伊班膦酸钠联合唑来膦酸治疗绝经后骨质疏松症患者的临床效果及对生活质量的影响
|
摘要
目的观察伊班膦酸钠联合唑来膦酸治疗绝经后骨质疏松症患者的临床效果及对生活质量的影响。方法选取2016年6月—2018年2月四川省骨科医院内科诊治的绝经后骨质疏松症患者116例为研究对象,以随机数字表法分成2组,各58例。对照组采用唑来膦酸治疗,观察组采用唑来膦酸和伊班膦酸钠治疗。对比2组治疗前后的骨代谢指标、骨密度指标、疼痛VAS评分、生活质量WHOQOL-BREF评分及用药安全性。结果治疗3个月后,2组的骨钙素、人骨碱性磷酸酶、I型胶原交联羧基末端肽均较治疗前明显改善(P<0.05),且对照组改善优于观察组(t/P=2.130/0.047、2.136/0.047、2.173/0.046);治疗6个月后,2组的上述骨代谢各指标及腰椎正位和股骨颈部骨密度均较治疗前明显改善(P<0.05),而2组间比较差异无统计学意义(P>0.05);治疗6个月2组疼痛和生活质量的评分均较治疗前明显改善,且观察组较对照组改善更为显著(t/P=4.172/0.024、2.607/0.038、2.503/0.040、2.511/0.040、2.781/0.036);对照组不良反应发生率高于观察组(75.86%vs. 6.90%,χ~2=14.531,P=0.000),且多数需对症用药处理。结论伊班膦酸钠与唑来膦酸联合治疗绝经后骨质疏松症的临床效果较好,能明显改善患者的骨代谢指标,提高骨密度和生活质量。
Objective To compare and analyze the clinical effect of zoledronic acid alone and combined with ibandronate sodium in the treatment of postmenopausal women with osteoporosis and its impact on the quality of life of patients. Methods One hundred and sixteen patients with postmenopausal osteoporosis were selected from June 2016 to February 2018 in the Department of Internal Medicine of Sichuan Orthopedic Hospital. They were divided into two groups by random number table, 58 cases in each group. The control group was treated with zoledronic acid, while the observation group was treated with ibandronate and zoledronic acid. Bone metabolism, bone mineral density, pain VAS score, quality of life WHOQOL BREF score and medication safety were compared between the two groups before and after treatment. Results After 3 months of treatment, the osteocalcin, human bone alkaline phosphatase, and type I collagen cross-linked carboxy-terminal peptide were significantly improved in the two groups(P<0.05), and the control group improved better than the observation group(t/P=2.130/0.047, t/P=2.136/0.047, t/P=2.173/0.046); after 6 months of treatment, the above indexes of bone metabolism and lumbar vertebrae and femoral neck bone mineral density were compared in the two groups. There was significant improvement before(P<0.05), but there was no significant difference between the two groups(P>0.05). The scores of pain and quality of life in the two groups were significantly improved compared with those before treatment, and the observation group was better than the control group. The improvement was more significant(t/P=4.172/0.024, t/P=2.607/0.038, t/P=2.503/0.040, t/P=2.511/0.040, t/P=2.781/0.036). The incidence of adverse reactions in the control group was higher than that in the observation group(75.86% vs. 6.90%, χ~2=14.531,P=0.000), and most of them required symptomatic medication. Conclusion The combination of ibandronate and zoledronic acid in the treatment of postmenopausal women with osteoporosis has a good clinical effect. It can significantly improve the bone metabolism index, bone mineral density and quality of life of patients.
