阿法骨化醇联合唑来膦酸对骨质疏松症患者骨密度及OPG、BMP-2的影响
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摘要
目的探讨阿法骨化醇联合唑来膦酸的治疗方案对骨质疏松患者骨密度及OPG、BMP-2的影响。方法将80例骨质疏松患者随机分成联合组和单一治疗组。两组患者均接受常规基础治疗,单一治疗组患者在此基础上接受唑来膦酸治疗,联合治疗组患者接受阿法骨化醇联合唑来膦酸的治疗方案。于治疗前及治疗12个月后评估两组患者的腰椎正位(L_(2-4))骨密度、股骨颈骨密度、骨保护蛋白(OPG)水平、骨形态发生蛋白-2(BMP-2)水平及治疗效果。结果治疗后,两组患者的腰椎正位(L_(2-4))骨密度、股骨颈骨密度、OPG及BMP-2均较治疗前有所改变(P<0.01);联合治疗组患者的腰椎正位(L_(2-4))骨密度及股骨颈骨密度均高于单一治疗组患者(P<0.01);联合治疗组患者的OPG水平高于单一治疗组患者(P<0.01);联合治疗组患者的BMP-2水平高于单一治疗组患者(P<0.01);联合治疗组患者的总有效率(97.5%)高单一治疗组患者(82.5%)(P<0.01)。结论阿法骨化醇联合唑来膦酸在骨质疏松患者中的效果较好,可明显提高患者的骨密度,提高OPG水平,提升BMP-2水平,促进患者的恢复。
Objective To explore the effect of alfacalcidol combined with zoledronic acid on bone mineral density(BMD), osteoprotegerin(OPG), and bone morphogenetic protein-2(BMP-2) in patients with osteoporosis. Methods Eighty patients with osteoporosis were randomly divided into the combined treatment group and the single treatment group. Patients in both groups received conventional basic treatment. Patients in the single treatment group received zoledronic acid treatment, and patients in the combined treatment group received alfacalcidol combined with zoledronic acid treatment. BMD of the lumbar spine(L_(2-4)) and the femoral neck, levels of OPG and BMP-2, and treatment effect were evaluated before and 12 months after treatment. Results After the treatment, BMD, OPG, and BMP-2 of the patients in both groups were different from those before the treatment(P<0.01). BMD of L_(2-4 )and the femoral neck were higher in the combined treatment group than in the single treatment group(P<0.01). The OPG level in the combined treatment group was higher than that in the single treatment group(P<0.01). The level of BMP-2 in the combined treatment group was higher than that in the single treatment group(P<0.01). Total effective rate was higher in the combined treatment group(97.5%) than that in the single treatment group(82.5%, P<0.01). Conclusion Alfacalcidol combined with zoledronic acid has a good effect in patients with osteoporosis, which can significantly improve BMD and the levels of OPG and BMP-2 and promote the recovery of the patients.
Objective To explore the effect of alfacalcidol combined with zoledronic acid on bone mineral density(BMD), osteoprotegerin(OPG), and bone morphogenetic protein-2(BMP-2) in patients with osteoporosis. Methods Eighty patients with osteoporosis were randomly divided into the combined treatment group and the single treatment group. Patients in both groups received conventional basic treatment. Patients in the single treatment group received zoledronic acid treatment, and patients in the combined treatment group received alfacalcidol combined with zoledronic acid treatment. BMD of the lumbar spine(L_(2-4)) and the femoral neck, levels of OPG and BMP-2, and treatment effect were evaluated before and 12 months after treatment. Results After the treatment, BMD, OPG, and BMP-2 of the patients in both groups were different from those before the treatment(P<0.01). BMD of L_(2-4 )and the femoral neck were higher in the combined treatment group than in the single treatment group(P<0.01). The OPG level in the combined treatment group was higher than that in the single treatment group(P<0.01). The level of BMP-2 in the combined treatment group was higher than that in the single treatment group(P<0.01). Total effective rate was higher in the combined treatment group(97.5%) than that in the single treatment group(82.5%, P<0.01). Conclusion Alfacalcidol combined with zoledronic acid has a good effect in patients with osteoporosis, which can significantly improve BMD and the levels of OPG and BMP-2 and promote the recovery of the patients.
