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
|
摘要
目的观察骨化三醇配伍阿仑膦酸钠治疗绝经后骨质疏松症患者对骨密度、骨代谢及基质金属蛋白酶-13(MMP-13)、组织金属蛋白酶抑制因子-1(TIMP-1)的影响。方法将2015年1月—2016年12月湖北省荆门市第二人民医院妇科收治的绝经后骨质疏松症患者60例,随机信封法分为观察组及对照组各30例。对照组采用阿仑膦酸钠治疗,观察组采用骨化三醇配伍阿仑膦酸钠治疗,疗程6个月。观察并比较2组治疗前后骨痛程度(VAS评分),股骨颈、腰椎正位、股骨粗隆的骨密度水平,骨型碱性磷酸酶(BALP)、酸性磷酸酶异构体5b(TRACP-5b)、MMP-13及TIMP-1水平。结果观察组患者治疗后VAS评分显著低于对照组(t=9.487,P=0.000);治疗后观察组腰椎正位、股骨颈及股骨粗隆处骨密度均明显高于对照组,差异有统计学意义(t=14.033、3.988、5.317,P均=0.000);治疗后,观察组血中BALP及TRACP-5b水平显著低于对照组(t=2.323、4.400,P均<0.05);治疗后观察组血中MMP-13及MMP-13/TIMP-1水平显著低于对照组(t=19.321、2.903,P<0.01),TIMP-1水平显著高于对照组(t=2.113,P=0.036)结论绝经后骨质疏松患者采用骨化三醇联合阿仑膦酸钠治疗后,可有效提高临床疗效,并调控MMP-13、MMP-13/TIMP-1水平。
Objective To observe the effect of ossification of three alcohol combined with alendronate on bone metabolism and MMP-13 and MMP-13/TIMP-1 in postmenopausal women with osteoporosis, and to explore the mechanism of treatment,so as to provide evidence for clinical application. Methods From January 2015 to December 2016, 60 eases of osteoporosis who were admitted to the department of Gynecology of Jingmen Second People's Hospital of Hubei province were randomly divided into observation group and control group; the control group using alendronate treatment,observation group with ossification in three alcohol combined with alendronate sodium. Before and after treatment, the VAS method is applied to evaluate the degree of pain, detect of femoral neck, lumbar spine, femoral trochanter bone density, bone alkaline phosphatase(BALP), TRACP 5 and MMP-13 and TIMP-1 level. Results After treatment, the VAS scores in observation group were significantly lower than the control group(t=9.487,P =0.000); observation group after treatment, lumbar spine, femoral neck and trochanter bone density were significantly higher than the control group, and the difference is statistical significance(t=14.033,P = 0.000; t=3.988,P=0.000; t = 12.660,P =0.000); after treatment, observation group's BALP and the level of TRACP 5 b in the blood was significantly lower than the control group(t = 2. 323, P =0. 024; t =4. 400, P =0. 000);MMP-13 and MMP-13/TIMP-1 levels after treatment in the observation group was significantly lower than that in the control group(t = 19.321, P = 0.000; t=2903, P=0.006). After treatment, the level of TIMP-1 in the observation group was significantly higher than that in the control group(t=2. 113, P= 0.036). Conclusion In postmenopausal osteoporosis, the treatment of three alcohol combined with alendronate can effectively improve the clinical efficacy, and regulate the levels of MMP-13 and MMP-13/TIMP-1.
