绝经后妇女骨关节炎合并骨质疏松三联治疗的临床观察
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摘要
目的探讨绝经后妇女骨关节炎合并骨质疏松三联治疗的临床效果。方法选取2017年4月至2018年3月在我院治疗的64例绝经后骨关节炎合并骨质疏松患者进行研究,按照简单随机法将患者分为对照组、观察组,对照组予以非甾体类药物(NSAID)+玻璃酸钠治疗,观察组予以NSAID+玻璃酸钠+依降钙素治疗。比较两组患者的治疗效果及治疗前后VAS评分、Lysholm膝关节评分、WOMAC评分、腰骨密度值变化。结果对照组患者治疗有效率为78.13%,观察组治疗有效率为93.75%,观察组患者治疗有效率高于对照组(P<0.05)。两组患者治疗后骨密度高于治疗前(P<0.05);而在治疗后3个月、6个月,观察组患者骨密度高于对照组(P<0.05)。两组患者治疗后VAS评分、Lysholm膝关节评分、WOMAC评分低于治疗前(P<0.05);而在治疗后3个月、6个月,观察组患者VAS评分、Lysholm膝关节评分、WOMAC评分均低于对照组(P<0.05)。结论 NSAID、玻璃酸钠、依降钙素联合应用于绝经后妇女骨关节炎合并骨质疏松治疗,不仅可提高治疗效果,改善膝关节功能,还能提高活动度及患者生活质量,应用于临床可起到积极作用。
Objective To explore the clinical effect of triple therapy for postmenopausal women with osteoarthritis and osteoporosis. Methods From April 2017 to March 2018, 64 cases of postmenopausal osteoarthritis with osteoporosis were studied in our hospital. According to the simple randomization method, the patients were divided into the control group and the observation group. The control group was treated with non-steroid drugs(NSAID) and sodium hyaluronate, and the observation group was treated with NSAID, sodium hyaluronate and calcitonin. The therapeutic effects of the two groups were compared, and the changes in VAS score, Lysholm knee score, WOMAC score and waist bone mineral density before and after treatment were compared. Results The effective rate of the control group was 78.13%, the effective rate of the observation group was 93.75%, and the effective rate of the observation group was higher than that of the control group(P<0.05). Bone mineral density of the two groups after treatment was higher than that before treatment(P<0.05), and bone mineral density of the observation group was higher than that of the control group at 3 months and 6 months after treatment(P<0.05). After treatment, the VAS score, Lysholm knee score and WOMAC score of the two groups were lower than those before treatment(P<0.05), and at 3 months and 6 months after treatment, the VAS score, the Lysholm knee score and the WOMAC score in the observation group were all lower than those of the control group(P<0.05). Conclusion The combination of NSAID, sodium hyaluronate and calcitonin in the treatment of postmenopausal women with arthritis and osteoporosis could not only improve the therapeutic effect, improve the function of the knee joint, but also improve the activity and the quality of life of the patients. It could play a positive role in the clinical application.
Objective To explore the clinical effect of triple therapy for postmenopausal women with osteoarthritis and osteoporosis. Methods From April 2017 to March 2018, 64 cases of postmenopausal osteoarthritis with osteoporosis were studied in our hospital. According to the simple randomization method, the patients were divided into the control group and the observation group. The control group was treated with non-steroid drugs(NSAID) and sodium hyaluronate, and the observation group was treated with NSAID, sodium hyaluronate and calcitonin. The therapeutic effects of the two groups were compared, and the changes in VAS score, Lysholm knee score, WOMAC score and waist bone mineral density before and after treatment were compared. Results The effective rate of the control group was 78.13%, the effective rate of the observation group was 93.75%, and the effective rate of the observation group was higher than that of the control group(P<0.05). Bone mineral density of the two groups after treatment was higher than that before treatment(P<0.05), and bone mineral density of the observation group was higher than that of the control group at 3 months and 6 months after treatment(P<0.05). After treatment, the VAS score, Lysholm knee score and WOMAC score of the two groups were lower than those before treatment(P<0.05), and at 3 months and 6 months after treatment, the VAS score, the Lysholm knee score and the WOMAC score in the observation group were all lower than those of the control group(P<0.05). Conclusion The combination of NSAID, sodium hyaluronate and calcitonin in the treatment of postmenopausal women with arthritis and osteoporosis could not only improve the therapeutic effect, improve the function of the knee joint, but also improve the activity and the quality of life of the patients. It could play a positive role in the clinical application.