引文
[1] 中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊疗指南(2017 年)[J].中华骨质疏松和骨矿盐疾病杂志,2017,10(5):413-444.Chinese Society of Bone and Mineral Research.Guidelines for the diagnosis and treatment of primary osteoporosis(2017)[J]. Chinese journal of osteoporosis and bone mineral salt disease,2017,10(5):413-444.(in Chinese)
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[4] 冯颖瑜,修玲玲,苏磊.骨质疏松症的药物治疗[J].医学综述.2014,20(1):105-109.Feng YY, Xiu LL, Su L. Drug therapy for osteoporosis [J]. Medical review. 2014,20(1):105-109. (in chinese)
[5] 杨志新,杨磊,钱阳晶.唑来膦酸对骨质疏松患者骨痛、骨密度和血清骨代谢标志物的影响[J].解放军医药杂志.2017,29(4):85-88.Yang ZX, Yang L, Qian YJ. Zoledronic acid on bone pain and bone density in patients with osteoporosis and the effects of serum bone metabolism markers [J]. PLA medical journal. 2012,29(4):85-88. (in chinese)
[6] 中华医学会风湿病学分会.原发性骨质疏松症诊治指南(2011年)[J].中华骨质疏松和骨矿盐疾病杂志.2011,4(1):2-17.Chinese society of rheumatology. Guidelines for the diagnosis and treatment of primary osteoporosis (2011)[J]. Chinese journal of osteoporosis and bone mineral salt diseases.2011,4(1):2-17. (in chinese)
[7] 陈立,李佳,韩海滨,等.唑来膦酸对绝经后骨质疏松患者骨密度、骨代谢指标、生活质量及疗效的影响[J].河北医药.2016,38(12):1789-1791.Chen L,LI J, Han HB, et al. Effects of zoledronic acid on bone mineral density, bone metabolism index, quality of life and curative effect in postmenopausal osteoporosis patients [J]. Hebei medicine, 2016,38(12):1789-1791. (in chinese)
[8] Bernabei R,Martone AM,Ortolani E,et al.Screening,diagnosis and treatment of osteoporosis:a brief review[J].Clinical Cases in Mineral and Bone Metabolism.2014,11(3):201-207.
[9] Urano T.Genetics of osteoporosis[J].Nihon Rinsho Japanese Journal of Clinical Medicine.2014,452(2):287-293.
[10] Ohta H.Prevention of osteoporosis in different life stages and conditions[J].Clinical Calcium. 2014,24(3):391-400.
[11] 沈追孟.唑来膦酸对骨质疏松症的疗效及其对骨代谢指标的影响[J].中国生化药物杂志.2016,36(4):74-76.Sheng ZM.Effect of chondromeng zoledronic acid on osteoporosis and its effect on bone metabolism index [J]. Chinese journal of biochemical medicine.2016,36(4):74-76. (in chinese)
[12] 谢楚海,陈斌伟,郭剑鸿,等.阿法骨化醇与骨化三醇对骨质疏松患者HOP、BALP及组织形态学的影响[J].中国老年学杂志.2015,35(19):5590-5591.Xie CH, Chen BW, Guo JH, et al. Effects of alfa and ossionol on HOP, BALP and histomorphology of osteoporosis patients [J]. Chinese journal of gerontology.2015,35(19):5590-5591. (in chinese)
[13] 胡雅婷,汪亚军.骨化三醇治疗甲亢性骨质疏松症的疗效及其对OPG及RANKL水平的影响[J].临床医学研究与实践.2018,25:35-36.Hu YT,Wang YJ. Effects of ossifying triol on hyperthyroidism and its effects on OPG and RANKL levels [J]. Clinical medical research and practice. August, 2008,25:35-36. (in chinese)
[14] 褚建国,王季军.骨质疏松骨代谢的OPG/RANKL/RANK作用机制[J].中国老年学杂志.2013,33(20):5015-5017.Zhu JG, Wang JJ. OPG/RANKL/RANK mechanism of osteoporosis bone metabolism [J]. Chinese journal of gerontology.2013,33(20):5015-5017. (in chinese)
[15] 简小冲,陈江,黄文秀,等.辛伐他汀对去卵巢骨质疏松大鼠骨组织BMP-2及信号转导蛋白Smad1/5表达的影响[J].南京医科大学学报(自然科学版).2007,27(11):1217-1220.Jan XH, Chen J, Huang WX, et al. Effects of simvastatin on the expression of bmp-2 and smad1/5 in ovariectomized osteoporosis rats [J]. Journal of nanjing medical university (natural science edition).2007,27(11):1217-1220. (in chinese)