Objective To compare and analyze the clinical effect of zoledronic acid alone and combined with ibandronate sodium in the treatment of postmenopausal women with osteoporosis and its impact on the quality of life of patients. Methods One hundred and sixteen patients with postmenopausal osteoporosis were selected from June 2016 to February 2018 in the Department of Internal Medicine of Sichuan Orthopedic Hospital. They were divided into two groups by random number table, 58 cases in each group. The control group was treated with zoledronic acid, while the observation group was treated with ibandronate and zoledronic acid. Bone metabolism, bone mineral density, pain VAS score, quality of life WHOQOL BREF score and medication safety were compared between the two groups before and after treatment. Results After 3 months of treatment, the osteocalcin, human bone alkaline phosphatase, and type I collagen cross-linked carboxy-terminal peptide were significantly improved in the two groups(P<0.05), and the control group improved better than the observation group(t/P=2.130/0.047, t/P=2.136/0.047, t/P=2.173/0.046); after 6 months of treatment, the above indexes of bone metabolism and lumbar vertebrae and femoral neck bone mineral density were compared in the two groups. There was significant improvement before(P<0.05), but there was no significant difference between the two groups(P>0.05). The scores of pain and quality of life in the two groups were significantly improved compared with those before treatment, and the observation group was better than the control group. The improvement was more significant(t/P=4.172/0.024, t/P=2.607/0.038, t/P=2.503/0.040, t/P=2.511/0.040, t/P=2.781/0.036). The incidence of adverse reactions in the control group was higher than that in the observation group(75.86% vs. 6.90%, χ~2=14.531,P=0.000), and most of them required symptomatic medication. Conclusion The combination of ibandronate and zoledronic acid in the treatment of postmenopausal women with osteoporosis has a good clinical effect. It can significantly improve the bone metabolism index, bone mineral density and quality of life of patients.
引文
[1] 刘海龙, 卫荣. 绝经后骨质疏松症中西医临床治疗进展[J]. 现代中西医结合杂志, 2014, 23(14):1594-1596. DOI: 10.3969/j.issn.1008-8849.2014.14.049.
[2] 周俊文, 马翔, 翟所迪. 双膦酸盐类抗骨质疏松治疗的相对有效性及安全性评估[J]. 中国临床药理学杂志, 2015, 31(12):1197-1201. DOI: 10.13699/j.cnki.1001-6821.2015.12.035.
[3] 吕晴, 王丽娟, 侯日莹, 等. 绝经后骨质疏松症疗法研究新进展[J]. 中国妇幼保健, 2015, 30(16):2682-2684. DOI: 10.7620/zgfybj.j.issn.1001-4411.2015.16.75.
[4] 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. DOI: 10.3969/j.issn.1674-2591.2011.01.002.
[5] Rausch M, Zehetleitner M. A comparison between a visual analogue scale and a four point scale as measures of conscious experience of motion[J]. Conscious Cogn, 2014, 28(6): 126-140. DOI: 10.1016/j.concog.2014.06.012.
[6] 文丽, 何林, 王翠平. 强化健康宣教对绝经期骨质疏松症患者相关知识、行为和心理应对方式的影响[J]. 中国健康心理学杂志, 2018, 26(7):1048-1052. DOI: 10.13342/j.cnki.cjhp.2018.07.027.
[7] Tella SH, Gallagher JC. Prevention and treatment of postmenopausal osteoporosis[J].J Steroid Biochem Mol Biol, 2014,142:155-170. DOI: 10.1016/j.jsbmb.2013.09.008.
[8] 马玉红. 唑来膦酸注射液对骨质疏松大鼠模型的治疗效果分析[J]. 安徽医药, 2016, 20(2): 246-248. DOI: 10.3969/j.issn.1009-6469.2016.02.011.
[9] 万勇, 郎红梅, 游志清,等. 唑来膦酸治疗绝经后骨质疏松患者2年结果分析[J]. 西南国防医药, 2014, 24(2):175-178. DOI: 10.3969/j.issn.1004-0188.2014.02.022.
[10] 杨海明, 汪洋, 张华军. 针药联合治疗原发性骨质疏松症40例临床研究[J]. 江苏中医药, 2017, 49(9):59-61. DOI: 10.3969/j.issn.1672-397X.2017.09.025.
[11] 陈德才, 廖二元, 徐苓,等. 骨代谢生化标志物临床应用指南[J]. 中华骨质疏松和骨矿盐疾病杂志, 2015, 8(4):283-293. DOI: 10.3969/j.issn.1674-2591.2015.04.001.
[12] 谷文莎, 游利, 陈琳,等. 高龄老年女性骨质疏松患者骨代谢特点及使用双膦酸盐的疗效[J]. 中华骨质疏松和骨矿盐疾病杂志, 2015, 8(4):300-304. DOI: 10.3969/j.issn.1674-2591.2015.04.003.
