3种治疗方案对骨质疏松症患者骨密度的影响  

Comparison of the efficacy of three medications on osteoporosis:results of a one-year prospective study

作　　者：马俊岭[1] 史历[1] 阳晓东[1] 侯钦午[1] 郭海英[1] 黄淑贤[1] 张燕[1] 贺明华[1] 

机构地区：[1]上海市浦东新区北蔡社区卫生服务中心,上海201204

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2011年第2期96-100,共5页Chinese Journal Of Osteoporosis And Bone Mineral Research

基　　金：上海市浦东新区卫生系统医学领先人才培养项目(PWRd2008-3);上海市浦新区科技发展基金创新资金项目(PKJ2008-Y24)

摘　　要：目的观察以3种用药方案治疗老年骨质疏松症(osteoporosis,OP)1年对骨密度(BMD)的影响。方法选取2008年10月至2009年6月经骨质疏松筛查T值<一2.0的92例受试者,随机分为(1)中成药组(A组):补骨脂颗粒(20 g,Bid口服)单药连续使用3个月后,改用仙灵骨葆(3#,2次/d口服)单药连续使用9个月;(2)西药组(B组):依降钙素(10 U,2次/周肌注)单药连续使用3个月后,联合应用福善美(70 mg,1次/周,口服)和阿法迪三(0.5μg,1次/d),口服)持续使用9个月;(3)中西药联合治疗组(C组):中成药组+西药组联合治疗。测定治疗前后腰椎、股骨颈与全髋的骨密度值(bone mineraldensity,BMD)。结果中药组:治疗后L_1、L_3、L_4、L_(2-4)、股骨颈、髋全部的BMD下降,股骨颈BMD治疗前后差异有统计学意义(P<0.05),其余差异均无统计学意义(P>0.05);L2、粗隆的BMD治疗后上升,但治疗前后差异无统计学意义(P>0.05)。西药组:治疗后L_1、L_2、L_3、L_4、L_(2-4)、股骨颈、粗隆、髋全部的BMD均上升,其中L_1、L_2、L_(2-4)、粗隆的BMD治疗前后差异有统计学意义(P<0.05),其余差异无统计学意义(P>0.05)。中西药联合治疗组:治疗后除L_1外,L_2、L_3、L_4、L_(2-4)、股骨颈、粗隆、髋全部的BMD均上升,其中L_3、粗隆治疗前后差异有统计学意义(P<0.05),其余差异治疗前后均无统计学意义(P>0.05)。3组治疗后BMD变化值(治疗后一治疗前)比较:L_(2-4)、股骨颈BMD的变化值差异有统计学意义(P<0.05);两两比较结果显示,中药治疗组和西药治疗组差异均有统计学意义(P<0.05);中西药联合治疗组和西药治疗组差异无统计学意义(P>0.05);中西药联合治疗组和中药治疗组股骨颈BMD变化值差异有统计学意义(P<0.05)。结论西药组治疗老年T值<-2.0者疗效较好,可明显提高骨密度。中西药联合应用时中药可能干扰西药的疗效。Objective To compare the effects of three medications on senile osteoporosis after a one-year follow up. Methods A total of 92 patients with osteoporosis selected from October 2008 to June 2009 were assigned randomly into three protocols： A group （traditional Chinese medicine） ： patients received Bugu capsule （20 g Bid p. o. ） for the first 3 months, then changed to receive Xianling Gubao （3# Bid p. o. ） for 9 monthso B group （ Western medicine） ： patients received Elcatonin （10 U Biw i. m. ） for the first 3 months, then changed to receive both Fosamax （70 mg QW p. o. ） and alfacalcidol （0. 5 μg qd p. o. ） for 9 months; C group （integrated Chinese and Western medicine） ： patients received both A and B protocols. The outcome was the change in bone mineral density （BMD） of the lumbar spine, fem- oral neck, and total hip in 12 months. Results A group： Decrease in L1 , L3 , L4 , L24, femoral neck, and total hip BMD were observed before treatment. Increase in femoral neck BMD showed significant difference after treatment （P 〈 O. 05） while other positions showed no significant difference （ P 〉 O. 05）. Increase in L2 and troehanter BMD were observed, but without significant difference （ P 〉 O. 05 ） o B group ： Increase in L1 , L2 , L3 , L4 , L2-4, femoral neck, trochanter and total hip BMD were observed, among which L1 , L2 , L2-4, and trochanter showed significant difference （ P 〈 0.05） . C group： Increase in L2, L3, L4, L2-4, femoral neck, troehanter, total hip BMD were observed except L1. Significant difference was only observed in L3 and troehater BMD （ P 〈 O. 05 ）. Significant increase in L2.4 , femoral neck BMD were observed in all patients （ P 〈 0. 05 ） , regardless which protocols they received. Significant difference was observed in A group and B group （ P 〈 0. 05 ）. Without significant difference was observed in B group and C group （ P 〉 0. 05 ）. Significant difference of BMD （femoral neck） were observed in A

关 键 词：骨密度 骨质疏松症 治疗 

分 类 号：R681[医药卫生—骨科学]