摘要
目的:回顾性分析使用唑来膦酸钠治疗类风湿关节炎继发性骨质疏松症3次以上的患者骨密度及骨代谢的变化,探讨唑来膦酸钠是否能长期改善并维持患者的骨密度,及其对患者骨代谢标志物的影响。方法:选取海军军医大学长海医院风湿免疫科2010年5月至2015年12月的住院患者,其中使用唑来膦酸钠治疗类风湿关节炎继发性骨质疏松症的124例患者为治疗组,均采用醋酸钙0.6 g,qd,po+骨化三醇0.25μg,qd,po+唑来膦酸钠5 mg,每12个月1次,ivgtt治疗。以124例类风湿关节炎不合并骨质疏松症的患者为对照组,醋酸钙和骨化三醇治疗同治疗组。测定和比较两组患者在治疗前,治疗后1年、2年、3年及3年以上随访的腰椎L_(1-4)骨密度(bone mineral density,BMD)以及骨代谢标志物指标。结果:两组患者治疗后腰椎BMD均有提高。与对照组比较,治疗组患者腰椎BMD显著提高(P<0.05)。与治疗前比较,两组患者治疗后骨代谢标志物Ⅰ型前胶原氨基端原肽(PINP)和25羟基维生素D均显著升高(P<0.05),β-胶原降解产物(β-CTX)显著下降(P<0.05)。结论:唑来膦酸钠联合钙剂和骨化三醇方案治疗类风湿关节炎继发性骨质疏松症患者可以显著提高患者腰椎BMD,但长期使用唑来膦酸钠(>3次)对患者BMD的提高与使用次数不呈正相关,同时这种治疗对骨代谢转化影响较小,可有效抑制骨吸收,降低骨转换率。
Objective:To retrospectively analyze the changes of bone mineral density(BMD)and bone metabolism in the patients with secondary rheumatoid arthritis osteoporosis treated with zoledronic acid sodium for over 3 times,explore whether long-term use of zoledronic acid sodium could improve and maintain the BMD of the patients for a long time,and also to observe the effects of zoledronic acid sodium on bone metabolism markers of the patients.Methods:124 patients with secondary rheumatoid arthritis osteoporosis treated with zoledronic acid sodium and hospitalized in Changhai Hospital,Naval Medical University from May 2010 to December 2015 were selected as the treatment group.The patients in the treatment group were treated with 6 g of calcium acetate,qd,0.25μg of calcitriol,po,qd and 5 mg of zoledronic acid sodium,po,once every 12 months,by ivgtt.Another 124 patients with rheumatoid arthritis but without osteoporosis were selected as the control group and were also treated with calcium acetate and calcitriol in the same way as the treatment group.The BMD values of L_(1-4) lumbar vertebra and bone metabolism markers of the patients in the two groups were detected and compared before treatment and after treatment for 1,2 and 3 years and a medical follow-up for over 3 years.Results:The BMD values of lumbar vertebra increased in both groups after treatment.However,the BMD values of the treatment group increased more significantly as compared with those of the control group(P<0.05).As compared with before treatment,the bone metabolism markers typeⅠprocollagen amino terminal pro peptide(PINP)and 25 hydroxyvitamin D(25-OH-D3)all increased significantly(P<0.05),andβ-collagen degradation products(β-CTX)significantly decreased(P<0.05).Conclusion:Zoledronic acid sodium combined with calcium and calcitriol could significantly improve the BMD value of lumbar vertebra in the patients with secondary rheumatoid arthritis osteoporosis.However,prolonged use of zoledronic acid sodium(for more than 3 times)is not directly correlated wi
作者
陈磊
张兰玲
俞登荣
朱晓俊
夏云霞
万伟
CHEN Lei;ZHANG Lanling;YU Dengrong;ZHU Xiaojun;XIA Yunxia;WAN Wei(Department of Pharmacy,Changhai Hospital,Naval Medical University,Shanghai 200433,China;Department of Rheumatology and Immunology,Changhai Hospital,Naval Medical University,Shanghai 200433,China)
出处
《药学服务与研究》
CAS
2021年第6期408-411,共4页
Pharmaceutical Care and Research
关键词
唑来膦酸钠
类风湿关节炎
骨质疏松症
骨密度
骨代谢标志物
zoledronic acid sodium
rheumatoid arthritis
osteoporosis
bone mineral density
bone metabolic marker
