摘要
目的探讨滋阴补阳法对T2DM合并骨质疏松症(OP)患者炎症反应及骨代谢水平的影响。方法随机对照试验研究。选择2022年1月-2023年12月本院80例T2DM合并OP患者作为观察对象,采用随机数字表法分为2组,每组40例。在常规治疗基础上,对照组嚼服维D钙咀嚼片,观察组加服滋阴补阳中药。2组均治疗6个月。分别于治疗前后进行中医证候评分;采用智能血糖监测仪检测患者空腹血糖(FPG)、2 hPG、HbA1c水平,全自动血液分析仪检测血清中性粒细胞、淋巴细胞水平并计算中性粒细胞/淋巴细胞比值(NLR);采用全自动化学发光分析仪检测患者血清IL-1β、TNF-α水平,ELISA法检测Ⅰ型前胶原氨基末端前肽(PINP)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、25羟基维生素D3[25-(OH)D3]水平;采用骨密度检测仪检测骨密度(BMD)。观察记录治疗期间的不良反应,评价临床疗效。结果观察组总有效率为92.5%(37/40)、对照组为75.0%(30/40),2组比较差异有统计学意义(χ^(2)=4.50,P=0.034)。治疗后,观察组腰酸膝软、腰背酸痛、小便清长、舌淡苔白积分低于对照组(t值分别为3.11、3.75、3.51、3.74,P<0.01);血清FPG、2 hPG、HbA1c水平低于对照组(t值分别为3.11、3.20、3.39,P<0.01);血清NLR[(2.63±0.68)比(3.24±0.79),t=3.70]及IL-1β[(81.65±8.30)ng/L比(89.03±8.98)ng/L,t=3.82]、TNF-α[(35.14±5.11)μg/L比(39.96±5.38)μg/L,t=4.11]水平低于对照组(P<0.01)。治疗后,观察组PINP[(29.83±3.92)ng/L比(34.02±4.03)ng/L,t=4.71]、β-CTX[(21.30±3.95)ng/L比(25.32±4.18)ng/L,t=4.42]水平低于对照组(P<0.01),25-(OH)D3[(42.86±5.12)μg/L比(38.08±4.55)μg/L,t=4.41]、BMD[(0.90±0.18)g/cm^(3)比(0.78±0.16)g/cm^(3),t=3.15]水平高于对照组(P<0.01)。治疗期间,观察组不良反应发生率为12.5%(5/40)、对照组为10.0%(4/40),2组比较差异无统计学意义(χ^(2)=0.13,P=0.723)。结论滋阴补阳法可有效改善T2DM合并OP患者的中医证候,降低血糖及炎症因子水平,改善骨代谢,提高临床疗效且治疗安全性良好。
Objective To investigate the effect of nourishing yin and tonifying yang method on inflammatory response and bone metabolism in patients with T2DM complicated with osteoporosis(OP).Methods A randomized controlled trial.From January 2022 to December 2023,80 patients with T2DM and OP in our hospital were selected as the observation objects,and they were divided into two groups by random number table method,with 40 cases in each group.On the basis of conventional treatment,the control group chewed vitamin D calcium chewable tablets,and the observation group added nourishing yin and tonifying yang Chinese medicine.Both groups were treated for 6 months.TCM syndrome scores were performed before and after treatment;the levels of fasting blood glucose(FPG),2 hPG and HbA1c were detected by intelligent blood glucose monitor;the levels of serum neutrophils and lymphocytes were detected by automatic blood analyzer,and the neutrophil/lymphocyte ratio(NLR)was calculated;the levels of serum IL-1βand TNF-αwere detected by automatic chemiluminescence analyzer,the levels of type I procollagen amino terminal propeptide(PINP),type I collagen carboxy terminal peptideβspecial sequence(β-CTX)and 25-hydroxy vitamin D3[25-(OH)D3]were detected by ELISA;Bone mineral density(BMD)was detected by bone mineral density detector.The adverse reactions during treatment were observed and recorded,and the clinical efficacy was evaluated.Results The total effective rate was 92.5%(37/40)in the observation group and 75.0%(30/40)in the control group,the difference between the two groups was statistically significant(χ^(2)=4.50,P=0.034).After treatment,the scores of soreness and weakness of waist and knees,soreness and pain of waist and back,clear and long urine,pale tongue and white coating in the observation group were lower than those in the control group(t=3.11,3.75,3.51,3.74,P<0.01);the levels of serum FPG,2 hPG and HbA1c in the observation group were lower than those in the control group(t=3.11,3.20,3.39,P<0.01).The levels of serum NLR(2.63±0.68 vs.3.24±0.79,t=3.70),IL-1β[(81.65±8.30)ng/L vs.(89.03±8.98)ng/L,t=3.82]and TNF-α[(35.14±5.11)μg/L vs.(39.96±5.38)μg/L,t=4.11]in the observation group were lower than those in the control group(P<0.01).After treatment,the levels of PINP[(29.83±3.92)ng/L vs.(34.02±4.03)ng/L,t=4.71]andβ-CTX[(21.30±3.95)ng/L vs.(25.32±4.18)ng/L,t=4.42]in the observation group were lower than those in the control group(P<0.01),the levels of 25-(OH)D3[(42.86±5.12)μg/L vs.(38.08±4.55)μg/L,t=4.41]and BMD[(0.90±0.18)g/cm^(3)vs.(0.78±0.16)g/cm^(3),t=3.15]were higher than those in the control group(P<0.01).During the treatment,the incidence of adverse reactions was 12.5%(5/40)in the observation group and 10.0%(4/40)in the control group,there was no significant difference between the two groups(χ^(2)=0.13,P=0.723).Conclusion The method of nourishing yin and tonifying yang can effectively improve the TCM syndromes of T2DM patients with OP,reduce the levels of blood glucose and inflammatory factors,improve bone metabolism,improve clinical efficacy and have good treatment safety.
作者
马凌云
刘德峰
刘爱茹
张娜娜
宋佳桐
卞伟煜
纪玉娟
姬云妍
李文东
迟秀娥
Ma Lingyun;Liu Defeng;Liu Airu;Zhang Nana;Song Jiatong;Bian Weiyu;Ji Yujuan;Ji Yunyan;Li Wendong;Chi Xiu'e(Department of Endocrinology and Diabetes,Cangzhou Combined Hospital of Traditional Chinese and Western Medicine,Cangzhou 061001,China;Department of Orthopedics,Cangzhou Combined Hospitalof Traditional Chinese and Western Medicine,Cangzhou 061001,China;Outpatient Office,Cangzhou Combined Hospital of Traditional Chinese and Western Medicine,Cangzhou 061001,China)
出处
《国际中医中药杂志》
2025年第3期312-317,共6页
International Journal of Traditional Chinese Medicine
基金
河北省中医药管理局科研计划项目(2021351)。
关键词
糖尿病
2型
骨质疏松
滋阴补阳法
炎症反应
骨代谢
Diabetes mellitus,type 2
Osteoporosis
Nourishing yin and tonifying yang
Inflammatory response
Bone metabolism
