特立帕肽联合双膦酸盐对老年性椎体压缩骨折术后骨质疏松患者PINP和CTX-1的影响  

Effects of telipatide combined with bisphosphonate on PINP and CTX-1 in elderly patients with osteoporosis after vertebral compression fracture

作　　者：刘玉章[1] 潘东续 赵晓英 李耀华[1] 段永刚[1] 唐晓龙[1] Liu Yuzhang;Pan Dongxu;Zhao Xiaoying;Li Yaohua;Duan Yonggang;Tang Xiaolong(Department of Orthopedic,Second Affiliated Hospital of Hebei North University,Zhangjiakou 075100,China)

机构地区：[1]河北北方学院附属第二医院骨外科,张家口075100

出　　处：《中华老年骨科与康复电子杂志》2020年第5期271-278,共8页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：张家口市重点研发计划项目(1921020D)。

摘　　要：目的探究特立帕肽联合双膦酸盐对老年性椎体压缩骨折术后骨质疏松患者Ⅰ型前胶原N末端前肽(PINP)、Ⅰ型胶原C末端肽(CTX-1)的影响。方法前瞻性收集2017年9月至2018年3月在河北北方学院附属第二医院骨科就诊的老年性椎体压缩骨折术后骨质疏松患者,共44例,依据随机数字表将患者分为A组(24例),B组(20例),另取因无法耐受术后药物治疗等而未进行治疗的患者为C组(20例),给予A组:特立帕肽+双膦酸盐(唑来膦酸)+钙剂(钙尔奇D咀嚼片)治疗,给予B组维生素D+钙尔奇D咀嚼片治疗,治疗后随访12个月。记录3组随访情况及手术情况,观察并比较3组不同时间点视觉模拟疼痛评分(VAS)、Oswestry功能障碍指数(ODI)、骨密度(BMD)、(腰椎L1-4)、PINP、CTX-1、不良反应和再次骨折发生率。结果 64例患者均获得完整随访,随访率100%,随访时间12~22个月,平均(13.82±1.24)个月。64例患者平均手术时间(17.63±2.04)min,骨水泥灌注量3~7 mL,平均(3.32±0.46)mL,术后发生骨水泥渗漏12例(18.75%),其中A组5例,B组4例,C组3例。A组在治疗后3个月、6个月、9个月、12个月的VAS评分[(3.06±1.12、1.82±0.74、1.52±0.54、1.41±0.49)分]和ODI指数(28.42±5.16、21.64±4.92、18.76±4.52、17.59±4.38)均小于B组[VAS:(3.81±1.28、3.19±1.13、2.76±0.97、2.53±0.85)分;ODI:34.58±6.13、31.27±5.86、28.48±5.34、27.94±5.17)和C组[VAS:(4.51±1.42、4.16±1.49、3.98±1.31、3.59±1.24)分;ODI:37.71±6.54、35.48±6.07、33.97±5.87、33.61±5.80)(均P<0.05),B组在治疗后3个月时,与C组比较,差异无统计学意义(P>0.05),在治疗后6个月、9个月、12个月时,均小于C组(P<0.05)。A组在治疗后3个月时,BMD、PINP和CTX-1水平[(0.835±0.103)g/cm2,(134.08±27.29)ng/mL,(216.85±26.63)μg/L]高于B组[(0.774±0.076)g/cm2,(93.57±19.85)ng/mL,(216.85±26.63)μg/L]和C组的[(0.706±0.051)g/cm2,(49.74±10.59)ng/mL,(161.05±15.42)μg/L],且B组各指标水平均高于C组(均P<0.05)。随访Objective To investigate the effect of tripartide combined with bisphosphonate on type Ⅰ procollagen N-terminal propeptide(PINP) and type Ⅰ collagen C-terminal peptide(CTX-1) in patients with osteoporosis after senile vertebral compression fracture. Methods A total of 44 senile osteoporotic patients with vertebral compression fracture treated in our hospital between September 2017 and March 2018 were selected. According to the order of admission, they can be divided into group A(24 cases) and group B(20 cases). In addition, the group C(20 cases) was selected as the patients who did not receive treatment due to intolerance of postoperative drug therapy. Group A was treated with tripeptide+bisphosphonate(zoledronic acid)+calcium(calqid chewable tablets), and group B was treated with vitamin D+calqid chewable tablets and followed up for 12 months. The follow-up and operation of the three groups were recorded. The visual analogue pain score(VAS), Oswestry dysfunction index(ODI), bone mineral density(BMD),(lumbar L1-4), serumPINP, CTX-1, adverse reactions and the incidence of re-fracture were observed and compared among thethree groups at different time points. Results All 64 patients were followed up completely with a follow-up rate of 100% and a follow-up time of 12-19 months, with an average of(13.82 ± 1.24) months, of which group A was followed up for 12-18 months, with an average of(13.57±1.17) months. Group B was followed up for 13 to 22 months, with an average of(14.23 ± 1.29) months. Group C was followed up for 12 to 20 months, with an average of(13.71±1.20) months. The average operation time of 64 patients was(17.63±2.04)min, the bone cement perfusion volume was 3-7 mL, and the average was(3.32±0.46) mL. Twelve patients(18.75%) had bone cement leakage after operation, including 5 cases in group A, 4 cases in group B, and 3 cases in group C.At 3 months, 6 months, 9 months and 12 months after treatment, the scores of VAS in group A were(3.06 ± 1.12),(1.82 ± 0.74),(1.52 ± 0.54),(1.41 ± 0.49) respec

关 键 词：特立帕肽 双膦酸盐 骨质疏松 椎体压缩骨折 骨密度 

分 类 号：R687.3[医药卫生—骨科学]