| Objective : To explore the distribution characteristics of TCM syndromes in patients with osteoporosis and the relationship between TCM syndromes of osteoporosis and bone metabolism markers;the patients with primary osteoporosis were treated with vitamin D2 injection combined with zoledronic acid.The correlation between serum 25-hydroxyvitamin D(25-(OH)D)level and bone mineral density and bone metabolism indexes was analyzed.Methods : 1.A total of 300 patients who met the inclusion criteria were collected from November 2021 to November 2022 in the Department of Endocrinology,Department of Orthopedics,Department of Geriatrics,and Department of Geriatrics of Changsha Hospital of Traditional Chinese Medicine(Changsha Eighth Hospital).The patients were dialectically classified,the distribution characteristics of TCM syndromes of osteoporosis were analyzed,and the correlation between different syndromes and bone mineral density,serum 25-(OH)D,P1 NP,and β-CTX was analyzed.2.In the first part,60 OP patients with liver and kidney yin deficiency syndrome were selected for anti-osteoporosis treatment.They were divided into two groups by random number table method.One group was vitamin D2 injection intensive treatment group,and the other group was routine treatment group,including 30 cases in intensive treatment group and 30 cases in routine treatment group.Both groups were treated with zoledronic acid 5mg intravenous infusion once;calcium carbonate D3 tablets,600 mg,once a day,orally;the conventional treatment group used vitamin D drops,800 units,once a day,orally.The vitamin D2 intensive treatment group was given intramuscular injection of vitamin D2 injection 600 thousand international units(IU)in 0 month and 2 months,and serum 25-(OH)D was reviewed in 6months.If there was a lack or deficiency,vitamin D2 injection 600 thousand international units(IU)was injected once.The differences of vitamin D level,bone mineral density and bone metabolic markers between the two groups were compared.Results : 1.A total of 300 OP patients were collected in this study,and the proportion of each syndrome type was from high to low,followed by qi stagnation and blood stasis syndrome(36 %),liver and kidney yin deficiency syndrome(28.3 %),kidney deficiency and blood stasis syndrome(17 %),spleen and stomach weakness syndrome(12 %),spleen and kidney yang deficiency syndrome(6.7 %).2.There are differences in gender of OP patients among different syndromes,males account for more in spleen and stomach deficiency syndrome(52.8 %),and females account for more in spleen and kidney yang deficiency syndrome(74.1 %),P0.05.3.There was a statistically significant difference in bone mineral density between OP patients with different syndromes,P < 0.001;the bone mineral density of qi stagnation and blood stasis syndrome was higher than that of liver and kidney yin deficiency syndrome,spleen and stomach deficiency syndrome,spleen and kidney yang deficiency syndrome and kidney deficiency and blood stasis syndrome,and the differences were statistically significant(P <0.05).The bone mineral density of liver and kidney yin deficiency syndrome was lower than that of spleen and kidney yang deficiency syndrome and kidney deficiency and blood stasis syndrome,and the difference was statistically significant(P < 0.05).The bone mineral density of spleen and stomach deficiency syndrome was lower than that of spleen and kidney yang deficiency syndrome and kidney deficiency and blood stasis syndrome,and the difference was statistically significant(P < 0.05).There was no significant difference in bone mineral density between liver and kidney yin deficiency syndrome and spleen and stomach deficiency syndrome,spleen and kidney yang deficiency syndrome and qi stagnation and blood stasis syndrome,P > 0.05.4.Comparison of 25-(OH)D levels between different syndromes,the difference was statistically significant,P < 0.001;liver and kidney yin deficiency.The syndrome of kidney deficiency and blood stasis was lower than that of kidney deficiency and blood stasis,the syndrome of liver and kidney yin deficiency was lower than that of qi stagnation and blood stasis,the syndrome of spleen and stomach deficiency was lower than that of kidney deficiency and blood stasis,and the syndrome of spleen and stomach deficiency was lower than that of qi stagnation and blood stasis.The difference was statistically significant(P <0.05).5.Comparison of P1 NP levels between different syndromes,the difference was statistically significant,P < 0.001;the difference of P1 NP level between qi stagnation and blood stasis syndrome and spleen and stomach weakness syndrome,qi stagnation and blood stasis syndrome and liver and kidney yin deficiency syndrome was statistically significant(P <0.05).There was no significant difference in P1 NP level between liver and kidney yin deficiency syndrome and spleen and kidney yang deficiency syndrome,liver and kidney yin deficiency syndrome and spleen and stomach deficiency syndrome,liver and kidney yin deficiency syndrome and kidney