| Objective:By exploring the relationship between TCM syndrome differentiation and bone metabolism index,including bone metabolism biochemical index and bone density,and inflammation index,joint function and disease activity,we hope to find the relationship between TCM syndrome type of as and bone mass loss,and provide TCM treatment direction for clinical syndrome differentiation and early prevention and treatment of bone mass loss.Method:The cross-sectional study was used in this study.138 patients who met the inclusion criteria were classified scientifically and reasonably by rheumatology professional TCM doctors.The self-designed questionnaire was used to collect the general conditions of all patients;laboratory indexes,including bone metabolism indexes such as Ca,ALP,BGP,PTH,PINP,β-CTX,vitamin D,ESR,CRP inflammatory indexes,and HLA-B27;the Z values of L1-L4 in left hip joint and lumbar spine were measured and recorded by dual energy X-ray absorptiometry,and BASFI and BASDAI evaluation were inquired and recorded carefully points.According to the classification of syndromes,spss26.0 statistical software was used to analyze the correlation between five TCM syndromes and biochemical indexes of bone metabolism,ESR,CRP,BMD,BASFI and BASDAI.Result:1.General information of the case:138 AS patients,104 males and 34 females,with a sex ratio of 3.06:1,met the inclusion criteria;127 patients were HLA-B27 positive,the positive rate of HLA-B27 was 92.03%.The total number of patients with osteopenia was 52,accounting for 37.68%of the study.Among them,deficiency of liver and kidney,deficiency of kidney yang and dampness heat blocking syndrome were more distributed,which were 55.88%,42.31%and 30%respectively.(1)The distribution of dampness heat obstruction syndrome was the most(30 cases,27.74%),followed by deficiency of liver and kidney(34 cases,24.64%),deficiency of kidney yang(26 cases,18.84%);There are some differences in age and course of disease in each group(P<0.05),but there is no difference in gender(P>0.05);the age of the patients with liver and kidney deficiency is the largest;the course of blood stasis syndrome is the longest,followed by liver and kidney deficiency syndrome,and the course of damp heat syndrome is the shortest.(2)Bone mineral density:Although there was no significant correlation between the lumbar L1-4 and the hip Z value and age in this study(P>0.05),further study found that age was still an important risk factor for as bone mass reduction(P<0.05,or=1.084);there was no significant statistical significance between the lumbar Z value and gender(P>0.05),but the left hip Z value was related to gender,male patients.The Z value of hip joint was lower than that of female(P<0.01,r=0.224).There was no correlation between the Z value of lumbar L1-4 and the course of disease(P>0.05),but there was a negative weak correlation between the Z value of left hip joint and the course of disease(P<0.05,r=-0.236).In addition,this study found that high BASFI score was also a risk factor for osteopenia(P<0.05,or=1.032).2.Biochemical indexes of bone metabolism:(1)Correlation between bone mineral density and biochemical indexes of bone metabolism:There was a significant negative correlation between the left hip Z value and ALP(P<0.05,r=-0.216),but no significant correlation with Ca,BGP,PTH,PINP,β-CTX,vitamin D(P>0.05).There was no significant correlation between L1-4 and Ca,ALP,BGP,PTH,PINP,β-CTX,vitamin D(P>0.05).(2)Correlation between syndrome types of traditional Chinese medicine and biochemical indexes of bone metabolism:The difference of Ca,PTH and BGP was statistically significant(P<0.05).The indexes of bone formation of liver and kidney deficiency syndrome,dampness heat Bi obstruction syndrome and kidney yang deficiency syndrome were lower.However,ALP,β-CTX,PINP and vitamin D had no difference among the syndrome groups(P>0.05).The differences of ALP,β-CTX,PINP and vitamin D between the two groups were not statistically significant(P>0.05).3.TCM syndrome type and bone mineral density:There was no significant difference with L1-4 of lumbar vertebrae and Z value of hip joint(P>0.05).In terms of the mean value of bone mineral density(BMD)of lumbar L1-4 and left hip joint of each syndrome type,the BMD level of the patients with kidney yang deficiency syndrome is the lowest,followed by the syndrome of liver and kidney deficiency and the syndrome of blood stasis blocking.4.ESR、CRP:(1)In terms of bone mineral density:There was no significant correlation between ESR and CRP and L1-4 of lumbar spine and Z value of hip joint(P>0.05).(2)In TCM Syndromes:There were significant differences in ESR and CRP between dampness heat arthralgia syndrome and cold dampness arthralgia syndrome,blood stasis arthralgia syndrome,deficiency of Kidney Yang Syndrome and deficiency of liver and kidney syndrome(P<0.05).ESR and CRP were the highest in damp heat Bi obstruction syndrome.5.BASFI、BASDAI:(1)In terms of bone mineral density:There was no significant correlation between the Z value of lumbar Ll-4 and BASFI or BASDAI(P>0.05)there was a significant negative correlation between the Z value of left hip and BASFI(P<0.01,r=-0.247),but no correlation with BASDAI(P>0.05).(2)In TCM Syndromes:Among the five types of syndrome,there were differences in BASFI(P<0.05),but there was no difference in BASDAI level between the five TCM syndrome group(P>0.05).the level of BASFI was the highest in the group of stagnation of blood stasis.The level of BASDAI was the highest in the damp heat arthralgia syndrome group,and more than 4 points.Conclusion:1.There is bone loss phenomenon in as,the Z value of left hip joint of male as patients is lower than that of female patients,and the ALP level of patients with decreased bone density of left hip joint is higher,the BASFI score is also higher,and the joint function is worse;and the BASFI level of old age and high score is the risk factor of as bone mass reduction,so we should pay attention to early bone mass monitoring of patients with poor joint function2.As patients with syndrome differentiation of deficiency of liver and kidney and deficiency of kidney yang are more likely to have low bone mass,which is related to low level of Ca,PTH and BGP,indicating that there is imbalance of bone metabolism,which may be weak in bone formation;3.As patients with syndrome differentiation of dampness heat Bi obstruction tend to have higher ESR and CRP,and BASDAI is more than 4 points,most of them are in the active stage of disease,and the levels of PTH and BGP are low.4.Vitamin D levels in all AS patients were lower than normal,so vitamin D supplementation should be carried out early... |
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