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糖尿病性骨质疏松的辨证施治
林晓波,王刚,梅求安,瞿亿明,刘宽,苏道静,郭爽,杨坤,黄钰滢,庞玺奎,龚泰芳
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湖北省十堰市太和医院(湖北医药学院附属医院)康复中心骨伤一区(十堰 442000);吉林省长春市南关百草堂中医门诊部(长春 130000);湖北省十堰市太和医院(湖北医药学院附属医院)骨关节科(十堰 442000)
摘要:
探讨辨证施治糖尿病性骨质疏松的效果。方法:糖尿病性骨质疏松患者144例根据中医证型分为肝肾亏虚证60例、阴阳两虚证40例、气滞血瘀证44例,肝肾亏虚证给予滋肾降糖丸治疗,阴阳两虚证给予糖骨康胶囊治疗,气滞血瘀证给予归丸加味胶囊治疗,均治疗观察3个月,观察或比较两组疗效。结果:治疗3个月后肝肾亏虚证、阴阳两虚证、气滞血瘀证的总有效率分别为96.7%、95.0%和97.7%,3证型间无显著差异(P>0.05);上述3证型的治疗3个月空腹血糖分别为(5.38±1.49)mmol/L、(5.42±1.22)mmol/L、(4.39±1.74)mmol/L,糖化血红蛋白分别为(6.10±0.58)%、(6.08±1.11)%、(6.13±1.42)%,都较治疗前呈显著下降的趋势(P<0.05);腰椎正位1~4椎体骨密度都显著高于治疗前(P<0.05);血清白细胞介素-17分别为(5.20±1.48)pg/nL、(4.99±2.19)pg/nL、(5.09±2.81)pg/nL,都显著低于治疗前(P<0.05),但证型间对比无显著差异(P>0.05)。结论:辨证施治糖尿病性骨质疏松,能抑制炎症因子的释放,促进骨密度的恢复,降低血糖与糖化血红蛋白值,从而提高治疗疗效。
关键词:  辨证施治  糖尿病  骨质疏松  骨密度  炎症因子
DOI:10.3969/j.issn.1007-6948.2019.01.002
基金项目:2014年十堰市科学技术研究与开发项目(14Y23)
Dialectical Treatment of Diabetic Osteoporosis
LIN Xiao-bo,WANG Gang,MEI Qiu-an,QU Yiming,LIU Kuan,SU Daojing,GUO Shuang,YANG Kun,HUANG Yuying,PANG Xikui,GONG Taifang
Rehabilitation Center, Bone Injury, Taihe Hospital, Affiliated Hospital of Hubei University of Medicine, Shiyan (442000), China;Nanguan Baicaotang Traditional Chinese Medicine Clinic, Changchun City, Jilin Province (Changchun 130000);Department of Orthopaedics, Taihe Hospital of Shiyan City, Hubei Province (Affiliated Hospital of Hubei Medical College) (Shiyan 442000)
Abstract:
Objective To investigate the outcomes of diabetic osteoporosis treated based on syndrome differentiation. Methods The patients with diabetic osteoporosis (144 cases) were divided into 60 cases of liver and kidney deficiency syndrome, 40 cases of yin-yang deficiency syndrome and 44 cases of qi stagnation and blood stasis syndrome according to syndrome types of traditional Chinese medicine (TCM). Zishen Jiangtang Pills were given to patients with liver and kidney deficiency syndrome. Patients with yin-yang deficiency syndrome were treated with Tangukang Capsule, and patients with qi stagnation and blood stasis syndrome were treated with Guiwan Jiawei Capsule. Patients in all groups were treated and observed for 3 months. Outcomes of two groups were compared. Results After 3 months of treatment, the total effective rates of liver-kidney deficiency syndrome, yin-yang deficiency syndrome, and qi stagnation and blood stasis syndrome were 96.7%, 95.0% and 97.7%, respectively, without significant difference among the three syndrome types (P>0.05). The fasting blood glucose of patients in the above 3 groups after 3-month treatment were (5.38±1.49) mmol/L, (5.42±1.22) mmol/L and (4.39±1.74) mmol/L, respectively, and glycosylated hemoglobin levels were (6.10±0.58)%, (6.08±1.11)% and (6.13±1.42)%, respectively, which were significantly lower compared with those before treatment (P<0.05); the bone density of vertebral body 1–4 was significantly higher than that before treatment (P<0.05); serum interleukin-17 levels were (5.20±1.48) pg/nL, (4.99±2.19) pg/nL and (5.09±2.81) pg/nL, respectively, which were significantly lower than those before treatment (P<0.05), but there was no significant difference among the syndrome types (P>0.05). Conclusion Treatment of diabetic osteoporosis based on syndrome differentiation can inhibit the release of inflammatory cytokines, promote recovery of bony density, and decrease blood glucose and glycosylated hemoglobin levels, thereby improve therapeutic outcomes.
Key words:  Treatment based on syndrome differentiation  diabetes  osteoporosis  bone density  inflammatory factors

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