本文選題：骨質(zhì)疏松癥 + 腰椎退行性變��； 參考：《廣州中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:本研究試圖通過采用聚類分析等統(tǒng)計學(xué)方法來觀察骨質(zhì)疏松癥(Osteoporosis,OP)合并下肢神經(jīng)癥狀患者的中醫(yī)證型分布規(guī)律,以期為該疾病的更精確的辨證施治及提高臨床療效提供理論依據(jù)。本研究還對骨質(zhì)疏松癥患者之腰椎退行性改變特點(diǎn)進(jìn)行觀察,以進(jìn)一步探討骨質(zhì)疏松癥與腰腿痛的關(guān)系。方法:收集在廣州中醫(yī)藥大學(xué)第三附屬醫(yī)院就診并確診為骨質(zhì)疏松癥的患者120例,根據(jù)患者是否伴有下肢神經(jīng)癥狀,分為A組(同時符合骨質(zhì)疏松癥與下肢神經(jīng)癥狀的診斷標(biāo)準(zhǔn))和B組(符合骨質(zhì)疏松癥診斷標(biāo)準(zhǔn)),對兩組患者的一般資料、腰椎骨密度(L1、L2、L3和L4)、股骨頸骨密度、腰椎間隙高度、腰椎椎體高度、腰椎骨贅程度等資料進(jìn)行收集,采用相關(guān)中醫(yī)證候?qū)W調(diào)查表,對兩組患者就診時的四診資料進(jìn)行搜集,最后運(yùn)用SPSS 19.0版統(tǒng)計軟件中的相關(guān)統(tǒng)計學(xué)方法對所有數(shù)據(jù)進(jìn)行分析。結(jié)果:1、OP患者多見于女性,但兩組間的性別構(gòu)成比經(jīng)統(tǒng)計學(xué)檢驗無顯著的統(tǒng)計學(xué)意義(P0.05)。2、兩組之間的年齡比較:A組患者平均年齡為70.86±4.90歲,B組患者平均年齡為60.16±5.58歲,兩組之間的年齡差異經(jīng)統(tǒng)計學(xué)檢驗有顯著統(tǒng)計學(xué)差異(P0.01)。3、兩組之間的身高比較:A組患者平均身高157.31 ±5.53cm,B組患者平均身高158.70±5.69cm,兩組之間的身高差異經(jīng)統(tǒng)計學(xué)檢驗未見顯著統(tǒng)計學(xué)差異(P0.05)。4、兩組之間的體重比較:A組患者平均體重50.20±5.48kg,B組患者平均體重51.97±4.57kg,兩組之間的體重差異經(jīng)統(tǒng)計學(xué)檢驗未見顯著統(tǒng)計學(xué)差異(P0.05)。5、中醫(yī)證候聚類分析及證型分布:兩組患者的四診資料經(jīng)聚類分析后,可將A組60例患者的中醫(yī)證候聚為四類,其具體分布情況如下:腎陽虧虛型共有15例,所占比例為25%;寒濕阻絡(luò)型共有13例,所占比例為21.7%;濕熱阻絡(luò)型共有12例,所占比例為20%;氣滯血瘀型共有20例,所占比例為33.3%。B組患者的四診資料經(jīng)聚類分析后,將60例患者的中醫(yī)證候聚為三類,其具體分布情況如下:脾腎陽虛型共有28例,所占比例為46.7%;肝腎陰虛型共有20例,所占比例為33.3%;氣滯血瘀型為12例,所占比例為20%。6、腰椎及股骨頸骨密度的測量:在A組中:腰1骨密度平均值為0.75±0.07 g/cm2,腰2骨密度平均值為0.82±0.10g/cm2,腰3骨密度平均值為0.85 ± 0.08g/cm2,腰4骨密度平均值為0.91±0.08g/cm2;而在B組中:腰1骨密度平均值為0.61±0.09 g/cm2,腰2骨密度平均值為0.64±0.11g/cm2,腰3骨密度平均值為0.60±0.10g/cm2,腰4骨密度平均值為0.70±0.09g/cm2。二組間相對應(yīng)的腰椎節(jié)段的骨密度值差異經(jīng)統(tǒng)計學(xué)檢驗后均具有顯著統(tǒng)計學(xué)差異(P0.01),即A組患者各節(jié)段的腰椎骨密度均值要高于B組;A組股骨頸的骨密度平均值為:0.50±0.06 g/cm2,B組股骨頸的骨密度平均值為:0.58±0.07 g/cm2,兩組之間的差異經(jīng)統(tǒng)計學(xué)檢驗后均具有顯著統(tǒng)計學(xué)差異(P0.01),即A組患者股骨頸骨密度均值要低于B組。7、兩組腰椎間隙高度(SLIH)、椎體高度(LVH)、腰椎骨贅程度(SL0D)的比較。對兩組患者各相應(yīng)節(jié)段SLIH進(jìn)行兩兩比較,采用獨(dú)立樣本t檢驗,發(fā)現(xiàn)A組各節(jié)段的SLIH均小于B組,差異均存在統(tǒng)計學(xué)意義(p0.01)。對兩組患者各節(jié)相應(yīng)LVH進(jìn)行兩兩比較,采用獨(dú)立樣本t檢驗,其結(jié)果提示A組LVH低于B組,差異有統(tǒng)計學(xué)意義(P0.01);其高度差異主要表現(xiàn)為Ha/Hp比值,其次為Hm/Hp比值,而兩組Hp/Hpi+1比值未見明顯差異。對兩組患者各節(jié)段腰椎骨贅程度進(jìn)行比較,采用秩和檢驗,發(fā)現(xiàn)A組與B組之間的骨贅程度差異有統(tǒng)計學(xué)意義(p0.01),A組的腰椎骨贅程度分級主要集中于ⅣV度,而B組的腰椎骨贅程度分級主要集中于Ⅰ度和Ⅱ度,即A組的腰椎骨贅嚴(yán)重程度要大于B組。結(jié)論:1、伴神經(jīng)癥狀的骨質(zhì)疏松癥的中醫(yī)證型可分為氣滯血瘀型、腎陽虧虛型、寒濕阻絡(luò)型和濕熱阻絡(luò)型,氣滯血瘀是伴下肢神經(jīng)癥狀的骨質(zhì)疏松癥患者中最常見的中醫(yī)證型,在臨床治療中應(yīng)多注重活血化瘀、通絡(luò)止痛等治療方法;骨質(zhì)疏松癥的中醫(yī)證型可分為脾腎陽虛型、肝腎陰虛型和氣滯血瘀型,脾腎陽虛是骨質(zhì)疏松癥患者中最常見的中醫(yī)類型,在臨床治療中應(yīng)注重補(bǔ)益脾腎兩陽。2、骨質(zhì)疏松癥患者出現(xiàn)下肢神經(jīng)癥狀往往是骨質(zhì)疏松癥病情進(jìn)展的一種表現(xiàn)形式,提示腰椎及椎管的骨質(zhì)、形態(tài)發(fā)生了更嚴(yán)重的病變。3、出現(xiàn)下肢神經(jīng)癥狀的骨質(zhì)疏松癥患者其腰椎骨密度未必出現(xiàn)明顯的下降,此時應(yīng)注意觀察股骨近端骨密度加以甄別。
[Abstract]:Objective: This study attempts to observe the pattern of TCM Syndrome Distribution in patients with Osteoporosis (OP) with lower extremity nerve symptoms by using statistical methods such as cluster analysis, in order to provide a theoretical basis for the more accurate diagnosis and treatment of the disease and to improve the clinical efficacy of the disease. The characteristics of sexual change were observed to further explore the relationship between osteoporosis and lumbago and leg pain. Methods: 120 cases