長期使用糖皮質(zhì)激素絕經(jīng)后骨質(zhì)疏松癥中醫(yī)證型分布及動(dòng)物實(shí)驗(yàn)研究
發(fā)布時(shí)間：2019-03-30 11:46
【摘要】：第一部分長期服用糖皮質(zhì)激素絕經(jīng)后骨質(zhì)疏松癥的中醫(yī)證型分布特點(diǎn)目的：統(tǒng)計(jì)長期使用糖皮質(zhì)激素絕經(jīng)后骨質(zhì)疏松癥患者的中醫(yī)證型分布特點(diǎn)方法：收集我院2013年1月1日至2015年12月31日之間住院的患者,設(shè)置診斷條件為“腎病綜合征”、“腎小球腎炎”、“腎小球硬化癥”、“系統(tǒng)性紅斑狼瘡”、“類風(fēng)濕性關(guān)節(jié)炎”、“支氣管哮喘”、“慢性阻塞性肺病”、“干燥綜合征”及“多發(fā)性肌炎”,查看患者病史,糖皮質(zhì)激素治療超過12周,根據(jù)納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)納入合適病例,隨訪獲得患者癥狀,參照中醫(yī)證型相關(guān)標(biāo)準(zhǔn)對納入的病例進(jìn)行中醫(yī)辨證分型。結(jié)果：總共納入例數(shù)共83例,其中腎陽虛證在所有證型中所占比例最大為39.76%(33例),其后依次為肝腎陰虛證25.30%(21例),脾腎陽虛證18.07%(15例),氣滯血瘀型9.63%(8例),陰陽兩虛證7.23%(6例)結(jié)論：婦女長期使用GC絕經(jīng)后骨質(zhì)疏松癥,腎虛為基礎(chǔ),其中腎陽虛更為常見,肝腎陰虛次之,繼而是脾腎陽虛、氣滯血瘀甚至陰陽兩虛的證型。第二部分去卵巢聯(lián)合糖皮質(zhì)激素干預(yù)的骨質(zhì)疏松動(dòng)物模型的特點(diǎn)目的：研究去卵巢聯(lián)合糖皮質(zhì)激素(GC)干預(yù)的小鼠骨質(zhì)疏松模型與激素性骨質(zhì)疏松、去卵巢骨質(zhì)疏松模型的差異,并探討其可能的病理機(jī)制。方法：3月齡SD雌性大鼠52只,隨機(jī)分為空白組、地米組、去卵巢組、復(fù)合組,每組14只。地米組給予皮下注射鹽酸地塞米松注射液,0.3 mg/kg/d,連續(xù)12周；去卵巢組于實(shí)驗(yàn)開始時(shí)手術(shù)摘除雙側(cè)卵巢；復(fù)合組于摘除雙側(cè)卵巢一周后開始皮下注射地塞米松注射液,0.3 mg/kg/d,連續(xù)12周；各組分別于干預(yù)第4、8、12周時(shí)進(jìn)行取材,分別檢測腰椎骨密度、骨微細(xì)結(jié)構(gòu)、生物力學(xué)、血清雌激素、PINP、βCTX水平及Runx2, OPG, Sclerostin, cathepsink基因的表達(dá)水平。結(jié)果：復(fù)合組與地米組骨密度(BMD)及骨礦物含量(BMC)明顯低于去卵巢組；Micro-CT檢測發(fā)現(xiàn),復(fù)合組骨小梁數(shù)量明顯低于其它組,復(fù)合組骨小梁分離度明顯高于其它組；腰椎生物力學(xué)發(fā)現(xiàn)在第12周時(shí),復(fù)合組腰椎骨強(qiáng)度及能量吸收值明顯低于去卵巢組。復(fù)合組雌激素水平在第12周時(shí)明顯低于其它組；復(fù)合組血清中PINP、β-CTX水平在第12周時(shí)明顯高于去卵巢組。地米組、去卵巢組、復(fù)合組三組之間Runx2, OPG表達(dá)較空白組均下調(diào),Cathepsin k表達(dá)上調(diào),且復(fù)合組表達(dá)量最高；復(fù)合組sclerostin表達(dá)明顯高于去卵巢組與地米組。結(jié)論：去卵巢與GC聯(lián)合干預(yù)比單純?nèi)ヂ殉不蛱瞧べ|(zhì)激素干預(yù)對骨骼的破壞更明顯。
[Abstract]:Part one: distribution characteristics of TCM Syndrome types in Postmenopausal Osteoporosis after long-term use of glucocorticoid objective: to investigate the distribution characteristics of TCM syndrome types in postmenopausal osteoporosis patients with long-term use of glucocorticoids: methods: to collect the methods of TCM syndrome distribution in our hospital. Patients hospitalized between 1 January 2013 and 31 December 2015, The diagnostic conditions were "nephrotic syndrome", "glomerulonephritis", "glomerulosclerosis", "systemic lupus erythematosus", "rheumatoid arthritis", "bronchial asthma", "chronic obstructive pulmonary disease". "Sjogren's syndrome" and "polymyositis", check the patient history, glucocorticoid treatment for more than 12 weeks, according to the inclusion criteria and exclusion criteria into the appropriate cases, follow-up to obtain the symptoms of the patients, Referring to the relevant standards of TCM syndrome types, the included cases were classified according to TCM syndrome differentiation. Results: a total of 83 cases were included, among which the proportion of kidney-yang deficiency syndrome in all syndrome types was 39.76% (33 cases), followed by liver-kidney yin deficiency syndrome (25.30%), spleen-kidney yang deficiency syndrome (18.07%), and spleen-kidney yang deficiency syndrome (18.07%), followed by liver-kidney yin deficiency syndrome (25.30%) and spleen-kidney yang deficiency syndrome (18.07%). 