老年髋部骨折患者唑来膦酸治疗中的骨代谢监测价值  

Value of Bone Metabolism Monitoring in Elderly Patients with Hip Fracture in the Treatment of Zoledronic Acid.

作　　者：原源[1] 邓晓慧[1] 岳睿[1] 葛晓竹 田巍[1] YUAN Yuan;DENG Xiaohui;YUE Rui(Department of Geriatrics,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院老年医学科,100035

出　　处：《医学研究杂志》2023年第3期142-147,共6页Journal of Medical Research

摘　　要：目的观察老年髋部骨折患者术后1周内给予唑来膦酸(zoledronic acid,ZOL)治疗对骨代谢标志物的影响。方法收集2015年5~12月北京积水潭医院收治的99例老年髋部骨折患者的临床资料,分为ZOL组(n=55)和对照组(n=44)。于用药前、用药后2周~1个月、用药后1~3个月、用药后3~6个月、用药后6~9个月、用药后≥9个月6个时间点检测患者血清总Ⅰ型胶原氨基末端前肽(total procollagen typeⅠamino terminal peptide,tPINP)、碱性磷酸酶(alkaline phosphatase,ALP)、Ⅰ型胶原羧基端肽β特殊序列(β-isomerized C-terminal telopeptides,β-CTX)、血清骨钙素(osteocalcin,OC)、25-羟基维生素D 3、甲状旁腺激素及血钙、血磷水平,比较两组骨代谢标志物特点及变化差异。结果ZOL组在用药后2周~1个月β-CTX及OC均值出现下降,且用药2周后的5个检测点两指标均数皆显著低于对照组(P均<0.05);ZOL组tPINP及ALP均数在用药后2周~1个月出现波峰消失(P<0.05),且用药后2周~6个月的3个检测点两指标均数皆显著低于对照组(P<0.05),25-羟基维生素D 3、甲状旁腺激素及血钙、血磷组间比较,差异无统计学意义。结论老年髋部骨折患者术后早期输注ZOL,可出现骨吸收及骨转换水平迅速、显著而且持久的抑制;术后骨形成高峰呈“消减”表现,但对骨形成的抑制作用于6个月后不再显著。上述骨代谢标志物变化特点未见显著的性别差异。ZOL对骨代谢的持续作用有待更长时间的随访观察。Objective To observe the effects of zoledronic acid(ZOL)treatment on bone metabolic markers in elderly patients with hip fracture,which was given within 1 week after operation.Methods The clinical data of 99 elderly patients with hip fracture who underwent hip fracture surgery in Beijing Jishuitan Hospital from May to December 2015 were collected,and divided into ZOL group(n=55)and control group(n=44).Total procollagen typeⅠamino terminal peptide(tPINP),osteocalcin(OC),alkaline phosphatase(ALP),β-isomerized C-terminal telopeptides(β-CTX),25(OH)VD 3,parathyroid hormone(PTH)and the levels of calcium and phosphate were detected pre-medication,and 2nd week-1st month,1st-3rd month,3rd-6th month,6th-9th month and≥9th month post-medication,then compared between the two groups.Results The level ofβ-CTX and OC in the ZOL group began to decreased from 2nd week-1st month post-medication,there were inter group differences in the mean values of the 5 time periods were significantly lower than those in control group after 2 weeks of treatment(P<0.05);the peak level of tPINP and ALP in the ZOL group disappeared from 2nd week-1st month post-medication(P<0.05),there were still significant differences in the mean levels between 1st month-6th month post-medication(P<0.05).There was no significant difference in calcium and phosphate metabolic hormones,serum calcium and phosphate between groups.Conclusion The early postoperative infusion of ZOL in elderly patients with hip fracture can result in rapid,significant and lasting inhibition of bone resorption and bone turnover;the peak of postoperative bone formation appears to be″reduced″,but the inhibition is no longer significant after 6months.The sustained effect of ZOL on BTMs needs to be observed with longer follow-up.

关 键 词：唑来膦酸 老年 髋部骨折 骨代谢标志物 骨转换 

分 类 号：R592[医药卫生—老年医学]