特立帕肽联合利塞膦酸钠治疗骨质疏松椎体压缩骨折患者的骨代谢  

Effect of teriparatide combined with risedronate sodium on bone metabolism in patients with osteoporotic vertebral compression fractures

作　　者：翟晓 杨新明[2] 刘芳宏 孙建威 Zhai Xiao;Yang Xinming;Liu Fanghong;Sun Jianwei(Department of Medical Imaging,Handan Branch,Fengfeng General Hospital,North China Healthcare Group,Handan 056000,Hebei Province,China;Department of Orthopedics,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,Hebei Province,China;Department of Spine Orthopedics,Handan Branch,Fengfeng General Hospital of North China Medical and Health Group,Handan 056000,Hebei Province,China)

机构地区：[1]华北医疗健康集团峰峰总医院邯郸院区医学影像科,河北省邯郸市056000 [2]河北北方学院附属第一医院骨科,河北省张家口市075000 [3]华北医疗健康集团峰峰总医院邯郸院区脊柱骨科,河北省邯郸市056000

出　　处：《中国组织工程研究》2022年第35期5685-5692,共8页Chinese Journal of Tissue Engineering Research

基　　金：2021年度河北省卫健委医学科学研究课题(20210570),项目负责人:杨新明;2018年张家口高层次创新团队建设项目(201804),项目负责人:杨新明。

摘　　要：背景:对于骨质疏松性椎体压缩骨折,椎体成形术后的邻近椎体再发骨折率较高,骨质疏松是导致再发骨折的一种独立危险因素,因而术后选择疗效较好的抗骨质疏松药物是临床热点问题。目的:探讨骨质疏松椎体压缩性骨折术后联合应用特立帕肽与利塞膦酸钠的效果。方法:纳入华北医疗健康集团峰峰总医院邯郸院区2018年9月至2020年10月收治的骨质疏松椎体压缩性骨折患者151例,年龄50-75岁,接受经皮椎体成形治疗后,按照随机数字表法分4组,对照组(n=28)口服钙剂,利塞膦酸钠组(n=41)每天口服钙剂、利塞膦酸钠,特立帕肽组(n=41)每天口服钙剂+皮下注射特立帕肽,联合治疗组(n=41)每天口服钙剂、利塞膦酸钠+皮下注射特立帕肽。连续治疗6个月后,评估4组患者目测类比评分、Oswestry功能障碍指数、骨密度及血清骨代谢指标,记录不良反应及再骨折发生率。结果与结论:(1)与治疗前比较,4组患者治疗后的疼痛、功能障碍及血清骨代谢水平明显改善(P<0.05),骨密度值升高(P<0.05);治疗6个月后,联合治疗组患者的目测类比、Oswestry功能障碍指数低于其他3组(P<0.05),骨密度值高于其他3组(P<0.05),血清骨钙素、总Ⅰ型前胶原氨基端延长肽水平高于其他3组(P<0.05),血清Ⅰ型胶原羧基端β降解产物水平低于其他3组(P<0.05),治疗效果最好;(2)在不同的年龄段中,联合治疗组的治疗效果明显好于其他3组;相同用药方式下,男性与女性的治疗效果无明显差异;在相同的骨折时间内,4组治疗效果无明显差异;(3)特立帕肽和利塞膦酸钠仅导致少数患者发生轻度或中度的呕吐、心悸、头痛或眩晕等症状,151例患者肝肾功能未见明显异常;(4)对照组、利塞膦酸钠组、特立帕肽组、联合治疗组再骨折发生率分别为7.14%,7.32%,7.32%,4.88%,4组间比较差异无显著性意义(P>0.05);(5)对于骨质疏松椎体压缩性骨折术后患者,联�BACKGROUND:Osteoporotic vertebral compression fracture can lead to an increase in the rate of recurrence of adja cent ve rtebrae fractures after vertebroplasty.Osteoporosis is an independent risk factor leading to recurrence of fra ctures,so it is a clinical hot issue to select anti-osteoporotic drugs with better curative effects for postoperative treatment.OBJECTIVE:To explore the effect of teriparatide combined with risedronate sodium after ve rtebro plasty in patients with osteoporotic ve rtebral compression fractures.METHODS:151 patients with osteoporotic ve rtebral compression fractures,aged 50-75 years,were enrolled from the Handan Branch,Fengfeng General Hospital of North China Healthcare G roup from September 2018 to October 2020.All the patients were randomly divided into four groups according to the random number to ble method,namely control group(n=28;oral calcium),risedronate sodium group(n=41;oral calcium+o ral risedronate sodium),teriparatide group(n=41;oral calcium+subcutaneous injection of te riparatide)and combination therapy group(n=41;oral calcium+o ral risedronate sodium+subcutaneous injection of te riparatide).After 6 months of treatment,visual analog scale score,Oswestry dysfunction index,bone mineral density,and serum bone metabolism indexes were evaluated.Adverse reactions and incidence of refra ctures were recorded.RESULTS AND CONCLUSION:Compared with baseline data,the visual analog scale score,Oswestry dysfunction index,serum bone metabolism level,and bone mineral density were significantly improved in the four groups after treatment(P<0.05).After 6 months of treatment,the combination therapy group achieved the best therapeutic effects and had lower visual analog scale score and Oswestry dysfunction index,higher bone mineral density,and lowerβ-degradation product level at the carboxyl end of type I collagen than the other three groups(all P<0.05).The combination therapy showed significantly better therapeutic effects than the other three groups at different age stages.There was no signi

关 键 词：特立帕肽 利塞膦酸钠 椎体压缩骨 椎体成形 骨质疏松 骨密度 

分 类 号：R459.9[医药卫生—治疗学] R318.01[医药卫生—临床医学]