甲状旁腺激素和降钙素治疗绝经后骨质疏松的短期疗效比较  

The comparison of the clinical outcomes between parathyroid hormone and calcitonin in short-term treatment of postmenopausal osteoporosis

作　　者：谭金枚[1] 包丽华[2] 马玉伟[2] 叶正芹[3] 张晓乐[4] 张克勤[1] 

机构地区：[1]南京医科大学第一附属医院内分泌科,江苏南京210029 [2]南京医科大学第一附属医院核医学科,江苏南京210029 [3]南京市中医院内分泌科,江苏南京210000 [4]无锡市第四人民医院内分泌科,江苏无锡214062

出　　处：《南京医科大学学报（自然科学版）》2010年第5期709-712,共4页Journal of Nanjing Medical University(Natural Sciences)

摘　　要：目的:比较甲状旁腺激素(PTH)和降钙素(CT)对绝经后妇女骨质疏松的短期疗效。方法:绝经后骨质疏松妇女26例,随机分为两组,所有患者在每天口服补充元素钙500mg和维生素D200U的同时,分别接受重组人PTH1-34(特立帕肽)或人工合成的鲑鱼降钙素(密盖息)治疗24周,具体用法为PTH1-34每天皮下注射20μg,鲑鱼降钙素每天鼻喷200U。用双能X线吸收仪(DEXA)测定腰椎(L2-4)、股骨颈、大转子和全髋骨密度(BMD),用化学发光法和连续速率法分别测定血清骨钙素(OC)和碱性磷酸酶(AKP)水平。结果:治疗24周后,PTH组和CT组腰椎BMD分别比治疗前上升5.11%(P<0.01)和2.13%(P>0.05),两组的股骨颈、大转子和全髋BMD在治疗前后无明显变化,终点时两组相应位点BMD差异也无统计学意义。PTH组OC和AKP水平分别较治疗前上升173.04%和47.48%(P<0.001),而CT组两者治疗前后改变均无统计学差异,相应时点PTH组OC和AKP水平均大于CT组(P<0.01)。结论:PTH能有效增加绝经后骨质疏松患者的腰椎BMD,虽然PTH组血成骨标志物水平上升多于CT组,但短期内两者疗效相似。Objective：To evaluate the short-term therapeutic efficacy of parathyroid hormone and calcitonin in postmenopausal osteoporotic women.Methods：A total of 26 postmenopausal women with osteoporosis were randomly classified into two groups to receive open-label use of 20 μg biosynthetic human parathyroid hormone（PTH） subcutaneously or 200 U salmon calcitonin（CT） in a nasal spray per day,and all patients were supplemented daily with 500 mg elemental calcium and 200 U vitamin D throμghout the 24 weeks.The bone mineral densities（BMD） of all patients were measured before and after 24-week treatment.At the same time the biochemical marker of bone formation serum osteocalcin（OC） and alkaline phosphatase（AKP） were determined.Results：The BMD increase at the lumber spine（L2-4） in the PTH and the CT group were 5.11%（P〈 0.01）and 2.13%（P 〉0.05）respectively at 24 weeks,but the BMD changes at the femoral neck,trochanter and the total hip in each group were not significant,and no significant difference of final BMD was observed at any matching site between the two groups.There were obvious increases in serum osteocalcin（OC） and alkaline phosphatase（AKP） level in the PTH group（173.04%,47.48% respectively,all P 〈0.001）,but the levels of both markers were not changed in the CT group.Conclusion：PTH application was associated with larger increases in lumbar spine BMD,although PTH can increase bone formation markers while CT can not,PTH seems to be equally effective with CT in the short-term treatment.

关 键 词：骨质疏松 甲状旁腺激素 降钙素 骨密度 骨钙素 碱性磷酸酶 

分 类 号：R681.1[医药卫生—骨科学]