deficiency and blood stasis syndrome,qi stagnation and blood stasis syndrome and spleen and kidney yang deficiency syndrome,qi stagnation and blood stasis syndrome and kidney deficiency and blood stasis syndrome,spleen and stomach deficiency syndrome and spleen and kidney yang deficiency syndrome,spleen and stomach deficiency syndrome and kidney deficiency and blood stasis syndrome,P > 0.05.6.Comparison of β-CTX levels between different syndromes,the difference was statistically significant,P < 0.001;2.Comparison of β-CTX levels between different syndromes,spleen and stomach deficiency syndrome was higher than qi stagnation and blood stasis syndrome,liver and kidney yin deficiency syndrome was higher than qi stagnation and blood stasis syndrome,spleen and stomach deficiency syndrome was higher than kidney deficiency and blood stasis syndrome,liver and kidney yin deficiency syndrome was higher than kidney deficiency and blood stasis syndrome,the differences were statistically significant,P < 0.05;there was no significant difference between liver and kidney yin deficiency syndrome and spleen and stomach deficiency syndrome,liver and kidney yin deficiency syndrome and spleen and kidney yang deficiency syndrome,qi stagnation and blood stasis syndrome and spleen and kidney yang deficiency syndrome,qi stagnation and blood stasis syndrome and kidney deficiency and blood stasis syndrome,spleen and stomach deficiency syndrome and spleen and kidney yang deficiency syndrome,spleen and kidney yang deficiency syndrome and kidney deficiency and blood stasis syndrome,P > 0.05.7.There was no significant difference in Ca,CRP and ESR levels between OP patients with different syndromes,P > 0.05;8.Logistic regression analysis showed that 25-(OH)D was negatively correlated with liver and kidney deficiency,B(25-(OH)D)=-0.049,P(25-(OH)D)= 0.002).25-(OH)D was negatively correlated with spleen and stomach weakness,B(25-(OH)D)=-0.086,P(25-(OH)D)0.05;β-CTX was positively correlated with liver and kidney deficiency,B(β-CTX)= 0.004,P(β-CTX)< 0.05;β-CTX was positively correlated with spleen and stomach weakness,B(β-CTX)= 0.004,P(β-CTX)< 0.05;there was no significant correlation between β-CTX and qi stagnation and blood stasis syndrome,spleen and kidney yang deficiency syndrome,P(β-CTX)> 0.05;there was no correlation between P1 NP and liver and kidney yin deficiency syndrome,qi stagnation and blood stasis syndrome,spleen and stomach deficiency syndrome,spleen and kidney yang deficiency syndrome,P > 0.05.9.The scores of TCM syndromes in the intensive treatment group and the conventional treatment group were significantly lower than those before treatment,and the difference was statistically significant(P < 0.05);after treatment,the femoral neck bone mineral density of the patients in the intensive treatment group and the conventional treatment group was significantly higher than that before treatment,and the difference was statistically significant,P < 0.001;after 6 months and 12 months of treatment,the levels of 25-(OH)D in the two groups were higher than those before treatment,P < 0.05;after 12 months of treatment,the level of P1 NP in OP patients in the intensive treatment group was significantly lower than that before treatment,and the difference was statistically significant(P = 0.004).There was no significant difference in P1 NP level between June and before treatment(P = 0.426,P =0.052).After 6 months and 12 months of treatment,the level of P1 NP in the conventional treatment group was significantly lower than that before treatment,and the difference was statistically significant(P < 0.05).After 6 months and 12 months of treatment,the level ofβ-CTX in the two groups decreased significantly compared with that before treatment,and the difference was statistically significant(P < 0.001).10.The serum 25-(OH)D level of patients in the intensive treatment group was significantly higher than that in the conventional treatment group after 6 months and 12 months of treatment,and the difference was statistically significant(P < 0.05).Conclusion :1.In this study,the incidence of qi stagnation and blood stasis syndrome in OP patients was the highest,and that of spleen and kidney yang deficiency syndrome was the lowest.There are more women in spleen and kidney yang deficiency syndrome,and more men in spleen and stomach deficiency syndrome;2.25-(OH)D is the protective factor of liver and kidney yin deficiency syndrome,spleen and stomach deficiency syndrome;β-CTX is a risk factor for liver and kidney yin deficiency syndrome and spleen and stomach deficiency syndrome;3.Vitamin D combined with zoledronic acid in the treatment of OP patients with liver-kidney yin deficiency syndrome can effectively improve the serum 25-(OH)D level,reduce the TCM syndrome score,P1 NP and β-CTX level,and improve the BMD level of femoral neck.Vitamin D2 combined with zoledronic acid is more conducive to patients to supplement serum25-(OH)D levels and improve bone mineral density. |
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