9.63% (8 cases) of qi stagnation and blood stasis type, 7.23% (6 cases) of yin-yang deficiency syndrome. Conclusion: long-term use of GC postmenopausal osteoporosis is based on kidney deficiency, in which kidney yang deficiency is more common, liver-kidney yin deficiency is the second, and spleen-kidney yang deficiency is followed by spleen-kidney yang deficiency. Qi stagnation blood stasis and even yin-yang deficiency syndrome. Objective: to study the osteoporosis model and hormone-induced osteoporosis in ovariectomized and glucocorticoid-induced osteoporosis (GC)-induced ovariectomized and glucocorticoid-induced osteoporosis in mice. The difference of ovariectomized osteoporosis model and its possible pathological mechanism. Methods: 52 3-month-old female SD rats were randomly divided into blank group, rice group, ovariectomized group and compound group with 14 rats in each group. Dexamethasone Hydrochloride injection was injected subcutaneously into the rice group for 12 weeks, and bilateral ovaries were removed at the beginning of the experiment in the ovariectomized group. The compound group received subcutaneous injection of dexamethasone one week after bilateral ovariectomy, 0.3 mg/kg/d, for 12 weeks. Bone mineral density (BMD), bone microstructure, biomechanics, serum estrogens, PINP, 尾 CTX levels and the expression of Runx2, OPG, Sclerostin, cathepsink gene were measured in each group at 4,8 and 12 weeks after intervention respectively. Results: the bone mineral density (BMD) and bone mineral content (BMC) of the composite group and the ground rice group were significantly lower than those of the ovariectomized group, and the number of trabecular bone in the composite group was significantly lower than that of the other groups, and the trabecular separation degree of the composite group was significantly higher than that of the other groups. Lumbar biomechanical findings showed that the lumbar bone strength and energy absorption in the composite group were significantly lower than those in the ovariectomized group at the 12th week. The serum level of PINP, 尾-CTX in the composite group was significantly higher than that in the ovariectomized group at the 12th week, and the estrogen level in the composite group was significantly lower than that in the other groups at the 12th week. Compared with the blank group, the expression of Runx2, OPG in the rice group, ovariectomized group and compound group were up-regulated, and the expression of sclerostin in the composite group was the highest, and the expression of sclerostin in the composite group was significantly higher than that in the ovariectomized group and the rice group. Conclusion: the combined intervention of ovariectomy and GC is more obvious than that of ovariectomy or glucocorticoid alone.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259
本文編號：2450050
[Abstract]:Part one: distribution characteristics of TCM Syndrome types in Postmenopausal Osteoporosis after long-term use of glucocorticoid objective: to investigate the distribution characteristics of TCM syndrome types in postmenopausal osteoporosis patients with long-term use of glucocorticoids: methods: to collect the methods of TCM syndrome distribution in our hospital. Patients hospitalized between 1 January 2013 and 31 December 2015, The diagnostic conditions were "nephrotic syndrome", "glomerulonephritis", "glomerulosclerosis", "systemic lupus erythematosus", "rheumatoid arthritis", "bronchial asthma", "chronic obstructive pulmonary disease". "Sjogren's syndrome" and "polymyositis", check the patient history, glucocorticoid treatment for more than 12 weeks, according to the inclusion criteria and exclusion criteria into the appropriate cases, follow-up to obtain the symptoms of the patients, Referring to the relevant standards of TCM syndrome types, the included cases were classified according to TCM syndrome differentiation. Results: a total of 83 cases were included, among which the proportion of kidney-yang deficiency syndrome in all syndrome types was 39.76% (33 cases), followed by liver-kidney yin deficiency syndrome (25.30%), spleen-kidney yang deficiency syndrome (18.07%), and spleen-kidney yang deficiency syndrome (18.07%), followed by liver-kidney yin deficiency syndrome (25.30%) and spleen-kidney yang deficiency syndrome (18.07%). 