CAJ | 학술논문

目的观察阿仑膦酸钠预防糖皮质激索性骨质疏松症的骨密度以及骨代谢指标的变化.方法选择140例患有风湿性疾病需长期应用糖皮质激素的非骨质疏松病人,包括系统性红斑狼疮、多发性肌炎、皮肌炎、干燥综合征等.将上述病人随机分为:阿仑膦酸钠组74例(阿仑膦酸钠10 mg,1次/d,加上钙尔奇D 0.6 g,1次/d),单纯钙剂组66例(钙尔奇0.6 g,1次/d),疗程24周.分别测定用药前,用药24周后的骨密度、血钙、血磷、血清碱性磷酸酶(AKP)、血清骨钙素(BGP)、尿I型胶原交联氨基末端肽(NTX)的水平.结果阿仑膦酸钠治疗组骨密度较治疗前有不同程度的增加,其中腰椎、股骨颈、大转子、WARD'S区的骨密度分别增加6.1%,6.3%,3.3%,2.2%,BGP较治疗前上升,但差异无统计学意义,尿NTX较治疗前下降(P＜0.05),而对照组的腰椎骨密度下降了8.7%,股骨颈下降9.1%(P＜0.01),大转子下降7.7%、WARD'S区下降6.4%(P＜0.05),血钙、磷、BGP、尿NTX变化差异无统计学意义.结论阿仑膦酸钠可以提高骨密度,具有预防糖皮质激素性骨质疏松的作用;单用钙剂并不能阻止激素诱导的骨质疏松的发生.
목적 관찰아륜련산납예방당피질격색성골질소송증적골밀도이급골대사지표적변화.방법 선택140례환유풍습성질병수장기응용당피질격소적비골질소송병인,포괄계통성홍반랑창、다발성기염、피기염、간조종합정등.장상술병인수궤분위:아륜련산납조74례(아륜련산납10 mg,1차/d,가상개이기D 0.6 g,1차/d),단순개제조66례(개이기0.6 g,1차/d),료정24주.분별측정용약전,용약24주후적골밀도、혈개、혈린、혈청감성린산매(AKP)、혈청골개소(BGP)、뇨I형효원교련안기말단태(NTX)적수평.결과 아륜련산납치료조골밀도교치료전유불동정도적증가,기중요추、고골경、대전자、WARD'S구적골밀도분별증가6.1%,6.3%,3.3%,2.2%,BGP교치료전상승,단차이무통계학의의,뇨NTX교치료전하강(P＜0.05),이대조조적요추골밀도하강료8.7%,고골경하강9.1%(P＜0.01),대전자하강7.7%、WARD'S구하강6.4%(P＜0.05),혈개、린、BGP、뇨NTX변화차이무통계학의의.결론 아륜련산납가이제고골밀도,구유예방당피질격소성골질소송적작용;단용개제병불능조지격소유도적골질소송적발생.
Objective To investigate the effects of alendronate(Alen)on the prevention of systemic glueocortieoid-induced osteopomsis in patients with rheumatic diseases.Methods 140 patients suffering from rheumatic diseases,including systemic lupus erythematosus,polymyositis,dermatomyositis,and Sj(o)gren's syndrome,with normal boRe mineral density(BMD)and treated with oral glucocorticoids Were randomly divided into 2 groups:Alen+calcium group(n=74)receiving Aten 10 mg once a day and caltrate D 600 0.6 g once a day for 24 weeks and control group(n=66)receiving eahrate D 600 0.6 g once a day for 24 weeks.The BMD and biomarkers of bone turnover were measured at baseline and 24 weeks afterinitiating glucocorticoid therapy.Results After 24 weeks.the BMD Values at lumbar spine,femoral neck,major troehanter,and Ward's triangle increased by 6.1%,6.3%,3.3%,and 2.2% respectively compared with those at baseline(all P＜0.05),however,those of the control group decreased by 8.7%,9.1%,7.7%,and 6.4%respectively(P＜0.01,P＜0.05),and the BMD levels at lumbar spine and femoral neck 24 weeks Iater of the Alen+calcium group were both higher than those of the control group (P＜0.01,P＜0.05).24 weeks later the level of urine cross linked N-telopeptides of type Ⅰ collagen (NTX)of the Alert+calcium group decreased(P＜0.05),and the blood osteocalcin(BGP)of the Alen+calcium group increased,however,not significantly(P＞0.05).There were no significant differences in scram AKP and BGP and urine NTX 24 weeks later between these 2 groups.Conclusion Improving BMD,alendronate plays an important role in the prevention of glueocorticoid-induced osteoporosis.However,calcium treatment alone fails to prevent the loss of bone.