长期华法林治疗对骨代谢指标及骨密度的影响  

Effect of long-term warfarin therapy on bone metabolic markers and bone mineral density in the patients

作　　者：余雪莲[1] 杜光红[1] 钟海花 YU Xuelian;DU Guanghong;ZHONG Haihua(Department of Geriatrics,Sichuan Provincial People1 s Hospital.Sichuan Academy of Medical Sciences,Chengdu 610041,China;Department of Endocrinology,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]四川省人民医院/四川省医学科学院老年医学科,四川成都610041 [2]西南医科大学附属医院内分泌科,四川泸州646000

出　　处：《中国骨质疏松杂志》2019年第12期1782-1786,共5页Chinese Journal of Osteoporosis

摘　　要：目的观察长期华法林治疗对患者骨代谢指标和骨密度(bone mineral density,BMD)的影响。方法对长期服用华法林的42名患者和28名对照组人群进行横断面研究。使用酶联免疫吸附测定(ELISA)试剂盒测量骨钙素(osteocalcin,OC),骨保护素(osteoprotegerin,OPG)和核因子-κB配体(RANKL)总可溶性受体激活剂的血清水平,并通过双能X射线吸收测定法评估受试者股骨颈和腰椎BMD。结果与对照组相比,华法林患者的OC浓度显著降低[(4.94±2.22)vs(10.68±4.5),P<0.001)]。OPG、sRANKL对数(log)、sRANKL/OPG对数比和BMD的水平相当。在女性华法林使用者中,发现OC和RANKL对数之间以及OC和RANKL/OPG对数比之间呈正相关(分别为P=0.017;P=0.005)、OC和OPG之间呈负相关(P=0.027)。结论长期华法林抗凝治疗可显著降低OC水平,但不影响其它骨代谢指标或BMD。此次研究结果还表明,长期使用华法林治疗可能会减轻绝经后妇女的骨吸收。Objective To observe the effect of long-term warfarin therapy on bone metabolic markers and bone mineral density(BMD)in the patients.Methods The cross-sectional study was carried out in 42 patients treated with long-term warfarin and 28 control subjects.Serum concentrations of osteocalcin(OC),osteoprotegerin(OPG),and total soluble receptor activator of nuclear factor-κB ligand(RANKL)were measured using enzyme linked immunosorbent assay(ELISA)kits.BMD of the femoral neck and lumbar spine was assessed with dual energy X-ray absorptiometry.Results A significantly decreased concentration of OC was found in warfarin users compared to control subjects[(4.94±2.22)vs(10.68±4.5),P<0.001)].Levels of OPG,sRANKL logarithm(log),sRANKL/OPG log ratio,and BMD were consistent.In female warfarin users,positive correlations between OC and RANKL log and between OC and RANKL/OPG log ratio(P=0.017;P=0.005,respectively),and a negative correlation between OC and OPG(P=0.027)were found.Conclusion Long-term warfarin anticoagulation significantly decreases OC concentration,but does not affect other bone metabolic markers or BMD.Our results also suggest the possibility that long-term treatment with warfarin may alleviate bone resorption in postmenopausal women.

关 键 词：华法林 骨密度 骨代谢 骨钙素 维生素K拮抗剂 

分 类 号：R969[医药卫生—药理学]