唑来膦酸治疗骨质疏松诱发急性相反应的危险因素及对治疗依从性的影响  

Acute phase reaction induced by zoledronic acid in the treatment of osteoporosis:risk factors,and effects on treatment adherence

作　　者：叶欣 田欣 邱婧文 周波[1] Ye Xin;Tian Xin;Qiu Jing-Wen;Zhou Bo(Department of Endocrinology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院内分泌内科,重庆400016

出　　处：《解放军医学杂志》2024年第7期770-775,共6页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨唑来膦酸(ZA)治疗骨质疏松后诱发的急性相反应(APR)的危险因素及对治疗依从性和持久性的影响。方法收集2013年1月-2022年1月在重庆医科大学附属第一医院接受5 mg ZA治疗的中位年龄67岁的471例骨质疏松症患者的临床资料进行回顾性分析。根据是否发生APR分为有APR组(n=79)与无APR组(n=392)。采用单因素和多因素logistic回归分析APR的影响因素,采用Kaplan-Meier曲线分析治疗持久性,并分析其治疗依从性。结果注射ZA后首次APR发生率为33.2%,且随着输注次数增加而逐渐递减。首次输注ZA或无口服双膦酸盐史、高血磷水平是APR的独立危险因素。有APR组患者的3年治疗依从性和持久性分别为53%、44%,无APR组则为52%和42%。Kaplan-Meier曲线分析显示,两组在使用ZA的持久性方面差异无统计学意义(P>0.05)。结论ZA治疗骨质疏松时易发生APR,但其对ZA治疗的依从性和持久性影响不明显。首次使用ZA、无口服双膦酸盐史和高血磷水平是APR的独立危险因素。Objective To investigate risk factors for acute phase reaction(APR)induced by zoledronic acid(ZA)treatment in osteoporosis and its impact on treatment adherence and persistence.Methods A retrospective analysis was conducted using clinical data from 471 osteoporosis patients with a median age of 67 years,who received 5 mg ZA in the First Affiliated Hospital of Chongqing Medical University between January 2013 and January 2022.Patients were divided into two groups based on the occurrence of APR:APR group(n=79)and non-APR group(n=392).Univariate and multivariate logistic regression analyses were used to identify factors inducing APR.The treatment persistence of ZA was analyzed using Kaplan-Meier curves.In addition,treatment adherence was analyzed.Results The incidence of APR was 33.2%after the first ZA injection,and it gradually decreased with an increase in the number of infusions.The multivariate logistic regression analysis showed that the first infusion,no history of oral bisphosphonate use,and high blood phosphorus levels were independent risk factors for APR.Three-year treatment adherence and persistence in APR group were 53%and 44%,respectively,while in non-APR group,they were 52%and 42%,respectively.Kaplan-Meier analysis showed no statistically significant difference in the persistence of ZA between two groups(P>0.05).Conclusions APR is prone to occur during ZA treatment for osteoporosis,but it does not affect the adherence and persistence of ZA treatment.First use of ZA,no history of oral bisphosphonates,and high blood phosphorus levels are independent risk factors for APR.

关 键 词：唑来膦酸 急性相反应 骨质疏松 危险因素 依从性 

分 类 号：R580[医药卫生—内分泌]