| 张萍,原源,李晓玉,等.不同给药途径的双膦酸盐治疗原发性骨质疏松效果对比[J].中国临床保健杂志,2021,24(5):588-594. |
| 不同给药途径的双膦酸盐治疗原发性骨质疏松效果对比 |
| Comparative study on the efficacy of bisphosphonate in the treatment of primary osteoporosis |
| 投稿时间：2021-07-18 |
| DOI：10.3969/J.issn.1672-6790.2021.05.003 |
| 中文关键词: 骨质疏松 阿屈膦酸盐 唑来膦酸 骨密度 骨重建 |
| 英文关键词: Osteoporosis Alendronate Zoledronic acid Bone density Bone remodeling 〖FL |
| 基金项目:北京市保健委科研课题 |
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| 中文摘要: |
| 目的 探讨阿仑膦酸钠和唑来膦酸治疗原发性骨质疏松症的疗效,以及骨转换标志物(BTMs)作为骨质疏松症药物疗效观察指标的优势。方法 收集2017年1月至2019年3月在北京积水潭医院骨质疏松症门诊就诊的原发性骨质疏松患者,64例患者纳入本研究,并按照随机数字表法分为阿仑膦酸盐组(ALN组,34例)和唑来膦酸盐组(ZOL组,30例)接受治疗。所有患者在就诊期间都完成了数据采集,包括一般临床情况、BTMs和骨密度(BMD)水平等。在使用抗骨质疏松药物3~6个月时,均重新检查BTMs,1年时检查BTMs和BMD水平。结果 ALN组和ZOL组的组间年龄和性别与治疗前肝肾功能、BTMs、BMD比较,均差异无统计学意义；治疗3~6个月,两组BTMs均下降,ALN组BTMs治疗有效率高于ZOL组[Ⅰ型胶原交联C-末端肽(CTX):(0.18±0.13)μg/L比(0.20±0.16)μg/L,P=0.56；Ⅰ型原胶原N-端前肽(P1NP):(23.46±11.33)μg/L比(22.98±10.10)μg/L,P=0.86;骨钙素(OC):(12.82±4.20)μg/L比(12.65±4.90)μg/L,P=0.88]。治疗1年,ALN组BTMs治疗有效率继续升高,ZOL组则下降[CTX:(0.15±0.08)μg/L比(0.21±0.17)μg/L,P=0.04；P1NP:(20.05±10.26)μg/L比(26.14±11.61)μg/L,P=0.03;OC:(10.53±3.06)μg/L比(12.62±5.40)μg/L,P=0.07]。两组BMD较原始值均增加(P≤0.05),BMD治疗有效率ALD组低于ZOL组。结论 ZOL对骨密度的改善作用优于ALN。BTMs水平显示,ZOL的作用相对更快,而ALN的作用更平缓、持续时间更长。对于接受唑来膦酸治疗的患者,建议下次治疗前应及时复查BTMs,必要时适当缩短治疗间隔。 |
| 英文摘要: |
| Objective To explore the efficacy of alendronate sodium and zoledronate in treating primary osteoporosis,and the advantages of bone turnover markers(BTMs) as an observation indicator of the drug efficacy in osteoporosis compared to bone mineral density(BMD).Methods A total of 64 patients,who first visited the osteoporosis clinic from January 2017 to March 2019 in Beijing Jishuitan Hospital,were included in the study.All patients had finished the tests during the visit,including general clinical characteristics,BTMs,and BMD,etc.We divided the patients into Alendronate groups (LN,n=34) and Zoledronate group (ZOL,n=30) randomly.After treating for 3-6 months of anti-osteoporosis drugs,all patients were re-examined BTMs,and then BTMs and BMD 1 year later.Results There were no significant differences in age,gender,liver and kidney function,BTMs,and BMD between the ALN group and the ZOL group;after 3~6 months of treatment,the BTMs of the two groups decreased,and the BTMs levels of the ALN group and ZOL group were respectively CTX (0.18±0.13) μg/L vs.(0.20±0.16)μg/L (P=0.56),P1NP (23.46±11.33) μg/L vs.(22.98±10.10) μg/L (P=0.86) and OC (12.82±4.20) μg/L vs.(12.65±4.90) μg/L (P=0.88),the effective rate of treatment evaluated by BTMs was higher than that of the former.After 1 year of treatment,the BTMs of the ALN group and ZOL group were CTX (0.15±0.08)μg/L vs.(0.21±0.17)μg/L (P=0.04),P1NP (20.05±10.26) μg/L vs.(26.14±11.61) μg/L (P=0.03),OC (10.53±3.06) μg/L vs.(12.62±5.40) μg/L (P=0.07),the effective rate of BTMs treatment in ALN group continued to increase,while that in ZOL group decreased;BMD in both groups increased compared with the original value (P≤0.05),the effective rate of BMD treatment in the ALD group was lower than that in the ZOL group.Conclusions BMD-increasing effect of ZOL is stronger than ALN.The BTMs levels showed that ZOL worked faster and more significantly,while ALN had a smoother effect and lasted longer.For patients treated with zoledronate,timely review of BTMs is recommended,shortening the treatment interval is recommendated if necessary. |
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