特立帕肽治疗不同基线血清25-羟基维生素D水平绝经后重度骨质疏松患者的效果  

The effect comparison of teriparatide in the treatment of postmenopausal patients with severe osteoporosis with different baselin eserum levels of 25-hydroxyvitamin D

作　　者：郝文卿 王春芝[2] 李华建[3] 吕雪 韩玉鑫 吕若琳 杨乃龙[1] Hao Wenqing;Wang Chunzhi;Li Huajian;Lyu Xue;Han Yuxin;Lyu Ruolin;Yang Nailong(Department of Endocrinology,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;不详)

机构地区：[1]青岛大学附属医院内分泌科,青岛266000 [2]海阳市人民医院老年医学科 [3]海阳市人民医院神经外科

出　　处：《中国临床保健杂志》2022年第5期647-651,共5页Chinese Journal of Clinical Healthcare

基　　金：山东省青岛开发区骨质疏松症及骨折的流行病学调查项目(1600)。

摘　　要：目的探讨特立帕肽治疗不同基线血清25-羟基维生素D[25(OH)D]水平绝经后骨质疏松(PMOP)患者的效果对比。方法选取2017年1月至2020年5月于青岛大学附属医院就诊的103例使用特立帕肽治疗的绝经后重度骨质疏松症患者,以患者用药前检测的血清25(OH)D水平作为基线,将患者分为10μg/L<25(OH)D<30μg/L组(60例)和30μg/L≤25(OH)D<150μg/L(43例)。检测患者治疗前、治疗6个月、治疗12个月的腰椎、股骨颈、全髋部骨密度(BMD);检测患者治疗前,治疗3、6、12个月后的骨转换标志物:Ⅰ型前胶原氨基端前肽(PINP)、Ⅰ型胶原蛋白C末端交联肽(CTX),同时监测患者血钙、血磷、25(OH)D、甲状旁腺激素(PTH)的变化,通过视觉模拟评分法(VAS评分)评估患者治疗前后疼痛水平。结果(1)2组患者腰椎BMD在用药6、12个月时均有显著提升(P<0.05),股骨颈和全髋BMD在用药6个月后与治疗前差异无统计学意义(P>0.05),用药12个月后与用药前相比有明显的提升(P<0.05)。但2组之间BMD变化差异无统计学意义(P>0.05)。(2)2组患者PINP、CTX水平的变化在3、6、12个月较基线值均有显著升高(P<0.05),治疗12个月,维生素D充足组的PINP上升水平较维生素D不足组有显著升高(P<0.05),而CTX上升水平显著降低(P<0.05)。(3)2组患者骨痛均有减轻(P<0.05),依据VAS评分,2组患者疼痛减轻程度差异无统计学意义(P>0.05)。结论无论25(OH)D的基线状态如何,使用特立帕肽治疗的绝经后重度骨质疏松均有效,1年后患者的BMD水平相近。Objective To investigate the effect of teriparatide in the treatment of postmenopausal osteoporosis patients with different baseline serum 25-hydroxyvitamin D[25(OH)D] levels.Methods A total of 103 postmenopausal patients with severe osteoporosis treated with teriparatide who were treated at Qingdao University Affiliated Hospital from January 2017 to May 2020 were selected, and the serum 25(OH)D level detected before treatment was used as the baseline.The patients were divided into a 10 μg/L<25(OH)D<30 μg/L group(60 cases) and a 30 μg/L≤25(OH)D<150 μg/L group(43 cases).The BMD values of the lumbar spine, femoral neck, and total hip were detected before treatment and after 6 and 12 months of the treatment.The bone turnover markers of patients were detected before treatment and after 3,6 and 12 months of the treatment, including type I procollagen amino-terminal propeptide(PINP),type I collagen C-terminal cross-linked peptide(CTX).Meanwhile, the changes of patient′s blood calcium, blood phosphorus, 25(OH)D,parathyroid hormone(PTH) were monitored, and the pain levels before and after treatment were assessed by visual analog scale(VAS score).Results(1) The lumbar vertebrae BMD of the two groups was significantly increased at 6 months and 12 months after treatment(P<0.05).There was no significant difference in the BMD of the femoral neck and total hip after treatment for 6 months and before treatment(P>0.05),and after 12 months of treatment, compared with before treatment, there was a significant increase(P<0.05).However, there was no significant difference in bone mineral density between the two groups(P>0.05).(2) The changes in the levels of PINP and CTX in the two groups were significantly increased at 3,6 and 12 months compared with the baseline values(P<0.05).After 12 months of treatment, the level of PINP in the adequate group was significantly higher than that in the vitamin D-deficient group(P<0.05),while the level of CTX was significantly decreased(P<0.05).(3) Bone pain was relieved in both groups(P<0

关 键 词：骨质疏松 绝经后 骨密度 骨化醇类 特立帕肽 

分 类 号：R580[医药卫生—内分泌]