| 王治国,李先华,李雅楠,等.停用特立帕肽的绝经后骨质疏松症患者行序贯治疗的效果分析[J].中国临床保健杂志,2025,28(3):372-376. |
| 停用特立帕肽的绝经后骨质疏松症患者行序贯治疗的效果分析 |
| Analysis of the effect of sequential treatment on postmenopausal osteoporosis patients who discontinued teriparatide |
| 投稿时间：2025-03-11 |
| DOI：10.3969/J.issn.1672-6790.2025.03.018 |
| 中文关键词: 骨质疏松,绝经后 特立帕肽 骨密度 序贯治疗 |
| 英文关键词: Osteoporosis,postmenopausal Teriparatide Bone density sequential treatment 〖FL |
| 基金项目: |
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| 中文摘要: |
| 目的 探讨停用特立帕肽的绝经后骨质疏松患者疗效下降后序贯地舒单抗或唑来膦酸治疗的临床效果及其对骨代谢标志物的影响。方法 回顾性分析2020—2023年在青岛大学附属医院经特立帕肽治疗后停药1~2年再行序贯治疗的101例绝经后骨质疏松患者临床资料。特立帕肽治疗时间为12~16个月。收集并比较所有研究对象特立帕肽治疗前1个月内、治疗6个月、12个月及停药1~2年后复诊的骨密度资料,以及治疗前1个月内、治疗3个月、6个月、12个月及停药1~2年后复诊的Ⅰ型前胶原氨基端前肽(P1NP)、Ⅰ型胶原蛋白C末端交联肽(CTX)水平。根据序贯治疗药物分为唑来膦酸组(静脉滴注唑来膦酸,5 mg/年)与地舒单抗组(皮下注射地舒单抗,每6个月60 mg),比较2组患者的治疗效果。结果 (1)骨代谢标志物:101例特立帕肽治疗的患者,与停药前相比,停药1年后P1NP、CTX均有显著下降(P<0.05)。40例患者使用地舒单抗序贯治疗12、24个月后骨形成标志物P1NP和骨吸收标志物CTX水平较治疗前均明显下降。50例患者使用唑来膦酸治疗12、24个月后,P1NP和CTX水平较治疗前均明显下降,差异有统计学意义(P＜0.01)。地舒单抗组与唑来膦酸组在治疗12个月、24个月后P1NP和CTX水平变化比较,差异均无统计学意义(均P>0.05)。(2)骨密度:与停药前相比,特立帕肽治疗患者腰椎、股骨颈骨密度在停药1年后均下降,差异有统计学意义(P<0.05)。唑来膦酸组和地舒单抗组患者治疗12、24个月后较基线腰椎骨密度、股骨颈骨密度均升高,差异有统计学意义(P＜0.01)。地舒单抗组与唑来膦酸组之间,在治疗12个月、24个月后腰椎、股骨颈骨密度水平变化无统计学意义(P>0.05)。结论 绝经后骨质疏松症的患者经过特立帕肽治疗停药后疗效难以持久。序贯地舒单抗或唑来膦酸治疗后,均可出现P1NP和CTX降低、骨密度升高。 |
| 英文摘要: |
| Objective To investigate the clinical efficacy of sequential treatment with sunitinib or zoledronic acid after discontinuation of teriparatide among postmenopausal osteoporosis patients and its impact on bone metabolism markers.Methods A retrospective analysis was conducted on the clinical data of 101 postmenopausal osteoporosis patients who were treated with teriparatide at the Affiliated Hospital of Qingdao University from 2020 to 2023 and stopped taking the drug for 1-2 years before undergoing sequential treatment.The treatment time for teriparatide is 12-16 months.Collect and compare the bone density data of all study subjects before treatment with teriparatide for 1 month,6 months,12 months,and 1-2 years after discontinuation,as well as the levels of type I procollagen N-terminal propeptide (P1NP) and type I collagen C-terminal cross-linked peptide (CTX) for 1 month before treatment,3 months,6 months,12 months after treatment,and 1-2 years after discontinuation.According to the sequential treatment of drugs,they were divided into the zoledronic acid group (intravenous infusion of zoledronic acid,5 mg/year) and the denosumab group (subcutaneous injection of denosumab,60 mg every 6 months),and the treatment effects of the two groups were compared.Results (1) Bone metabolism markers:among 101 patients treated with teriparatide,compared with before discontinuation,P1NP and CTX significantly decreased after 1 year of discontinuation (P<0.05).After sequential treatment with denosumab for 12 and 24 months,the levels of bone formation marker P1NP and bone resorption marker CTX in 40 patients decreased significantly compared to before treatment.After 12 and 24 months of treatment with zoledronic acid,the levels of P1NP and CTX in 50 patients decreased significantly compared to before treatment,and the difference was statistically significant (P<0.01).There was no statistically significant difference in the changes of P1NP and CTX levels between the denosumab group and the zoledronic acid group after 12 and 24 months of treatment (both P>0.05).(2) Bone density:Compared with before discontinuation,the bone density of lumbar spine and femoral neck in patients treated with teriparatide decreased significantly after 1 year of discontinuation,and the difference was statistically significant (P<0.05).The denosumab group and the zoledronic acid group after 12 and 24 months of treatment,the lumbar spine bone density and femoral neck bone density increased significantly compared to baseline (P<0.01).There was no significant difference in changes in lumbar spine and femoral neck bone density levels between the denosumab group and the zoledronic acid group after 12 and 24 months of treatment (P>0.05).Conclusions Patients with postmenopausal osteoporosis who receive treatment with teriparatide have significantly increased bone density,but the efficacy decreases after discontinuation of the medication.After sequential treatment with sunitinib or zoledronic acid,P1NP and CTX decreased and bone density increased. |
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