引文
[1] 赵昌盛,钟群杰,林剑浩.中国膝关节骨关节炎流行病学调查现状[J].广东医学,2016, 37(13):2050-2052.
[2] 秦集斌,宋洁富,薛旭红.原发性骨质疏松症的病因学研究进展[J].中国骨质疏松杂志,2016,22(4):511-514.
[3] 于乐.原发性膝骨关节炎患者骨质疏松及维生素D缺乏症患病率研究[J].解放军预防医学杂志,2016,34(5):704-705.
[4] Funovits J,Aletaha D,Bykerk V,et al.The 2010 American college of rheumatology/European league against rheumatism classification criteria for rheumatoid arthritis: Methodological report phase I[J]. Arthritis Rheum, 2010, 62(9):2582-2591.
[5] 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.
[6] 黎春华,郭燕梅,陈蔚,等.中文版Lequesne指数在膝骨关节炎评价中的评价者间信度[J].中国康复理论与实践,2010,16(6):554-555.
[7] 林建宁孙笑非,阮狄克.膝关节lysholms评分等级评价膝关节功能[J].中国骨与关节损伤杂志,2008,23(3):230-231.
[8] 吴树旭,郭俊彪.水针刀联合玻璃酸钠治疗膝骨性关节炎的WOMAC评分和VAS评分比较[J].哈尔滨医药,2016,36(2):119-120.
[9] Blaney Davidson EN, van Caam AP, Pm VDK. Osteoarthritis year in review 2016: biology[J]. Osteoarthritis & Cartilage,2016,25(2):175.
[10] Bellido M,Lugo L, Roman-Blas JA, et al. Subchondral bone microstructural damage by increased remodelling aggravates experimental osteoarthritis preceded by osteoporosis[J]. Arthritis Research & Therapy,2010,12(4):R152.
[11] 王子江,向川.骨质疏松症与骨关节炎的相关性研究新进展[J].中国骨质疏松杂志, 2014,3(3):310-314.
[12] 张佳慧,陈赛楠,陈文列,等.骨关节炎合并骨质疏松症及其药物干预的研究进展[J]. 风湿病与关节炎,2016,5(4):69-72.
[13] Boschitsch EP, Durchschlag E, Dimai HP. Age-related prevalence of osteoporosis and fragility fractures: real-world data from an Austrian Menopause and Osteoporosis Clinic[J]. Climacteric, 2017, 20(2):157-163.
[14] 黄雪珍,张建东,官荣光,等.1768例中老年妇女绝经后骨质疏松患病率及危险因素调查分析[J].检验医学与临床,2016,13(13):1841-1843.
[15] Chung SM, Hyun MH, Lee E, et al. Novel effects of sarcopenic osteoarthritis on metabolic syndrome, insulin resistance, osteoporosis, and bone fracture: the national survey[J]. Osteoporosis International, 2016, 27(8):2447-2457.
[16] Bandeira L, Lewiecki EM, Bilezikian JP. Pharmacodynamics and pharmacokinetics of oral salmon calcitonin in the treatment of osteoporosis[J]. Expert Opinion on Drug Metabolism & Toxicology,2016,12(6):1.
[17] Khan M, Cheung AM, Khan AA. Drug-related adverse events of osteoporosis therapy[J]. Endocrinology & Metabolism Clinics of North America,2017, 46(1):181-192.
[18] 余游,江伟,樊元胜,等.依降钙素联合阿法骨化醇促进骨折患者骨愈合效果研究[J]. 医学综述,2016,22(11):2240-2243.