9.63% (8 cases) of qi stagnation and blood stasis type, 7.23% (6 cases) of yin-yang deficiency syndrome. Conclusion: long-term use of GC postmenopausal osteoporosis is based on kidney deficiency, in which kidney yang deficiency is more common, liver-kidney yin deficiency is the second, and spleen-kidney yang deficiency is followed by spleen-kidney yang deficiency. Qi stagnation blood stasis and even yin-yang deficiency syndrome. Objective: to study the osteoporosis model and hormone-induced osteoporosis in ovariectomized and glucocorticoid-induced osteoporosis (GC)-induced ovariectomized and glucocorticoid-induced osteoporosis in mice. The difference of ovariectomized osteoporosis model and its possible pathological mechanism. Methods: 52 3-month-old female SD rats were randomly divided into blank group, rice group, ovariectomized group and compound group with 14 rats in each group. Dexamethasone Hydrochloride injection was injected subcutaneously into the rice group for 12 weeks, and bilateral ovaries were removed at the beginning of the experiment in the ovariectomized group. The compound group received subcutaneous injection of dexamethasone one week after bilateral ovariectomy, 0.3 mg/kg/d, for 12 weeks. Bone mineral density (BMD), bone microstructure, biomechanics, serum estrogens, PINP, 尾 CTX levels and the expression of Runx2, OPG, Sclerostin, cathepsink gene were measured in each group at 4,8 and 12 weeks after intervention respectively. Results: the bone mineral density (BMD) and bone mineral content (BMC) of the composite group and the ground rice group were significantly lower than those of the ovariectomized group, and the number of trabecular bone in the composite group was significantly lower than that of the other groups, and the trabecular separation degree of the composite group was significantly higher than that of the other groups. Lumbar biomechanical findings showed that the lumbar bone strength and energy absorption in the composite group were significantly lower than those in the ovariectomized group at the 12th week. The serum level of PINP, 尾-CTX in the composite group was significantly higher than that in the ovariectomized group at the 12th week, and the estrogen level in the composite group was significantly lower than that in the other groups at the 12th week. Compared with the blank group, the expression of Runx2, OPG in the rice group, ovariectomized group and compound group were up-regulated, and the expression of sclerostin in the composite group was the highest, and the expression of sclerostin in the composite group was significantly higher than that in the ovariectomized group and the rice group. Conclusion: the combined intervention of ovariectomy and GC is more obvious than that of ovariectomy or glucocorticoid alone.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259
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相關(guān)期刊論文 前2條
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