CAJ | 학술논문

目的：观察对绝经后骨质疏松症患者静脉注射唑来膦酸前后血生化、骨代谢指标的影响。方法本研究回顾性分析2012～2014年于我科住院部就诊、经骨密度测定证实为骨质疏松症女性患者148人。收集患者滴注唑来膦酸前及滴注24小时后血钙、血磷、血肌酐、骨代谢指标β胶原降解产物（S－CTX），总 I 型胶原氨基前肽（PINP）。结果女性患者年龄为65．98±9．53岁，注射密固达前血钙浓度为2．29±0．10 mmol／L，血磷浓度为1．13±0．15 mmol／L，血肌酐浓度为80．84±13．7μmol／L，肌酐清除率为53．94±13．96 mL／min，S－CTX 浓度为0．32±0．24 ng／mL，PINP浓度为44．98±27．89 ng／mL。注射密固达24小时血钙浓度为2．13±0．14 mmol／L，血磷浓度为1．11±0．15 mmol／L，血肌酐浓度为85．71±12．78μmol／L，肌酐清除率为50．78±12．98 mL／min，S－CTX 浓度为0．176±0．165 ng／mL，PINP 浓度为45．60±26．79 ng／mL。血钙较前降低（P＜0．05），其中55例患者注射后出现血钙降低，12例患者肌酐清除率低于35 mL／min，但无临床症状。血磷、血肌酐浓度明显降低（P＜0．05），但前后浓度均在正常范围内。注射唑来膦酸前后骨吸收标志物 S－CTX 明显降低（P＜0．05），骨形成标志物PINP 变化不明显（P＝0．65）。说明静脉滴注唑来膦酸能立刻抑制破骨细胞活性，而不能立即影响成骨细胞活性，可引起血钙降低，对血磷、肾功能影响不大。结论静脉滴注唑来膦酸能显著抑制骨吸收，安全有效。
목적：관찰대절경후골질소송증환자정맥주사서래련산전후혈생화、골대사지표적영향。방법본연구회고성분석2012～2014년우아과주원부취진、경골밀도측정증실위골질소송증녀성환자148인。수집환자적주서래련산전급적주24소시후혈개、혈린、혈기항、골대사지표β효원강해산물（S－CTX），총 I 형효원안기전태（PINP）。결과녀성환자년령위65．98±9．53세，주사밀고체전혈개농도위2．29±0．10 mmol／L，혈린농도위1．13±0．15 mmol／L，혈기항농도위80．84±13．7μmol／L，기항청제솔위53．94±13．96 mL／min，S－CTX 농도위0．32±0．24 ng／mL，PINP농도위44．98±27．89 ng／mL。주사밀고체24소시혈개농도위2．13±0．14 mmol／L，혈린농도위1．11±0．15 mmol／L，혈기항농도위85．71±12．78μmol／L，기항청제솔위50．78±12．98 mL／min，S－CTX 농도위0．176±0．165 ng／mL，PINP 농도위45．60±26．79 ng／mL。혈개교전강저（P＜0．05），기중55례환자주사후출현혈개강저，12례환자기항청제솔저우35 mL／min，단무림상증상。혈린、혈기항농도명현강저（P＜0．05），단전후농도균재정상범위내。주사서래련산전후골흡수표지물 S－CTX 명현강저（P＜0．05），골형성표지물PINP 변화불명현（P＝0．65）。설명정맥적주서래련산능립각억제파골세포활성，이불능립즉영향성골세포활성，가인기혈개강저，대혈린、신공능영향불대。결론정맥적주서래련산능현저억제골흡수，안전유효。
Objctive To observe the effect of blood biochemical levels and bone turnover markers after zoledronic acid intravenous drip in the patients with postmenopausal osteoporosis. Methods This study were retrospectively analyzed 148 inpatient women with osteoporosis confirmed by bone mineral density examination during 2012 to 2014 in our department. .The serum levels of calcium, phosphorus, creatinine, C-terminal crosslinking telopeptide of type I collagen (S-CTX), N-terminal propeptide of type I collagen (PINP) were detected and analyzed before and 24 hours after the injection of zoledronic acid were analyzed. Results The female patients were 65.98±9.53 years old. The concentration of serum calcium, phosphorus, creatinine, creatinine clearance, S-CTX and PINP was 2.29±0.10 mmol/L, 1.13±0.15 mmol/L, 80.84±13.7 μmol/L, 53.94±13.96 mL/min, 0.32± 0.24 ng/mL,.and 44.98 ±27.89 ng/mL before injection and 2.13 ±0.14 mmol/L,.1.11 ±0.15 mmol/L, 85.71±12.78μmol/L, 50.78±12.98 mL/min, 0.176±0.165 ng/mL, 45.60±26.79 ng/mL 24 hours after injection..The variation of serum calcium was decreased (P <0.05)..Fifty-five patients appeared hypocalcemia and 12 patients had a creatinine clearance lower than 35 mL/min ,.but had no clinical symptoms. By contrast, the variation of serum phosphorus and creatinine was statistically significantly (P<0.05), but all the date are in normal range. The concentration of S-CTX was significantly decreased after the injection (P<0.05). The variation of PINP was not significant (P=0.65). This indicated that the injection of zoledronic acid can inhibit the activity of osteoclast immediately and has no immediate effect on the activity of osteoblast , and can cause hypocalcemia for a short time and has little influence on phosphorus metabolism and the renal function. Conclusion The injection of zoledronic acid can significantly inhibit bone resorption , and it is safe and effective.