四物汤加减治疗对脑卒中后偏瘫继发性骨质疏松患者骨密度、骨代谢指标及肢体功能的影响

Effects of modified Siwu decoction on bone mineral density,bone metabolism indicators,and limb function in patients with post-stroke hemiplegia and secondary osteoporosis

中文关键词: 老年  脑卒中后偏瘫  骨质疏松  四物汤  骨密度  骨代谢  肢体功能

英文关键词: elderly  post-stroke hemiplegia  osteoporosis  Siwu decoction  bone mineral density  bone metabolism  limb function

中文摘要:

      目的 观察四物汤加减方治疗对脑卒中后偏瘫继发性骨质疏松患者骨密度(BMD)、骨代谢指标及肢体功能的影响.方法 2022年11月—2024年11月张家口市第一医院收治的150例脑卒中后偏瘫继发性骨质疏松患者,按随机数字表法分为观察组(n=75,脱落7例,最终有68例)和对照组(n=75,脱落4例,最终有71例).对照组给予西医常规治疗,观察组在对照组相同治疗的基础上加用四物汤加减方治疗,2组均连续治疗3个月后.于治疗前、治疗3个月,比较2组治疗有效率、中医症候积分、BMD与骨代谢、肢体功能及不良反应.结果 治疗3个月后,观察组治疗有效率高于对照组(P＜0.05);2组骨节刺痛、痛有定处、痛处拒按、舌质紫黯、脉涩或弦评分均较同组治疗前下降,且观察组评分低于对照组,差异均有统计学意义(P＜0.05);2组骨密度(BMD)、骨钙素(BGP)、25-羟基维生素D[25-(OH)D]及Ⅰ型前胶原氨基端延长肽(P1NP)水平均较同组治疗前升高(P＜0.05),β胶原降解产物(β-CTX)水平下降(P＜0.05),且观察组各指标改善幅度均大于对照组(P＜0.05);2组Fugl-Meyer运动功能评定量表(FMA)、Berg平衡量表(BBS)及日常生活能力(ADL)评分均较同组治疗前升高,且观察组评分高于对照组,差异均有统计学意义(P＜0.05);2组不良反应发生率差异无统计学意义(P＞0.05).结论 四物汤加减方治疗脑卒中后偏瘫继发性骨质疏松,可显著改善骨密度、骨代谢指标和肢体功能,疗效优于常规治疗,安全性较好.

英文摘要:

      Objective To investigate the effects of modified Siwu decoction on bone mineral density(BMD),bone metabolism indicators,and limb function in patients with post-stroke hemiplegia and secondary osteoporosis.Methods From November 2022 to November 2024,150 patients with post-stroke hemiplegia and secondary osteoporosis admitted to First Hos-pital of Zhangjiakou City were selected and randomly divided into observation group(n=75,7 cases dropped out,and ulti-mately 68 cases)and control group(n=75,4 cases dropped out,and ultimately 71 cases)according to the random number ta-ble method.The control group received conventional Western medical treatment,while the observation group was treated with modified Siwu decoction on the basis of the treatment in the control group.Both groups were treated continuously for 3 months.Before treatment and 3 months after treatment,the effective rate of treatment,TCM syndrome score,BMD and bone metabo-lism,limb function and adverse reactions were compared between the two groups.Results After 3 months of treatment,the effective rate in the observation group was higher than that in the control group(P＜0.05).The scores of joint stabbing pain,fixed location of pain,refusal to press at the pain site,dark purple tongue,and sluggish or taut pulse in both groups decreased compared with those in the same group before treatment(P＜0.05),and the observation group was lower than the control group(P＜0.05).The levels of BMD,osteocalcin(BGP),25-hydroxyvitamin D[25-(OH)D]and N-terminal propeptide of type Ⅰ procollagen(P1NP)in both groups increased compared with those in the same group before treatment(P＜0.05),and the level of β-collagen degradation products(β-CTX)decreased(P＜0.05).Meanwhile,the improvement amplitudes of the above indexes in the observation group were greater than those in the control group(P＜0.05).The scores of the Fugl-Meyer Assessment Scale(FMA),Berg Balance Scale(BBS),and Activities of Daily Living(ADL)in both groups were higher than those in the same group before treatment(P＜0.05),and the observation group was higher than the control group(P＜0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion The modified Siwu decoction in the treatment of patients with post-stroke hemiplegia and secondary osteoporosis can significantly improve bone density,bone metabolism indicators and limb function.Its therapeutic effect is superior to con-ventional treatment and it has good safety.