Objective To observe the effect of ossification of three alcohol combined with alendronate on bone metabolism and MMP-13 and MMP-13/TIMP-1 in postmenopausal women with osteoporosis, and to explore the mechanism of treatment,so as to provide evidence for clinical application. Methods From January 2015 to December 2016, 60 eases of osteoporosis who were admitted to the department of Gynecology of Jingmen Second People's Hospital of Hubei province were randomly divided into observation group and control group; the control group using alendronate treatment,observation group with ossification in three alcohol combined with alendronate sodium. Before and after treatment, the VAS method is applied to evaluate the degree of pain, detect of femoral neck, lumbar spine, femoral trochanter bone density, bone alkaline phosphatase(BALP), TRACP 5 and MMP-13 and TIMP-1 level. Results After treatment, the VAS scores in observation group were significantly lower than the control group(t=9.487,P =0.000); observation group after treatment, lumbar spine, femoral neck and trochanter bone density were significantly higher than the control group, and the difference is statistical significance(t=14.033,P = 0.000; t=3.988,P=0.000; t = 12.660,P =0.000); after treatment, observation group's BALP and the level of TRACP 5 b in the blood was significantly lower than the control group(t = 2. 323, P =0. 024; t =4. 400, P =0. 000);MMP-13 and MMP-13/TIMP-1 levels after treatment in the observation group was significantly lower than that in the control group(t = 19.321, P = 0.000; t=2903, P=0.006). After treatment, the level of TIMP-1 in the observation group was significantly higher than that in the control group(t=2. 113, P= 0.036). Conclusion In postmenopausal osteoporosis, the treatment of three alcohol combined with alendronate can effectively improve the clinical efficacy, and regulate the levels of MMP-13 and MMP-13/TIMP-1.
引文
[1]Yoon B K,Lee D Y,Park M C,et al.Effects of Combination Therapy of Alendronate and Hormonal Therapy on Bone Mineral Density in Postmenopausal Korean Women:Multicenter,Randomized Controlled Clinical Trial[J].Journal of Korean Medical Science,2017,32(6):992-998.001:10.3346/jkms.2017.32.6.992.
[2]Hassler N,Garnsjaeger S,Hofslelter B,et al.Effects of long-lenn aleiulnniate treatment on postmenopausal osteoporosis bone malarial properlies[J].Osteoporosis International,2015,26(1):339-352.DOI:10.1007/sOOI98-OI4-2929-5.
[3]Wen H J,Huang T H,Li T L,et al.Kffects of shorl-lerm step aerobics(;xcrciso on boiunuHaliolism and functional filness in postmenopausal women with low bone mass[J].Osteoporosis International,2016,28(2):l-9.DOI:10.1007/sOOI98-016-3759g.
[4]祁雷,姚运峰,荆珏华.基质金属蛋白酶抑制剂在骨关节炎治疗中应用的研究进展[J].齐鲁医学杂志,2017(1):111-113.D0I:10.13362/j.qlyx.201701038
[5]Lee K M,Chung C Y,Kwon S S,et al.Bone mineral density is not associated with musculoskeletal pain in postmenopausal Korean women agedg50years[J].Clinical Rheumatology,2015,34(2):337-343.DOI:10.1007/s10067-014-2790-0.
[6]Cosman F,Nieves J W,Zion M,et al.Daily or Cyclical Teriparalide Treatment in Women With Osteoporosis on no Prior Therapy and'Women on Alendronate[J].Journal of Clinical Endocrinology&Metabolism,2015,100(7):2769-76.DOI:10.1210/jc.2015-1715
[7]中国老年学学会骨质疏松委员会骨质疏松诊断标准学科组.中国人原发性骨质疏松症诊断标准(试行)[J].中国中西医结合杂志,1999,19(F03):1-3.DOI:10.3321/j.issn:1003-5370.1999.10.037
[8]Anastasilakis A D.Polyzos S A,Makras P,et al.Cinmlating semaphorin-4D and plexin-Bl levels in postmenopausal women with low bone mass:the 3-month effect of zoledronic acid,denosumab or teriparatide treatment.[J].Expert Opinion on Therapeutic Targets,2015,19(3):299-306.DOI:10.1517/14728222.2014.983078.
[9]陈铧,张峥,马海棠,等.局部应用骨形态发生蛋白-7复合纤维蛋白治疗大鼠骨质疏松性椎体骨折的可行性[J].疑难病杂志,2018,17(4):400-404.DOI;10.3969/j.issn.1671-6450.2018.04.018.
[10]鲁旭亮,侯波,陈伟巍,等.骨化三醇对甲状腺功能亢进患者甲状腺激素及骨密度的影响[J].疑难病杂志,20]7,16(7):686-689,693.D0I:10.3969/j.issn.1671-6450.2017.07.010.
