骨代谢生化标志物在原发性骨质疏松症药物治疗中的应用  

Biochemical markers of bone metabolism for drug selection in treatment of primary osteoporosis

作　　者：李晓峰[1] 徐大霞 王闯[1] 孔猛[1] 陈允震[1] 

机构地区：[1]山东大学齐鲁医院骨科,山东济南250012

出　　处：《中国矫形外科杂志》2017年第13期1193-1197,共5页Orthopedic Journal of China

摘　　要：[目的]分析骨代谢生化标志物在骨质疏松症治疗中对药物应用的指导意义,为骨质疏松药物治疗探索一条精准有效地治疗途径。[方法]采用自身前后对照临床研究,56例患者根据Ⅰ型前胶原N-端前肽(P1NP)与β-胶原特殊序列(β-cross Laps)测量值分为低骨转换组(30例)与高骨转换组(26例)。每组随机分别给予2种治疗方案:特立帕肽(20μg/d)与唑来膦酸注射液(5 mg/年),治疗时间为26个周,期间定期观察β-cross Laps、P1NP、腰椎、股骨颈骨密度(BMD)以及VAS疼痛评分的变化情况。[结果]在高、低骨转换组中,特立帕肽治疗后P1NP与β-cross Laps均较治疗前浓度升高(P<0.05),唑来膦酸治疗后P1NP与β-cross Laps均较治疗前浓度降低(P<0.05);低骨转换组特立帕肽治疗后腰椎BMD升高较唑来膦酸显著(P<0.05),高骨转换组唑来膦酸治疗后股骨颈BMD升高较特立帕肽显著(P<0.05);低骨转换组特立帕肽治疗后骨痛缓解优于唑来膦酸(P<0.05),高转换组中两种药物均能缓解骨痛,差异无统计学意义(P>0.05)。[结论]在原发性骨质疏松症治疗中,应以骨生化标志物作为药物选择的依据:低骨转换状态下以促成骨药物为主,高骨转换状态下以抑制骨吸收药物为主。[Objective] To investigate the clinical application of biochemical marker in bone metabolism as principle evidence for drug selection in treatment of osteoporosis. [Methods] According to the levels of N-terminal propeptide of type I collagen （PINP） and β-collagen specific sequence （β-crossLaps）, the biochemical markers of bone metabolism in serum, 58 osteoporotic patients were divided into the low bone turnover group （n=30） and the high bone turnover group （n=26）, who were given two teriparatide （20μg/d） and zoledronic acid injection （5 mg/year） respectively. During the 26-week treatment period, PINP, β-crossLaps, lumbar vertebral BMD, femoral neck BMD and VAS were observed and recorded at regular intervals. [Results] In both the low and high turnover groups, PINP and β-crossLaps significantly increased after treatment with teriparatide （P〈0.05）, whereas the markers remarkably decreased after treatment with zoledronic acid （P〈 0.05） . The BMD of lumbar vertebrae increased more significantly after treatment of teriparatide than zoledronic acid the in low bone turnover group （P〈0.05） . However, the BMD of femoral neck increased more significantly after treatment of zoledronic acid than teriparatide in the high bone turnover group （P〈0.05） . In the tow bone turnover group, bone pain was relieved more significantly by teriparatide than zoledronic acid （P〈0.05） . By contrast, there was no statistically significant difference in pain relief between the two drugs in the high bone turnover group （P 〉 0.05） . [Condusion ] For treatment of primary osteoporosis, the biochemical markers of bone metabolism can take as evidences for drug selection, anti-resorptive drugs used in the low bone turnover condition, whereas bone-forming drugs in the high bone turnover setting.

关 键 词：骨代谢 骨代谢生化标志物 骨密度 骨痛 原发性骨质疏松症 

分 类 号：R580[医药卫生—内分泌]