唑来膦酸钠联合碳酸钙D3片治疗骨质疏松症的疗效及其骨生化指标的变化  

Efficacy of Zoledronate Sodium Combined with Calcium Carbonate D3 in the Treatment of Osteoporosis and the Changes of Bone Metabolic Indexes and BTMs Level

作　　者：林家民 李娟[2] 张帆[1] Lin Jiamin;Li Juan;Zhang Fan(Department of Orthopaedics,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Hematology,Union Hospital,Tongji Medical College,Huazhong University of Scinece and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属同济医院骨科,武汉430030 [2]华中科技大学同济医学院附属协和医院血液内科,武汉430022

出　　处：《华中科技大学学报（医学版）》2021年第6期756-760,共5页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家自然科学基金资助项目(No.81202093)。

摘　　要：目的研究唑来膦酸钠联合碳酸钙D3治疗骨质疏松症(osteoporosis,OP)的疗效及其对骨代谢标志物(bone metabolic markers,BMMs)和骨转换标志物(bone turnover markers,BTMs)水平的影响。方法选取2017年6月至2019年1月华中科技大学同济医学院附属同济医院收治的160例OP患者,随机分为观察和对照组,每组80例,观察组给予碳酸钙D3片联合唑来膦酸钠治疗,对照组给予碳酸钙D3片治疗。比较两组患者的股骨颈、腰椎(L2~L4)骨密度,并分析血清BMMs(TRACP-5b、OC、BAP)和BTMs(CTX、PⅠNP、NTX)变化。评估疼痛视觉模拟量表(VAS)评分以及统计分析两组不良反应发生情况。结果两组患者经治疗后VAS评分显著降低,其中观察组在治疗后第3和第6个月的VAS评分均显著低于对照组(均P<0.01)。两组患者治疗后右股骨颈、腰椎正位(L2~L4)骨密度均显著增加,其中观察组患者在治疗后第6个月的骨密度显著高于对照组(均P<0.05)。两组患者治疗后BMMs指标(TRACP-5b、OC)和BTMs(CTX、PⅠNP、NTX)水平显著降低,而BAP显著增加,其中观察组患者在治疗后6个月的各血清指标水平均显著优于对照组(均P<0.05)。主要不良反应为肌肉酸痛、发热、头痛头晕、恶心呕吐,其中观察组发热和肌肉酸痛发生率显著高于对照组(均P<0.05),而骨折发生率显著低于对照组(P<0.05)。结论唑来膦酸钠联合碳酸钙D3治疗OP疗效显著,改善血清BMMs和BTMs水平,促进骨形成和提高骨密度,可有效降低OP患者疼痛和骨折风险。Objective To study the efficacy of zoledronate sodium combined with calcium carbonate D3 in the treatment of osteoporosis(OP)and its effect on bone metabolic markers(BMMs)and bone turnover markers(BTMs)levels.Methods One hundred and sixty female patients with OP were treated in our hospital from June 2017 to January 2019 and were divided into observation group and control group according to random digital table,80 cases per group.The control group was given calcium carbonate D3 tablets,while the observation group was given sodium zoledronate combined with calcium carbonate D3 tablets.The bone mineral densities of thigh neck and lumbar vertebrae(L2-L4)were compared between the two groups,and the serum BMMs and BTMs levels were measured.Pain was evaluated with the visual analogue scales(VAS),and the occurrence of adverse reactions in the two groups was statistically analyzed.Results The VAS scores of the two groups were significantly reduced after treatment,in which the VAS scores of the observation group were significantly lower than those of the control group at 3 and 6 months after treatment(P<0.05)).After treatment,mineral density of the right thigh neck and lumbar vertebrae(L2-L4)increased significantly in both groups,and the bone mineral density of the patients in the observation group was significantly higher than that in the control group after 6 months of treatment(P<0.05).After treatment,the levels of serum BMMs(TRACP-5 b,OC、BAP)and BTMs(CTX,PⅠNP,NTX)in the two groups were significantly decreased,while BAP was significantly increased.The serum levels of the markers in the patients in the observation group were significantly better than those in the control group at 6 months after treatment(P<0.05).The main adverse reactions were muscle soreness,fever,headache and dizziness,nausea and vomiting.The incidence of fever and muscle soreness in the observation group was significantly higher than that in the control group(P<0.05),while the incidence of fracture was significantly lower than that in the control

关 键 词：碳酸钙D3 唑来膦酸钠 骨质疏松症 骨代谢指标 骨转换标志物 

分 类 号：R681.4[医药卫生—骨科学]