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  • 學位論文

中藥龜鹿二仙膠對停經後婦女骨質密度的影響

The Effect of Guilu Erxian Decoction on Bone Mineral Density in Postmenopausal Women evaluated using Dual Energy X-ray Absorptiometry and Quantitative Ultrasound

指導教授 : 王士豪 何豐名

摘要


隨著我國正式邁入高齡化社會之後,骨質疏鬆所造成的骨折對國人的健康影響也日愈嚴重。故本研究將以停經後婦女64名為對象,予以隨機分配為中藥龜鹿二仙膠治療組及空白對照組,並在用藥前、停藥時(第12週)及停藥後14週(第26週),分別以雙能量X光骨質密度儀(dual energy x-ray absorptiometry, DXA)測量腰椎(lumbar spine)及股骨頸(femoral neck)的骨質密度(bone mineral density, BMD)及定量超音波骨質密度儀(quantitative ultrasound, QUS) 測量足跟骨(calcaneus) 的寬頻超音波衰減值(broadband ultrasound attenuation, BUA)。再據以探討龜鹿二仙膠對停經後婦女骨質密度的影響,另亦比較DXA 與QUS之間的相關性研究。 本研究結果顯示治療組(n=32)在服用龜鹿二仙膠第12週後,其DXA腰椎L1-L4之BMD(g/cm2)增加率為1.15%、DXA股骨頸之BMD增加率為1.11%、QUS足根骨之BUA(dB/MHz)增加率為3.26%,其增加量均達顯著水平 (p<0.01)。另外於第26週除了DXA腰椎L1-L4之BMD增加率未達顯著水平外(0.35%, p>0.05),DXA股骨頸及QUS足根骨,其增加量(1.80%, 3.76%)亦達到顯著水平(p<0.01)。在對照組方面,除了第26週之DXA腰椎L1-L4之BMD改變率減少達到顯著水平 (-0.98%, p<0.05)外,其餘均未達顯著水平(p>0.05)。所有骨質密度測量部位,治療組之骨質密度增加幅度均大於對照組(p<0.01)。結果顯示中藥龜鹿二仙膠確實可增加停經後婦女之骨質密度,且其藥效作用可持續增加股骨頸及足根骨之骨質密度至停藥後14週。 另外,DXA和QUS的相關性研究結果顯示,QUS(Quidel QUS2)根骨之T-score和DXA(Hologic QDR 4500C)腰椎L1-L4、股骨頸之T-score間的線性迴歸係數為中度相關(r=0.615及0.583,p<0.0001),此和其他文獻之結果相似(23-26)。但若要將QUS足根骨的診斷骨質疏鬆症靈敏度(sensitivity)達到95%(true positive fraction=95%)時,則其T-score cutoff level 值等於 -1.7,因此QUS(Quidel QUS Ⅱ)對於骨質疏鬆症的定義建議應考慮調整為:「當QUS測量之T-score < -1.7時,即為可能為骨質疏鬆症之高危險群」。綜合以上結果顯示,我們可以廣泛使用QUS測量足根骨的BUA值,來做為停經後婦女的骨質疏鬆症的篩檢,但是當QUS之T-score < -1.7時,必須經過DXA中軸骨(axial bone)骨質密度檢測之再確認,以避免造成漏診或誤診。

並列摘要


PURPOSE: To evaluate effects on the Bone Mineral Density (BMD) of oral Herbal drug Guilu Erxian Decoction in postmenopausal women. MATERIALS AND METHOLDS: In 64 postmenopausal women (aged 54.8b 6.6), double blind randomly assigned to treat with Guilu Erxian Decoction or placebo, individually, administered 3.1 g thrice daily for 12 weeks. The bone mineral density measurements (BMD) of the Dual Energy X-ray Absorptiometry (DXA) lumbar spine (L1-L4) and femoral neck were obtained, and quantitative ultrasound (QUS) was performed to determine the BUA and T-score of the calcaneus at 0, 12 and 26 weeks. RESULTS: Thirty-two participants showed progressive increase of BMD after treatment with Guilu Erxian Decoction. After 12 weeks treatment, mean BMD had increased significantly (p<0.01) at the lumbar spine (1.15%), femoral neck (1.11%), and mean BUA had increased significantly (p<0.01) at calcaneus (3.26%) in the treated group. The effect of Guilu Erxian Decoction could maintain till 26 weeks at the femoral neck and calcaneus. Increases in BMD were significantly (p<0.01) greater than in the placebo group at all sites. Furthermore, Linear regression analysis have a fair correlations between DXA lumbar spine, femoral neck and QUS (r=0.615 and 0.583, p<0.0001), and are similar in magnitude to those reported in other studies (23-26). CONCLUSION: This clinical trial study show that oral Guilu Erxian Decoction 3.1g thrice daily for 12 weeks has the effects in increasing BMD at the lumbar spine, femoral neck and calcaneus of postmenopausal women by DXA and QUS. This effect could maintain till 26 weeks. Furthermore, QUS can be used to screen the osteoporosis of postmenopausal women, but DXA is the gold standard at present. Low QUS values (T-score cutoff value < 1.7) should be followed by DXA measurement to confirm presence of osteoporosis.

參考文獻


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