从血瘀对骨代谢的影响探讨血瘀在女性原发性骨质疏松症发病中的作用机制

摘要

Objective This study is committed to discuss the correlations between blood cell parameters, blood stasis quantization score and bone metabolic markers in female patients with primary osteoporosis-kidney deficiency and blood stasis syndrome, in order to explore the possible mechanism that blood stasis lead to osteoporosis based on the correlation between blood stasis and bone metabolic function.Methods Ninety-nine patients meeting the inclusion criteria were divided into three groups according to age (group A:55-64y;group B:65-74y;group C:75-84y).Patients age, height, weight and bone mineral density (BMD) were recorded.The parameters of blood cells:mean corpuscular volume (MCV), red blood cell distribution width-coefficient of variation (RDW-CV), mean platelet volume (MPV), platelet distribution width (PDW), bone metabolic markers (PINP, β-CTx) and blood stasis quantization score were tested.Pearson correlation analysis was used to evaluate the relationships between blood cell parameters, bone metabolic markers and other related factors.Results (1) The level of MCV increased with the increase of patient's age.There was significant difference of MCV between group A and group C, P ＜ 0.01, and group B and group C, P ＜ 0.05.Blood stasis quantization score increased with the increase of patient's age.There was significant difference of blood stasis quantization score between group A and group C, P ＜ 0.01.BMD decreased with the increase of patients age.There was significant difference of BMD between group A and group C, P ＜0.01, and group B and group C, P ＜ 0.05.(2) There was a mild positive correlation between blood stasis quantization score and MCV and RDW-CV (γ =0.233, 0.257, P ＜ 0.05).There was a mild negative correlation between BMD and MCV and blood stasis quantization score (γ =-0.248, P ＜ 0.05;γ =-0.344,P ＜0.01).There was a mild negative correlation between PDW and β-CTx and PINP (γ =-0.199, γ =-0.221;P ＜ 0.05).There was a very mild negative correlation between β-CTx and RDW-CV and MPV (γ =-0.155, γ =-0.154).There was a very mild negative correlation between PINP and MPV (γ =-0.184).Conclusion This study showed that blood cell parameters and blood stasis quantization score gradually increased and BMD gradually reduced in female patients with primary osteoporosis with the increase in age.There was a mild negative correlation between blood cell parameters and BMD, PINP and β-CTx.It is supposed that blood stasis and abnormal blood cell parameters may cause bone microcirculation dysfunction, and as a result, bone microcirculation dysfunction led to abnormal bone metabolism, the metabolic rate of old bone resorption and new bone synthesis being slowed and bone reconstruction imbalanced, which led to osteoporosis.Our results suggested that blood stasis is a very important pathological basis of primary osteoporosis in female patients.%目的 分析女性原发性骨质疏松症(primary osteoporosis,POP)肾虚血瘀证患者血细胞参数、血瘀评分和骨代谢标志物的相关性,从血瘀对骨代谢影响的角度探讨血瘀在POP发病中的作用机制.方法 符合纳入标准的POP患者共99例,按年龄段每10岁1组,分为3组(A组:55～64岁;B组:65 ～74岁;C组:75 ～ 84岁),统计所有患者年龄、身高、体重和骨密度.检测所有患者血细胞参数:平均红细胞体积(mean corpuscular volume,MCV)、红细胞体积分布宽度(red blood cell distribution width-coefficient of vaviation,RDW-CV)、平均血小板体积(mean platelet volume,MPV)、血小板体积分布宽度(platelet distribution width,PDW);骨代谢标志物:Ⅰ型前胶原氨基端延长肽(PINP)、Ⅰ型胶原羧基端肽β特殊序列(β-CTx)并对患者进行血瘀量化评分,各项指标以直线相关分析方法进行统计分析.结果 (1)MCV水平随年龄增高呈上升趋势,且A组与C组相比较,差异有统计学意义(P＜0.01);B组与C组相比较,差异有统计学意义(P＜0.05);血瘀量化评分随年龄增高呈升高趋势,A组和C组相比较,差异有统计学意义(P＜0.01);骨密度随年龄增高呈降低趋势,A组和C组相比较,差异有统计学意义(P＜0.01);B组和C组相比较,差异有统计学意义(P＜0.05).(2)血瘀量化评分与MCV、RDW-CV呈低度正相关(γ=0.233、0.257,P＜0.05);骨密度与MCV、血瘀量化评分呈低度负相关(γ=-0.248,P＜0.05;γ=-0.344,P＜0.01);β-CTx、PINP与PDW均呈低度负相关(γ=-0.199、-0.221;P ＜0.05),β-CTx与RDW-CV、MPV存在极低度负相关(γ=-0.155、-0.154),PINP与MPV呈极低度负相关(γ=-0.184).结论 女性POP患者随年龄增加,血细胞参数及血瘀量化评分呈逐渐加重倾向,骨密度呈逐渐降低倾向,血细胞参数水平与骨密度和骨代谢标志物呈负相关.其机制可能是由于患者体内血瘀以及血细胞参数的异常改变引起骨内微循环障碍从而引起骨细胞代谢功能异常,导致旧骨吸收与新骨合成速率减慢,骨重建失衡,形成骨质疏松.研究表明血瘀是女性POP发病的重要病理基础.