of osteoporosis in Third Affiliated Hospitals of Guangzhou University of Chinese Medicine were collected. According to whether the patients were accompanied with lower extremity nerve symptoms, the patients were divided into A group (in the same time the diagnosis of osteoporosis and the diagnosis of lower extremity neurosis). Standard) and group B (in accordance with the diagnostic criteria for osteoporosis), the general data of two groups of patients, lumbar bone mineral density (L1, L2, L3 and L4), femoral neck bone density, lumbar intervertebral height, lumbar vertebra height, and lumbar osteophyte degree were collected, and the related TCM Syndrome questionnaire was used to collect the four diagnosis data of the two groups of patients. Finally, all data were analyzed with statistical methods in the SPSS 19 edition. Results: 1, OP patients were mostly seen in women, but the gender composition between the two groups was not statistically significant (P0.05).2, the age of the two groups was compared: the average age of the A group was 70.86 + 4.90 years, and the average age of the group B patients. For 60.16 + 5.58 years, the age difference between the two groups was statistically significant (P0.01).3, the height comparison between the two groups: the average height of the group A was 157.31 + 5.53cm, and the average height of the B group was 158.70 + 5.69cm. The height difference between the two groups was not statistically significant (P0.05).4, between the two groups. Weight comparison: the average weight of the A group was 50.20 + 5.48kg, and the average weight of the group B was 51.97 + 4.57kg. The weight difference between the two groups was not statistically significant (P0.05).5, TCM syndrome clustering analysis and Syndrome Distribution: the four diagnosis data of the two groups of patients were analyzed by polyclass analysis, and the TCM Syndromes of the 60 patients in group A could be gathered to four The specific distribution is as follows: there are 15 cases of kidney yang deficiency syndrome, the proportion of which is 25%, the cold dampness obstructing collaterals in 13 cases, the proportion of 21.7%, the damp heat obstructing collaterals in 12 cases, the proportion of 20%, the qi stagnation and blood stasis type in 20 cases, and the proportion of the four diagnosis data of the group 33.3%.B patients after clustering analysis, the TCM Syndromes of 60 patients are gathered into the TCM syndrome. The three kind, its specific distribution is as follows: there are 28 cases of spleen kidney yang deficiency type, accounting for 46.7%, 20 cases of liver kidney yin deficiency, 33.3% and 12 cases of qi stagnation and blood stasis, the proportion of 20%.6, the measurement of lumbar and femoral neck bone density: in group A, the average density of the waist 1 bone density is 0.75 + 0.07 g/cm2, and the average waist 2 bone density is 0.82 + 0. 