小剂量雌激素联合钙片对围绝经期妇女骨密度和骨代谢的影响
摘要
目的探讨小剂量雌激素联合钙片补充疗法对围绝经期妇女骨密度和骨代谢的影响。方法自2014年2月-2015年10月连续性收集围绝经期妇女114例,随机分为对照组和观察组,每组57例。所有患者均给予碳酸钙D3咀嚼片1片/d,观察组在此基础上给予雌激素片2 mg/d治疗,比较两组1年后骨密度和骨代谢水平的差异及不良反应发生率。结果两组患者基础骨密度及骨代谢水平未见统计学差异(P>0. 05)。治疗1年后,观察组腰椎平均骨密度明显增加(t=3. 428,P=0. 001),且显著性高于对照组(t=2. 117,P=0. 036)。相比于对照组,观察组治疗后骨代谢指标骨钙素(OC)显著性下降(t=2. 686,P=0. 008);总Ⅰ型胶原氨基酸前肽(PINP)显著性上升(t=4. 394,P=0. 000); 25-羟基维生素D [25 (OH) D]水平亦显著性增高(t=2. 221,P=0. 028);但两组治疗后甲状旁腺激素(PTH)水平比较差异无统计学意义(P>0. 05)。两组不良反应差异无统计学意义(P>0. 05)。结论小剂量雌激素联合钙片可有效降低围绝经期妇女骨丢失,且不增加患者风险。
引文
[1]王宝成.围绝经期女性雌激素水平与骨质疏松发病机制的临床研究[D].大连:大连医科大学,2014.
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[14]Chen F,Ouyang Y,Ye T,et al.Estrogen inhibits RANKL-induced osteoclastic differentiation by increasing the expression of TR-PV5 channel[J].J Cell Biochem,2014,115(4):651-658.
[15]Lee SH,Oh KN,Han Y,et al.Estrogen receptor alpha regulates Dlx3-mediated osteoblast differentiation[J].Mol Cells,2016,39(2):156-162.
[16]Han XG,Wang DW,Bi ZG,et al.Regulatory effect of estrogen receptor-alpha-mediated Wnt/beta-catenin signaling pathway on osteoblast proliferation[J].J Biol Regul Homeost Agents,2016,30(2):381-387.
[17]de Faria AN,Zancanela DC,Ramos AP,et al.Estrogen and phenol red free medium for osteoblast culture:study of the mineralization ability[J].Cytotechnology,2016,68(4):1623-1632.
[18]王峰,李振武,严锐峰,等.雌激素+黄体素联合常规方案治疗女性绝经后骨质疏松症的效果观察[J].中国药房,2016,27(2):237-239.
[19]黎涛.雌激素联合抗骨质疏松药物治疗绝经后妇女骨质疏松症75例临床疗效分析[J].中国医药科学,2015,5(24):54-56.
[2]王雄耀,常虹.雌激素及受体与绝经后骨质疏松症关系的研究进展[J].疾病监测与控制,2013,11(6):355-357.
[3]Southmayd EA,Mallinson RJ,Williams NI,et al.Unique effects of energy versus estrogen deficiency on multiple components of bone strength in exercising women[J].Osteoporos Int,2017,28(4):1365-1376.
[4]Zhang Z,Liu J,Veldhuis-Vlug AG,et al.Effects of Chronic Estrogen Administration in the Ventromedial Nucleus of the Hypothalamus(VMH)on Fat and Bone Metabolism in Ovariectomized Rats[J].Endocrinology,2016,157(12):4930-4942.
[5]Squire ME,Veglia MK,Drucker KA,et al.Estrogen levels influence medullary bone quantity and density in female house finches and pine siskins[J].Gen Comp Endocrinol,2016,22(11):134-137.
[6]Zhang B,Zhang CG,Zhou QB,et al.Estrogen improves the hyperdynamic circulation and hyporeactivity of mesenteric arteries by alleviating oxidative stress in partial portal vein ligated rats[J].World JGastroenterol,2013,19(40):6863-6868.
[7]Khaksari M,Abbasloo E,Dehghan F,et al.The brain cytokine levels are modulated by estrogen following traumatic brain injury:Which estrogen receptor serves as modulator?[J].Int Immunopharmacol,2015,28(1):279-287.
[8]Shang DP,Lian HY,Fu DP,et al.Relationship between estrogen receptor 1 gene polymorphisms and postmenopausal osteoporosis of the spine in Chinese women[J].Genet Mol Res,2016,15(2):231-235.
[9]Chou CW,Chiang TI,Chang IC,et al.Expression levels of estrogen receptor alpha m RNA in peripheral blood cells are an independent biomarker for postmenopausal osteoporosis[J].BBA Clin,2016,5:124-129.
[10]Wang L,Qiu XM,Gui YY,et al.Bu-Shen-Ning-Xin decoction:inhibition of osteoclastogenesis by abrogation of the RANKL-induced NFATc1 and NF-kappaB signaling pathways via selective estrogen receptor alpha[J].Drug Des Devel Ther,2015,9:3755-3766.
[11]Wang YD,Tao MF,Wang L,et al.Selective regulation of osteoblastic OPG and RANKL by dehydroepiandrosterone through activation of the estrogen receptor beta-mediated MAPK signaling pathway[J].Horm Metab Res,2012,44(7):494-500.
[12]Canon J,Bryant R,Roudier M,et al.RANKL inhibition combined with tamoxifen treatment increases anti-tumor efficacy and prevents tumor-induced bone destruction in an estrogen receptor-positive breast cancer bone metastasis model[J].Breast Cancer Res Treat,2012,135(3):771-780.
[13]Zhou L,Liu Q,Yang M,et al.Dihydroartemisinin,an anti-malaria drug,suppresses estrogen deficiency-induced osteoporosis,osteoclast formation,and rankl-induced signaling pathways[J].JBone Miner Res,2016,31(5):964-974.
[14]Chen F,Ouyang Y,Ye T,et al.Estrogen inhibits RANKL-induced osteoclastic differentiation by increasing the expression of TR-PV5 channel[J].J Cell Biochem,2014,115(4):651-658.
[15]Lee SH,Oh KN,Han Y,et al.Estrogen receptor alpha regulates Dlx3-mediated osteoblast differentiation[J].Mol Cells,2016,39(2):156-162.
[16]Han XG,Wang DW,Bi ZG,et al.Regulatory effect of estrogen receptor-alpha-mediated Wnt/beta-catenin signaling pathway on osteoblast proliferation[J].J Biol Regul Homeost Agents,2016,30(2):381-387.
[17]de Faria AN,Zancanela DC,Ramos AP,et al.Estrogen and phenol red free medium for osteoblast culture:study of the mineralization ability[J].Cytotechnology,2016,68(4):1623-1632.
[18]王峰,李振武,严锐峰,等.雌激素+黄体素联合常规方案治疗女性绝经后骨质疏松症的效果观察[J].中国药房,2016,27(2):237-239.
[19]黎涛.雌激素联合抗骨质疏松药物治疗绝经后妇女骨质疏松症75例临床疗效分析[J].中国医药科学,2015,5(24):54-56.