唑来膦酸联合碳酸钙D_(3)对老年骨质疏松患者骨代谢及预后的影响  

Effects of Zoledronic Acid Combined with Calcium Carbonate D_(3) on Bone Metabolism and Prognosis in Senile Patients with Osteoporosis

作　　者：陈吉[1] 黄磊涛 张晨 CHEN Ji;HUANG Leitao;ZHANG Chen(Dept.of Orthopaedics,the Fourth Affiliated Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学第四附属医院骨科,南京210000

出　　处：《中国医院用药评价与分析》2024年第6期676-680,共5页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：江苏省青年医学重点人才培养项目(No.CW2021013)。

摘　　要：目的:探讨唑来膦酸联合碳酸钙D_(3)对老年骨质疏松患者骨代谢及预后的影响。方法:采用前瞻性随机对照试验设计,选取2021年1月至2022年6月于该院就诊的104例老年骨质疏松患者,采用分层随机法分为对照组、研究组,各52例。两组患者均调整生活方式,补充钙剂,适当运动;对照组患者给予唑来膦酸治疗,研究组患者给予唑来膦酸联合碳酸钙D_(3)治疗。比较两组患者骨密度(BMD)、骨代谢、细胞因子、临床疗效和不良反应发生情况;并在患者治疗后每月随访1次,共随访3次,评价两组患者的短期预后。结果:治疗后,与对照组比较,研究组患者腰椎L_(1-4)、髋部、Wards三角区和股骨颈等部位BMD升高,差异均有统计学意义(P<0.05)。治疗后,与对照组比较,研究组患者Ⅰ型胶原氨基酸延长肽、骨钙素、Ⅰ型胶原羧基末端交联肽和抗酒石酸酸性磷酸酶-5b水平降低,骨碱性磷酸酶水平升高;与对照组比较,研究组患者骨保护素(OPG)表达量升高,核因子κB受体活化因子配体(RANKL)、核因子κB受体活化因子(RANK)表达量降低;与对照组比较,研究组患者肿瘤坏死因子α、白细胞介素6和γ-干扰素水平降低,上述差异均有统计学意义(P<0.05)。研究组患者的总有效率为94.23%(49/52),高于对照组的80.77%(42/52),差异有统计学意义(P<0.05)。研究组、对照组患者的不良反应发生率分别为9.62%(5/52)、7.69%(4/52),差异无统计学意义(P>0.05)。研究组短期预后优良率为90.38%(47/52),高于对照组的75.00%(39/52),差异有统计学意义(P<0.05)。结论:唑来膦酸联合碳酸钙D_(3)可能通过调控OPG/RANKL/RANK信号通路,改善细胞因子异常表达,纠正骨代谢异常,改善预后。OBJECTIVE:To probe into the effects of zoledronic acid combined with calcium carbonate D_(3) on bone metabolism and prognosis in senile patients with osteoporosis.METHODS:A prospective randomized controlled trial design was used to extract 104 senile patients with osteoporosis admitted into this hospital from Jan.2021 to Jun.2022,which were divided into control group and research group via stratified randomization,with 52 cases in each group.Patients in both groups had adjusted lifestyle,supplemented with calcium,and exercised appropriately;the control group was given zoledronic acid,and the research group was given zoledronic acid combined with calcium carbonate D_(3).The bone mineral density(BMD),bone metabolism,cytokines,clinical efficacy and incidences of adverse drug reactions were compared between two groups,and the short-term prognosis of both groups was evaluated by following up the patients once a month for three times after treatment.RESULTS:After treatment,compared with the control group,the BMD in lumbar vertebrae L_(1-4),hip,Wards’triangle and femoral neck of the research group were increased,with statistically significant differences(P<0.05).After treatment,compared with the control group,the levels of typeⅠcollagen amino acid extension peptide,osteocalcin,typeⅠcollagen carboxy-terminal cross-linked peptide and tartrate-resistant acid phosphatase-5b decreased,and the bone alkaline phosphatase level increased in the research group;compared with the control group,the expression quantity of osteoprotectin(OPG)increased,the expression quantities of receptor activator of nuclear factor KB ligand(RANKL)and receptor activator of nuclear factor KB(RANK)decreased in the research group;compared with the control group,the levels of tumour necrosis factorα,interleukin 6 andγ-interferon decreased in the research group,all of the above differences were statistically significant(P<0.05).The total effective rate of the research group was 94.23%(49/52),higher than 80.77%(42/52)of the control group,with stati

关 键 词：唑来膦酸 碳酸钙D_(3) 老年骨质疏松 骨代谢 预后 

分 类 号：R977[医药卫生—药品]