10g/cm2, the mean value of lumbar 3 bone density was 0.85 + 0.08g/cm2, and the mean value of lumbar 4 bone density was 0.91 + 0.08g/cm2, while in group B, the mean value of lumbar 1 bone density was 0.61 + 0.09 g/cm2, the average of the waist 2 bone density was 0.64 + 0.11g/cm2, the average of the waist 3 bone density was 0.60 + 0.10g/cm2, and the mean lumbar 4 bone density was the corresponding lumbar intervertebral body between the 0.70 + 0.09g/cm2. two groups. The bone mineral density of the segment had significant difference after statistical test (P0.01), that is, the mean value of lumbar bone density in each segment of group A was higher than that of group B; the average value of bone mineral density of the femoral neck in group A was 0.50 + 0.06 g/cm2, and the average value of bone mineral density in group B was 0.58 + 0.07 g/cm2, and the difference between the two groups was examined by statistical test. There were significant statistical differences (P0.01), that is, the femoral neck bone density in group A was lower than that of group B.7, two groups of lumbar intervertebral height (SLIH), vertebral height (LVH), and lumbar osteophyte degree (SL0D). 22 comparison of the corresponding segment SLIH in the two groups was compared, and the independent sample t test was used to find that SLIH of each segment of the A group was smaller than that of the B group. There were statistical significance (P0.01). 22 comparison of the corresponding LVH in each group of the two groups was compared with the independent sample t test. The results suggested that the LVH in the group A was lower than the B group (P0.01), and the difference was mainly shown as the ratio of Ha/Hp, followed by the ratio of Hm/Hp, while the ratio of Hp/Hpi+1 in the two groups was not significantly different. The degree of lumbar vertebrae osteophyte was compared. The difference of osteophyte between group A and group B was statistically significant (P0.01). The grade of lumbar osteophyte in group A was mainly concentrated on the degree of IV V, and the degree of lumbar osteophyte in group B mainly concentrated on degree I and II degree, that is, the severity of lumbar osteophyte in group A was greater than that of group B. Conclusion: 1, 1, Syndrome types of osteoporosis associated with neurological symptoms can be divided into qi stagnation and blood stasis type, kidney yang deficiency type, cold dampness obstructing collaterals and damp heat obstructing collaterals, qi stagnation and blood stasis is the most common TCM syndrome type of osteoporosis patients with lower extremity neurosis. In clinical treatment, more attention should be paid to the treatment of activating blood and removing stasis, dredging collaterals and relieving pain and so on; The TCM syndrome type can be divided into spleen kidney yang deficiency type, liver kidney yin deficiency type and qi stagnation blood stasis type, spleen kidney yang deficiency is the most common type of Chinese medicine in osteoporosis patients. In clinical treatment, we should pay attention to tonifying the spleen and kidney of two Yang.2. The symptoms of the lower limbs of the patients with osteoporosis are often a form of expression of the progress of osteoporosis. The bone of vertebra and spinal canal has a more serious form of.3, and the bone density of the lumbar vertebrae in the patients with the symptoms of lower extremity may not be significantly reduced. At this time, attention should be paid to the screening of the bone density near the femur.
【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】：2017
【分類號】：R259
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本文編號：1963778