唑来膦酸联合骨化三醇治疗原发性骨质疏松症的疗效及对骨代谢、胰岛素样生长因子1和瘦素的影响  

Effect of zoledronic acid combined with calcitriol on primary osteoporosis in patients and bone metabolism,insulin-like growth factor 1 and leptin

作　　者：余筱燕[1] 叶一[2] 汤珂珂 吕迪[1] 毛玉山[1] YU Xiaoyan;YE Yi;TANG Keke;LYU Di;MAO Yushan(Department of Endocrinology,Affiliated Hospital of School of Medicine,Ningbo University,Ningbo 315020,China;Department of Spinal Surgery,Affiliated Hospital of School of Medicine,Ningbo University,Ningbo 315020,China)

机构地区：[1]宁波大学医学院附属医院内分泌科,宁波315020 [2]宁波大学医学院附属医院脊柱外科,宁波315020

出　　处：《中国临床药学杂志》2020年第3期161-164,共4页Chinese Journal of Clinical Pharmacy

基　　金：宁波市自然科学基金(编号2019A610271)。

摘　　要：目的探讨唑来膦酸联合骨化三醇对原发性骨质疏松症患者骨代谢、胰岛素样生长因子1(IGF-1)和瘦素的影响及临床疗效。方法选择2016年4月至2018年4月收治的原发性骨质疏松症患者108例,采用随机数字表法随机分为观察组与对照组,各54例。对照组给予骨化三醇胶丸0.25μg,qd,同时服用碳酸钙D3片1片,qd。观察组在对照组治疗基础上予唑来膦酸注射液5 mg,iv gtt,滴注时间>15 min,每年注射1次。2组患者疗程均为1年。比较2组治疗前后骨密度(BMD)、骨代谢、IGF-1和瘦素水平变化及疗效。结果2组治疗后腰椎L2~4和股骨颈BMD较治疗前增加(P<0.05),且观察组高于对照组(P<0.05)。观察组治疗后血清Ⅰ型原胶原N端前肽(PINP)、骨特异性碱性磷酸酶(B-ALP)和Ⅰ型胶原蛋白C末端交联肽(CTX)水平较治疗前降低(P<0.05),且观察组低于对照组(P<0.05)。2组治疗后血清IGF-1水平较治疗前升高,且观察组高于对照组。而瘦素水平较治疗前降低,且观察组低于对照组(P<0.05)。观察组总有效率高于对照组(92.59%vs 72.22%,P<0.05)。结论唑来膦酸联合骨化三醇对原发性骨质疏松症患者有良好疗效,可增加患者骨密度,改善患者骨代谢,提高IGF-1水平及降低瘦素水平。AIM To investigate the effect of zoledronic acid combined with calcitriol on bone metabolism,insulin-like growth factor 1(IGF-1)and leptin in patients with osteoporosis and its clinical efficacy.METHODS A total of 108 patients with osteoporosis admitted to our hospital from April 2016 to April 2018 were randomly divided into observation group and control group,with 54 patients in each group.The control group was given 0.25μg of calcitriol capsule,qd,and 1 tablet of calcium carbonate D3,qd.The observation group was given zoledronic acid injection 5 mg,iv gtt on the basis of the control group.The time of infusion was more than 15 min,once a year.The course of treatment was one year in both groups.The changes of bone mineral density(BMD),bone metabolism,levels of IGF-1 and leptin before and after treatment were compared between the 2 groups.RESULTS The BMD of L2-4 and femoral neck in the 2 groups increased after treatment(P<0.05),and that in the observation group was higher than that in the control group(P<0.05).The serum levels of N-terminal propeptide of typeⅠprocollagen,bone-specific alkaline phosphatase and C-terminal cross linked peptide in the observation group decreased after tratment,and the observation group were lower than those in the control group(P<0.05).The serum IGF-1 level of the 2 groups after treatment was higher than that before treatment,and the observation group was higher than the control group.The leptin level of the 2 groups after treatment was lower than that before treatment,and the observation group was lower than the control group(P<0.05).The total effective rate of the observation group was higher than that of the control group(92.59%vs 72.22%,P<0.05).CONCLUSION Zoledronic acid combined with calcitriol has a good effect on osteoporosis patients.It can increase bone mineral density,improve bone metabolism,increase the level of IGF-1 and decrease the level of leptin.

关 键 词：唑来膦酸 骨化三醇 骨质疏松症 骨代谢 胰岛素样生长因子1 瘦素 疗效 

分 类 号：R580[医药卫生—内分泌]