[11]喻琴云,詹晓峰,黄彦.刺芒柄花素对去势骨质疏松大鼠P38MAPK/MMP-9信号通路的影响[J].中闰临床药理学与治疗学,2017,22(12):1371-1376.
[12]杨承镔,刘忠华,于广波,等.女性绝经后骨质疏松症阿仑膦酸钠联合骨化三醇治疗的疗效[J].中国骨质疏松杂志,2015,2](l):75-79.DOI:10.3969/j.issn.1006-7108.2015.01.017.
[13]陈丽思,黄志荣,吴海游,等.辅酶Q10对去卵巢大鼠骨质和骨密度的影响[J].中国临床药琿学与治疗学,2016,21(8):868-872.
[14]Tenbroek E M,Yunker L,Nies M Ftet al.'Randomized controlled studies on the efficacy of antiarthritic agents in inhibiting cartilage degeneration and pain associated with progression of osteoarthritis in ihe rat[J].Arthritis Research&Therapy,2016,18(1):1-29.DOI:10.1186A13075-016-0921-5
[15]Simone E A D,Perrone GtCagiano N,et al.Levels of Cytokines and Matrix Mctalloproteinases 2 and 9 in the Synovial Fluid of Osteourihritic-Horses Treated With Pamidronate[J].Journal of Equine Veterinary Sc-ience,2015,35(7):577-583.DOI:10.1016/j.jevs.2015.03.194
[16]Rossini M,Adami StFracassi E,et al.Effects of intra-articulur clodronate in ihe Ireatment of knee osteoarthritis:resulls of a iloul)le-blind,randomized placebo-controlled trial[J].Rheumatology International,2015,35(2):255-263.DOI:10.1007/s00296-014-3l00-5.
[17]龚志贤,罗凌威,卢敏,等.跌打通痹資对兔膝骨关节炎关节软骨MMP-13、II型胶原mRNA表达的影响[J].湖南中医药大学学报,2016,36(11):18-21.DOI:10.3969/j.issn.1674~070X.2016.11.005
[18]Srinivasan P Pggrajuli A,Price C,et al.Inhibition of T-Type Voltage Sensitive Calcium Channel Reduces Load-Induced OA in Mic e and Suppresses the Catabolic Effect of Bone Mechanical Stress on Chondrocytes.[J].Plos One,2015,10(5):e0127290.DOI:10.1371/joumaI.pone.0127290.
[19]Zhou P R,Xu X J,Zhang Z L,el al.SOST polymorphisms and response to alendronate treatment in postmenopausal Chinese women with osteoporosis.[J].Pharmacogenoniics,2015,16(10):1077-88.DOI;10.2217/pgs.15.76.
[2]Hassler N,Garnsjaeger S,Hofslelter B,et al.Effects of long-lenn aleiulnniate treatment on postmenopausal osteoporosis bone malarial properlies[J].Osteoporosis International,2015,26(1):339-352.DOI:10.1007/sOOI98-OI4-2929-5.
[3]Wen H J,Huang T H,Li T L,et al.Kffects of shorl-lerm step aerobics(;xcrciso on boiunuHaliolism and functional filness in postmenopausal women with low bone mass[J].Osteoporosis International,2016,28(2):l-9.DOI:10.1007/sOOI98-016-3759g.
[4]祁雷,姚运峰,荆珏华.基质金属蛋白酶抑制剂在骨关节炎治疗中应用的研究进展[J].齐鲁医学杂志,2017(1):111-113.D0I:10.13362/j.qlyx.201701038
[5]Lee K M,Chung C Y,Kwon S S,et al.Bone mineral density is not associated with musculoskeletal pain in postmenopausal Korean women agedg50years[J].Clinical Rheumatology,2015,34(2):337-343.DOI:10.1007/s10067-014-2790-0.