[13] 于莉. 骨代谢标志物实验室检测在绝经后骨质疏松症治疗中的意义[J]. 风湿病与关节炎, 2015, 4(2):18-21. DOI: 10.3969/j.issn.2095-4174.2015.02.004.
[14] 龚健,梁俊生,张洪斌,等.骨疏康胶囊联合股骨近端防旋髓内钉内固定治疗老年骨质疏松性股骨粗隆间骨折的临床效果[J].中国医药,2018,13(7):1070-1074. DOI:10.3760/j.issn.1673-4777.2018.07.028.
[15] 姜爱凤,王以新,马立萍,等.阿托伐他汀钙与低剂量雌激素联合治疗围绝经期女性骨质疏松的临床效果[J].中国医药,2018,13(5):741-743. DOI:10.3760/j.issn.1673-4777.2018.05.027.
[16] 刘永菊, 李素梅, 荆春艳, 等. 绝经后2型糖尿病患者血清甲状旁腺素和25羟维生素D及骨代谢标志物与骨密度的相关性[J]. 中国临床保健杂志, 2015, 18(3):270-273. DOI: 10.3969/J.issn.1672-6790.2015.03.015.
[17] 许环顺,候平,邢忠,等.鲑鱼降钙素对骨质疏松症患者血清胰岛素样生长因子-1、白介素-6和肿瘤坏死因子-α的影响[J].疑难病杂志,2018,17(9):914-917,921. DOI:10.3969/j.issn.1671-6450.2018.09.012.
[18] 曹玉平,龙平,江梅,等.骨化三醇配伍阿仑膦酸钠对绝经后骨质疏松症患者骨密度及骨代谢等指标的影响[J].疑难病杂志,2018,17(6):606-609. DOI:10.3969/j.issn.1671-6450.2018.06.016.
[19] 凌翰彬, 蒋宇亮, 李致媛, 等. 双膦酸盐类药物致不良反应回顾性分析[J]. 现代生物医学进展, 2014, 14(35):6963-6966. DOI: 10.13241/j.cnki.pmb.2014.35.043.
[20] 范靖雪, 姜礼红, 孟佳,等. 双膦酸盐的作用机制和急性时相反应[J]. 中国骨质疏松杂志, 2016, 22(9):1216-1220. DOI: 10.3969/j.issn.1006-7108.2016.09.029.
[21] 董桂一, 成峰. 伊班膦酸钠与唑来膦酸对骨肿瘤患者的疗效比较[J]. 中国肿瘤临床与康复, 2017, 24(5):553-555. DOI: CNKI:SUN:ZGZK.0.2017-05-011.
[22] Sieber P, Lardelli P, Kraenzlin CA, et al. Intravenous bisphosphonates for postmenopausal osteoporosis: safety profiles of zoledronic acid and ibandronate in clinical practice[J]. Clin Drug Investig, 2013, 33(2): 117-122. DOI: 10.1007/s40261-012-0041-1.
[2] 周俊文, 马翔, 翟所迪. 双膦酸盐类抗骨质疏松治疗的相对有效性及安全性评估[J]. 中国临床药理学杂志, 2015, 31(12):1197-1201. DOI: 10.13699/j.cnki.1001-6821.2015.12.035.
[3] 吕晴, 王丽娟, 侯日莹, 等. 绝经后骨质疏松症疗法研究新进展[J]. 中国妇幼保健, 2015, 30(16):2682-2684. DOI: 10.7620/zgfybj.j.issn.1001-4411.2015.16.75.
[4] 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. DOI: 10.3969/j.issn.1674-2591.2011.01.002.
[5] Rausch M, Zehetleitner M. A comparison between a visual analogue scale and a four point scale as measures of conscious experience of motion[J]. Conscious Cogn, 2014, 28(6): 126-140. DOI: 10.1016/j.concog.2014.06.012.
[6] 文丽, 何林, 王翠平. 强化健康宣教对绝经期骨质疏松症患者相关知识、行为和心理应对方式的影响[J]. 中国健康心理学杂志, 2018, 26(7):1048-1052. DOI: 10.13342/j.cnki.cjhp.2018.07.027.
[7] Tella SH, Gallagher JC. Prevention and treatment of postmenopausal osteoporosis[J].J Steroid Biochem Mol Biol, 2014,142:155-170. DOI: 10.1016/j.jsbmb.2013.09.008.
