王永军　赵斌　刘宗仁

[摘要] 目的 探讨绝经后骨质疏松症的中医治疗方法。 方法 在山东省寿光市中医医院骨科门诊2015年3月～2016年3月就诊的绝经后骨质疏松症患者中，选出符合研究纳入标准的患者120例，分为滋肾调肝组（治疗组60例）、雷洛昔芬组（对照组60例），对治疗前后各组骨密度、骨代谢指标及安全性指标，治疗后的疗效评分进行对比。 结果 骨密度分析及疗效评价方面，治疗组及对照组在各个治疗周期内均较治疗前有明显好转，两组之间比较未显示出明显差异；安全性指标方面两组治疗前后及治疗期间内比较，差异无统计学意义，但治疗组在降低D-二聚体（P<0.05）、改善骨代谢指标（P<0.05）方面比对照组更有优势。 结论 滋肾调肝法治疗绝经后骨质疏松症疗效与雷洛昔芬无显著性差异，可使深静脉血栓风险减少，是治疗绝经后骨质疏松症的合理选择。

[关键词] 滋肾调肝法；绝经后骨质疏松症；雷洛昔芬；骨密度

[中图分类号] R259 [文献标识码] B [文章编号] 1673-9701（2017）19-0115-04

[Abstract] Objective To explore the Chinese medicine treatment for postmenopausal osteoporosis. Methods A total of 120 cases who met the research standards among the postmenopausal osteoporosis patients in orthopedic clinic of our hospital from March 2015 to March 2016 were selected. The patients were divided into nourishing kidney and accommodating liver group （treatment group） with 60 cases and raloxifene group （control group） with 60 cases .The bone density， bone metabolic index， safety index and treatment score between the two groups were compared before and after treatment. Results The treatment group and the control group were significantly improved in the bone density analysis and efficacy evaluation in every treatment cycle compared with those before treatment，with no significant difference between the two groups. There was no statistically significant difference between the two groups in terms of safety parameters before and after treatment and during treatment. But the treatment group had more advantages in reducing D-dimer （P<0.05） and improving bone metabolism indicators （P<0.05） than the control group. Conclusion The nourishing kidney and accommodating liver treatment has no significant difference with raloxifene in the treatment effect on postmenopausal osteoporosis， and its risk of deep venous is reduced， making it a reasonable choice for the treatment of postmenopausal osteoporosis.

[Key words] Nourishing kidney and accommodating liver； Postmenopausal osteoporosis； Raloxifene； Bone density

絕经后骨质疏松症属于高代谢型骨质疏松症[1]，高骨吸收率与高骨形成率并存，而骨吸收速率明显高于骨形成速率，导致全身骨量的急剧丢失，骨的脆性增加，骨折风险增加。绝经后骨质疏松症的发生与雌激素水平的下降呈负相关，双磷酸盐[2-5]作为一线抗骨质疏松药物主要通过抑制破骨细胞活性，抑制骨吸收来减少骨量丢失，长期及大剂量应用双磷酸盐药物抑制骨形成，下颌骨坏死的发生与双磷酸盐药物抑制成骨细胞活性相关[6-9]。雌激素类药物直接针对绝经后骨质疏松症的病因，临床疗效显著，但长期使用激素替代疗法会增加患乳腺癌、冠心病等疾病的概率。选择性雌激素受体调节剂的双向调节作用使其成为治疗绝经后骨质疏松症的理想药物，但临床应用后存在下肢深静脉血栓的风险，欧洲版的骨质疏松诊疗指南不再推荐雷洛昔芬作为绝经后骨质疏松的首选药物。……