[6]Cosman F,Nieves J W,Zion M,et al.Daily or Cyclical Teriparalide Treatment in Women With Osteoporosis on no Prior Therapy and'Women on Alendronate[J].Journal of Clinical Endocrinology&Metabolism,2015,100(7):2769-76.DOI:10.1210/jc.2015-1715
[7]中国老年学学会骨质疏松委员会骨质疏松诊断标准学科组.中国人原发性骨质疏松症诊断标准(试行)[J].中国中西医结合杂志,1999,19(F03):1-3.DOI:10.3321/j.issn:1003-5370.1999.10.037
[8]Anastasilakis A D.Polyzos S A,Makras P,et al.Cinmlating semaphorin-4D and plexin-Bl levels in postmenopausal women with low bone mass:the 3-month effect of zoledronic acid,denosumab or teriparatide treatment.[J].Expert Opinion on Therapeutic Targets,2015,19(3):299-306.DOI:10.1517/14728222.2014.983078.
[9]陈铧,张峥,马海棠,等.局部应用骨形态发生蛋白-7复合纤维蛋白治疗大鼠骨质疏松性椎体骨折的可行性[J].疑难病杂志,2018,17(4):400-404.DOI;10.3969/j.issn.1671-6450.2018.04.018.
[10]鲁旭亮,侯波,陈伟巍,等.骨化三醇对甲状腺功能亢进患者甲状腺激素及骨密度的影响[J].疑难病杂志,20]7,16(7):686-689,693.D0I:10.3969/j.issn.1671-6450.2017.07.010.
[11]喻琴云,詹晓峰,黄彦.刺芒柄花素对去势骨质疏松大鼠P38MAPK/MMP-9信号通路的影响[J].中闰临床药理学与治疗学,2017,22(12):1371-1376.
[12]杨承镔,刘忠华,于广波,等.女性绝经后骨质疏松症阿仑膦酸钠联合骨化三醇治疗的疗效[J].中国骨质疏松杂志,2015,2](l):75-79.DOI:10.3969/j.issn.1006-7108.2015.01.017.
[13]陈丽思,黄志荣,吴海游,等.辅酶Q10对去卵巢大鼠骨质和骨密度的影响[J].中国临床药琿学与治疗学,2016,21(8):868-872.
[14]Tenbroek E M,Yunker L,Nies M Ftet al.'Randomized controlled studies on the efficacy of antiarthritic agents in inhibiting cartilage degeneration and pain associated with progression of osteoarthritis in ihe rat[J].Arthritis Research&Therapy,2016,18(1):1-29.DOI:10.1186A13075-016-0921-5
[15]Simone E A D,Perrone GtCagiano N,et al.Levels of Cytokines and Matrix Mctalloproteinases 2 and 9 in the Synovial Fluid of Osteourihritic-Horses Treated With Pamidronate[J].Journal of Equine Veterinary Sc-ience,2015,35(7):577-583.DOI:10.1016/j.jevs.2015.03.194
[16]Rossini M,Adami StFracassi E,et al.Effects of intra-articulur clodronate in ihe Ireatment of knee osteoarthritis:resulls of a iloul)le-blind,randomized placebo-controlled trial[J].Rheumatology International,2015,35(2):255-263.DOI:10.1007/s00296-014-3l00-5.
[17]龚志贤,罗凌威,卢敏,等.跌打通痹資对兔膝骨关节炎关节软骨MMP-13、II型胶原mRNA表达的影响[J].湖南中医药大学学报,2016,36(11):18-21.DOI:10.3969/j.issn.1674~070X.2016.11.005
[18]Srinivasan P Pggrajuli A,Price C,et al.Inhibition of T-Type Voltage Sensitive Calcium Channel Reduces Load-Induced OA in Mic e and Suppresses the Catabolic Effect of Bone Mechanical Stress on Chondrocytes.[J].Plos One,2015,10(5):e0127290.DOI:10.1371/joumaI.pone.0127290.
[19]Zhou P R,Xu X J,Zhang Z L,el al.SOST polymorphisms and response to alendronate treatment in postmenopausal Chinese women with osteoporosis.[J].Pharmacogenoniics,2015,16(10):1077-88.DOI;10.2217/pgs.15.76.