[2] 邓昶,周明旺,付志斌,等.骨质疏松症的中医病因病机及其治疗进展[J].中国骨质疏松杂志.2017,23(8):1105-1111.Deng X,Zhou MW,Fu ZB,et al.Etiology, pathogenesis and treatment of osteoporosis [J]. Chinese journal of osteoporosis. 2017,23(8):1105-1111. (in chinese)
[3] 胡阳,金宇.老年性骨质疏松症患者施用子午流注纳支法穴位敷贴的疗效分析[J].中国骨质疏松杂志.2017,23(6):768-777.Hu Y,Jing Y.Analysis of the efficacy of meridional application of meridional infusion and acupuncture on senile osteoporosis patients [J]. Chinese journal of steoporosis.2017,23(6):768-777. (in chinese)
[4] 冯颖瑜,修玲玲,苏磊.骨质疏松症的药物治疗[J].医学综述.2014,20(1):105-109.Feng YY, Xiu LL, Su L. Drug therapy for osteoporosis [J]. Medical review. 2014,20(1):105-109. (in chinese)
[5] 杨志新,杨磊,钱阳晶.唑来膦酸对骨质疏松患者骨痛、骨密度和血清骨代谢标志物的影响[J].解放军医药杂志.2017,29(4):85-88.Yang ZX, Yang L, Qian YJ. Zoledronic acid on bone pain and bone density in patients with osteoporosis and the effects of serum bone metabolism markers [J]. PLA medical journal. 2012,29(4):85-88. (in chinese)
[6] 中华医学会风湿病学分会.原发性骨质疏松症诊治指南(2011年)[J].中华骨质疏松和骨矿盐疾病杂志.2011,4(1):2-17.Chinese society of rheumatology. Guidelines for the diagnosis and treatment of primary osteoporosis (2011)[J]. Chinese journal of osteoporosis and bone mineral salt diseases.2011,4(1):2-17. (in chinese)
[7] 陈立,李佳,韩海滨,等.唑来膦酸对绝经后骨质疏松患者骨密度、骨代谢指标、生活质量及疗效的影响[J].河北医药.2016,38(12):1789-1791.Chen L,LI J, Han HB, et al. Effects of zoledronic acid on bone mineral density, bone metabolism index, quality of life and curative effect in postmenopausal osteoporosis patients [J]. Hebei medicine, 2016,38(12):1789-1791. (in chinese)
[8] Bernabei R,Martone AM,Ortolani E,et al.Screening,diagnosis and treatment of osteoporosis:a brief review[J].Clinical Cases in Mineral and Bone Metabolism.2014,11(3):201-207.
[9] Urano T.Genetics of osteoporosis[J].Nihon Rinsho Japanese Journal of Clinical Medicine.2014,452(2):287-293.
[10] Ohta H.Prevention of osteoporosis in different life stages and conditions[J].Clinical Calcium. 2014,24(3):391-400.
[11] 沈追孟.唑来膦酸对骨质疏松症的疗效及其对骨代谢指标的影响[J].中国生化药物杂志.2016,36(4):74-76.Sheng ZM.Effect of chondromeng zoledronic acid on osteoporosis and its effect on bone metabolism index [J]. Chinese journal of biochemical medicine.2016,36(4):74-76. (in chinese)
[12] 谢楚海,陈斌伟,郭剑鸿,等.阿法骨化醇与骨化三醇对骨质疏松患者HOP、BALP及组织形态学的影响[J].中国老年学杂志.2015,35(19):5590-5591.Xie CH, Chen BW, Guo JH, et al. Effects of alfa and ossionol on HOP, BALP and histomorphology of osteoporosis patients [J]. Chinese journal of gerontology.2015,35(19):5590-5591. (in chinese)
[13] 胡雅婷,汪亚军.骨化三醇治疗甲亢性骨质疏松症的疗效及其对OPG及RANKL水平的影响[J].临床医学研究与实践.2018,25:35-36.Hu YT,Wang YJ. Effects of ossifying triol on hyperthyroidism and its effects on OPG and RANKL levels [J]. Clinical medical research and practice. August, 2008,25:35-36. (in chinese)
[14] 褚建国,王季军.骨质疏松骨代谢的OPG/RANKL/RANK作用机制[J].中国老年学杂志.2013,33(20):5015-5017.Zhu JG, Wang JJ. OPG/RANKL/RANK mechanism of osteoporosis bone metabolism [J]. Chinese journal of gerontology.2013,33(20):5015-5017. (in chinese)
[15] 简小冲,陈江,黄文秀,等.辛伐他汀对去卵巢骨质疏松大鼠骨组织BMP-2及信号转导蛋白Smad1/5表达的影响[J].南京医科大学学报(自然科学版).2007,27(11):1217-1220.Jan XH, Chen J, Huang WX, et al. Effects of simvastatin on the expression of bmp-2 and smad1/5 in ovariectomized osteoporosis rats [J]. Journal of nanjing medical university (natural science edition).2007,27(11):1217-1220. (in chinese)