[8] 马玉红. 唑来膦酸注射液对骨质疏松大鼠模型的治疗效果分析[J]. 安徽医药, 2016, 20(2): 246-248. DOI: 10.3969/j.issn.1009-6469.2016.02.011.
[9] 万勇, 郎红梅, 游志清,等. 唑来膦酸治疗绝经后骨质疏松患者2年结果分析[J]. 西南国防医药, 2014, 24(2):175-178. DOI: 10.3969/j.issn.1004-0188.2014.02.022.
[10] 杨海明, 汪洋, 张华军. 针药联合治疗原发性骨质疏松症40例临床研究[J]. 江苏中医药, 2017, 49(9):59-61. DOI: 10.3969/j.issn.1672-397X.2017.09.025.
[11] 陈德才, 廖二元, 徐苓,等. 骨代谢生化标志物临床应用指南[J]. 中华骨质疏松和骨矿盐疾病杂志, 2015, 8(4):283-293. DOI: 10.3969/j.issn.1674-2591.2015.04.001.
[12] 谷文莎, 游利, 陈琳,等. 高龄老年女性骨质疏松患者骨代谢特点及使用双膦酸盐的疗效[J]. 中华骨质疏松和骨矿盐疾病杂志, 2015, 8(4):300-304. DOI: 10.3969/j.issn.1674-2591.2015.04.003.
[13] 于莉. 骨代谢标志物实验室检测在绝经后骨质疏松症治疗中的意义[J]. 风湿病与关节炎, 2015, 4(2):18-21. DOI: 10.3969/j.issn.2095-4174.2015.02.004.
[14] 龚健,梁俊生,张洪斌,等.骨疏康胶囊联合股骨近端防旋髓内钉内固定治疗老年骨质疏松性股骨粗隆间骨折的临床效果[J].中国医药,2018,13(7):1070-1074. DOI:10.3760/j.issn.1673-4777.2018.07.028.
[15] 姜爱凤,王以新,马立萍,等.阿托伐他汀钙与低剂量雌激素联合治疗围绝经期女性骨质疏松的临床效果[J].中国医药,2018,13(5):741-743. DOI:10.3760/j.issn.1673-4777.2018.05.027.
[16] 刘永菊, 李素梅, 荆春艳, 等. 绝经后2型糖尿病患者血清甲状旁腺素和25羟维生素D及骨代谢标志物与骨密度的相关性[J]. 中国临床保健杂志, 2015, 18(3):270-273. DOI: 10.3969/J.issn.1672-6790.2015.03.015.
[17] 许环顺,候平,邢忠,等.鲑鱼降钙素对骨质疏松症患者血清胰岛素样生长因子-1、白介素-6和肿瘤坏死因子-α的影响[J].疑难病杂志,2018,17(9):914-917,921. DOI:10.3969/j.issn.1671-6450.2018.09.012.
[18] 曹玉平,龙平,江梅,等.骨化三醇配伍阿仑膦酸钠对绝经后骨质疏松症患者骨密度及骨代谢等指标的影响[J].疑难病杂志,2018,17(6):606-609. DOI:10.3969/j.issn.1671-6450.2018.06.016.
[19] 凌翰彬, 蒋宇亮, 李致媛, 等. 双膦酸盐类药物致不良反应回顾性分析[J]. 现代生物医学进展, 2014, 14(35):6963-6966. DOI: 10.13241/j.cnki.pmb.2014.35.043.
[20] 范靖雪, 姜礼红, 孟佳,等. 双膦酸盐的作用机制和急性时相反应[J]. 中国骨质疏松杂志, 2016, 22(9):1216-1220. DOI: 10.3969/j.issn.1006-7108.2016.09.029.
[21] 董桂一, 成峰. 伊班膦酸钠与唑来膦酸对骨肿瘤患者的疗效比较[J]. 中国肿瘤临床与康复, 2017, 24(5):553-555. DOI: CNKI:SUN:ZGZK.0.2017-05-011.
[22] Sieber P, Lardelli P, Kraenzlin CA, et al. Intravenous bisphosphonates for postmenopausal osteoporosis: safety profiles of zoledronic acid and ibandronate in clinical practice[J]. Clin Drug Investig, 2013, 33(2): 117-122. DOI: 10.1007/s40261-012-0041-1.