[19] 刘振宇.降钙素增强双膦酸盐对绝经后骨质疏松患者慢性腰背痛缓解及生活质量改善的作用[J].中国组织工程研究,2016,20(33):4899-4904.
[20] Meleleo D, Picciarelli V. Effect of calcium ions on human calcitonin. Possible implications for bone resorption by osteoclasts[J]. Biometals, 2016, 29(1):61-79.
[2] 秦集斌,宋洁富,薛旭红.原发性骨质疏松症的病因学研究进展[J].中国骨质疏松杂志,2016,22(4):511-514.
[3] 于乐.原发性膝骨关节炎患者骨质疏松及维生素D缺乏症患病率研究[J].解放军预防医学杂志,2016,34(5):704-705.
[4] Funovits J,Aletaha D,Bykerk V,et al.The 2010 American college of rheumatology/European league against rheumatism classification criteria for rheumatoid arthritis: Methodological report phase I[J]. Arthritis Rheum, 2010, 62(9):2582-2591.
[5] 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.
[6] 黎春华,郭燕梅,陈蔚,等.中文版Lequesne指数在膝骨关节炎评价中的评价者间信度[J].中国康复理论与实践,2010,16(6):554-555.
[7] 林建宁孙笑非,阮狄克.膝关节lysholms评分等级评价膝关节功能[J].中国骨与关节损伤杂志,2008,23(3):230-231.
[8] 吴树旭,郭俊彪.水针刀联合玻璃酸钠治疗膝骨性关节炎的WOMAC评分和VAS评分比较[J].哈尔滨医药,2016,36(2):119-120.
[9] Blaney Davidson EN, van Caam AP, Pm VDK. Osteoarthritis year in review 2016: biology[J]. Osteoarthritis & Cartilage,2016,25(2):175.
[10] Bellido M,Lugo L, Roman-Blas JA, et al. Subchondral bone microstructural damage by increased remodelling aggravates experimental osteoarthritis preceded by osteoporosis[J]. Arthritis Research & Therapy,2010,12(4):R152.
[11] 王子江,向川.骨质疏松症与骨关节炎的相关性研究新进展[J].中国骨质疏松杂志, 2014,3(3):310-314.
[12] 张佳慧,陈赛楠,陈文列,等.骨关节炎合并骨质疏松症及其药物干预的研究进展[J]. 风湿病与关节炎,2016,5(4):69-72.
[13] Boschitsch EP, Durchschlag E, Dimai HP. Age-related prevalence of osteoporosis and fragility fractures: real-world data from an Austrian Menopause and Osteoporosis Clinic[J]. Climacteric, 2017, 20(2):157-163.
[14] 黄雪珍,张建东,官荣光,等.1768例中老年妇女绝经后骨质疏松患病率及危险因素调查分析[J].检验医学与临床,2016,13(13):1841-1843.
[15] Chung SM, Hyun MH, Lee E, et al. Novel effects of sarcopenic osteoarthritis on metabolic syndrome, insulin resistance, osteoporosis, and bone fracture: the national survey[J]. Osteoporosis International, 2016, 27(8):2447-2457.
[16] Bandeira L, Lewiecki EM, Bilezikian JP. Pharmacodynamics and pharmacokinetics of oral salmon calcitonin in the treatment of osteoporosis[J]. Expert Opinion on Drug Metabolism & Toxicology,2016,12(6):1.
[17] Khan M, Cheung AM, Khan AA. Drug-related adverse events of osteoporosis therapy[J]. Endocrinology & Metabolism Clinics of North America,2017, 46(1):181-192.
[18] 余游,江伟,樊元胜,等.依降钙素联合阿法骨化醇促进骨折患者骨愈合效果研究[J]. 医学综述,2016,22(11):2240-2243.
[19] 刘振宇.降钙素增强双膦酸盐对绝经后骨质疏松患者慢性腰背痛缓解及生活质量改善的作用[J].中国组织工程研究,2016,20(33):4899-4904.
[20] Meleleo D, Picciarelli V. Effect of calcium ions on human calcitonin. Possible implications for bone resorption by osteoclasts[J]. Biometals, 2016, 29(1):61-79.