細(xì)化分組,因此不能準(zhǔn)確反映試驗(yàn)結(jié)果。這也有待進(jìn)一步深入研究。
[Abstract]:[Objective] by patients with acupuncture on the treatment of osteoporosis, observe the changes of bone mineral density and bone metabolism index, pain, quality of life and the improvement of TCM, to explore whether acupuncture can produce that effect on the treatment of osteoporosis, for the therapy for scientific basis. Methods: a randomized controlled study method that scheme by the ethics committee approval. Who met the inclusion criteria of the subjects, and signed informed consent 60. According to the random number into the group, set up the test and blank treatment control, the experimental group was treated with Caltrate D600mg/, according to supplement the kidney acupoint acupuncture treatment, control group was given oral Caltrate D600mg/ day. 3 months test cycle. The observation indexes include: Determination of X-ray absorptiometry and serum markers of bone metabolism in PINPCTXOP dual energy (before and after test); visual pain scores, life quality scores and Medical syndromes score (before and in the test at the end of each 1,2,3). The results this study enrolled 60 cases of postmenopausal women with osteoporosis subjects completed the trial in 48 cases. The acupuncture group of 23 cases, 25 cases in the control group did not meet the inclusion criteria were excluded in 5 cases, did not complete the treatment lost in 7 cases. The two groups before treatment were observed at baseline showed no significant difference, comparable. Through the test of normality, respectively, using t test and non parametric test to draw the conclusion: 1 after treatment, bone mineral density, bone mineral density, statistical analysis of hip bone mineral density, bone mineral density of lumbar vertebra acupuncture group after treatment was 0.88590 + 10920, the control group after treatment was 0.8754 + 0.22384; femoral neck BMD acupuncture group after treatment was 0.7413 + 0.09068, the control group after treatment was 0.7612 + 0.09043; total hip bone density in acupuncture group after treatment was 0.7921 + 0.07705, the control group after treatment was 0.8096 + 0.09850 . the results showed that the two groups after the treatment of acupuncture group and control group were no significant differences in bone mineral density (P0.05) of.2, bone metabolism index, PINP acupuncture group after treatment was 52.2146 + 19.45078, 52.7904 + 23.15097 in the control group after treatment; CTX acupuncture group after treatment was 458.5417 + 201.57402, the control group after treatment was 457.2083. 211.93415; 0C acupuncture group after treatment was 20.4992 + 5.17352, the control group after treatment was 20.9108 + 7.71508. by the normality test, t test of PINP, CTX, 0P statistical data analysis, the results showed that the two groups after the treatment of acupuncture group and control group the above indexes still had no statistical difference (P0.05.3) in January, after the treatment of acupuncture group pain score was 5.1667 + 0.70196, the control group score was 5.7917 + 0.72106; February after treatment acupuncture group pain score was 4.7083 + 0.55003, the control group score was 5.7083 + 0.85867; acupuncture group pain score after treatment in March 4.2917 + 0.55003, the control group score was 5.6250 + 0.85867; after repeated measurement analysis of variance test, the two groups were compared after treatment VAS score than the previous month were improved (F=26.788, P=0.0000.05), acupuncture group and control group after treatment time each month, the comparison of VAS scores between the two groups there were significant differences (F=18.252, P=0.0000.05). The acupuncture group than the control group.4 acupuncture group after treatment in January physical health measurement score was 44.7500 + 5.73509, the control group score was 44.3750 + 5.24042; acupuncture group after treatment in February physical health measurement score was 48.1667 + 7.53927, the control group score was 44.3750 + 5.31183 in March; after the acupuncture group total body health measurement score was 58.4583 + 10.99399, the control group score was 47.5000 + 5.80105; after repeated measurement analysis of variance test, results showed that acupuncture group and control group after treatment in each PCS The moon is that there were significant differences of PCS score after treatment were better than the previous month (F=52.159, P=0.0000.05). The acupuncture group and control group after treatment time each month, the comparison of PCS scores between the two groups was statistically significant (F=4.072, P=0.0490.05). The acupuncture group than in the control group.5, after the acupuncture treatment in January the mental health total measurement score was 63.7083 + 7.07709, the control group score was 60.5417 + 7.07709; acupuncture group mental health treatment in February after the total measurement score was 66.7083 + 6.36894, the control group score was 60.4583 + 7.26504; March after treatment acupuncture group mental health measuring total score was 70.4583 + 5.91960, the control group score was 60.7083 + 6.60355; after repeated measurement analysis of variance test, results showed that acupuncture group and control group after treatment MCS each month compared were different, the MCS score after treatment were better than the previous month (F= 54.506, P=0.0000.05), needle Moxibustion group and control group after treatment time each month, the comparison between the two groups of MCS score had significant difference (F=8.993, P=0.0040.05). The acupuncture group than in the control group.6 acupuncture, TCM syndrome treatment group in January after the score was 5.3333 + 0.96309, the control group score was 5.1667 + 0.96309; Acupuncture and TCM syndrome group in February after the score was 4.7917 + 0.72106, the control group score was 5.5417 + 0.88363; acupuncture and TCM syndrome treatment group in March after the score was 4.2500 + 0.94409, the control group score was 5.4167 + 0.97431; after repeated measurement analysis of variance test, results showed that acupuncture group and control group were compared in different traditional Chinese medicine syndrome score every month treatment later, after the treatment of TCM syndrome score were better than the previous month (F=25.379, P=0.0000.05). The acupuncture group and control group after treatment time each month, the comparison between the two groups of TCM syndrome score The difference (F=3.250, p=0.0480.05). The acupuncture group than the control group. Conclusion acupuncture treatment can improve the symptoms of pain, and improve the quality of life of patients, can be used as the basis for treatment of osteoporosis patients. The mechanism needs further research. This study reflects the BMDPINPCTXOP value was no significant difference before and after treatment. On the one hand and the test cycle is short, still can not produce the quality of bone imaging changes; on the other hand, osteoporosis metabolism can be high conversion type, can also be a low conversion type. This study can not refine the packet, which can not precisely reflect the test results. It also needs further study.

【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R246.1

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