中华关节外科杂志（电子版）
中華關節外科雜誌（電子版）
중화관절외과잡지（전자판）
CHINESE JOURNAL OF JOINT SURGERY(ELECTRONIC VERSION)
2015年
2期
215-220
,共6页
曹燕明%李兴%陈勇%何敏辉
曹燕明%李興%陳勇%何敏輝
조연명%리흥%진용%하민휘
SOST蛋白,人%RANKL蛋白%骨保护素%唑来膦酸钠%骨质疏松,绝经后
SOST蛋白,人%RANKL蛋白%骨保護素%唑來膦痠鈉%骨質疏鬆,絕經後
SOST단백,인%RANKL단백%골보호소%서래련산납%골질소송,절경후
SOST protein,human%RANKL protein%Osteoprotegerin%Zoledronic acid%Osteoporosis,postmenopausal
目的：探讨在运用唑来膦酸钠治疗绝经后骨质疏松症（ OP）患者中硬骨素、骨保护素（ OPG）及核因子κB受体激活因子配基（ RANKL）在治疗前后浓度水平变化，从而探索唑来膦酸钠的药物作用与骨转换表达的关系，为临床联合用药提供一定的实验基础。方法收集本组60～88岁诊断为绝经后OP患者22例，测定静脉注射唑来膦酸钠第0、2、7、30天患者血清中硬骨素、RANKL、OPG、CTX（Ⅰ型胶原交联羧基端肽）及PINP（Ⅰ型前胶原氨基端原肽）的浓度，并运用Pearson′s相关性分析，分析硬骨素、RANKL、OPG与CTX、PINP的相关性。结果（1）在注射唑来膦酸钠后，骨吸收指标CTX在第2、7、30天明显降低，并与注射前比较有统计学意义（ P＜0．01）；骨形成指标PINP在第2、7、30天降低，但只在第7、30天与注射前比较有统计学意义（P＜0．01）。（2）在注射唑来膦酸钠后，硬骨素在第2、7天急剧上升并有统计学意义（P＜0．01），在第30天后慢慢下降；硬骨素的变化与CTX的变化在第2天（r＝－0．518；P＜0．05）、第7天（r＝－0．571；P＜0．01）、第30天（r＝－0．484；P＜0．05）呈负性相关并有统计学意义；与PINP变化在第2天（r＝－0．927；P＜0．01）第7天（r＝－0．562；P＜0．01）、第30天（r＝－0．451；P＜0．05）呈负相关并有统计学意义。（3）在注射唑来膦酸钠后，RANKL在第2、7天上升，在第30天后下降，但无统计学意义（ P＞0．05）；OPG呈上升趋势，但无统计学意义（ P＞0．05）。结论由实验结果可知，在运用唑来膦酸治疗绝经后OP患者中，硬骨素的浓度早期急剧升高，而硬骨素对骨的形成起负性调节作用，因而在临床治疗中，可尝试将硬骨素单克隆抗体与唑来膦酸钠联合用药，增强患者对药物抗骨质疏松的能力，减轻患者病痛，提高老年患者生活质量。
目的：探討在運用唑來膦痠鈉治療絕經後骨質疏鬆癥（ OP）患者中硬骨素、骨保護素（ OPG）及覈因子κB受體激活因子配基（ RANKL）在治療前後濃度水平變化，從而探索唑來膦痠鈉的藥物作用與骨轉換錶達的關繫，為臨床聯閤用藥提供一定的實驗基礎。方法收集本組60～88歲診斷為絕經後OP患者22例，測定靜脈註射唑來膦痠鈉第0、2、7、30天患者血清中硬骨素、RANKL、OPG、CTX（Ⅰ型膠原交聯羧基耑肽）及PINP（Ⅰ型前膠原氨基耑原肽）的濃度，併運用Pearson′s相關性分析，分析硬骨素、RANKL、OPG與CTX、PINP的相關性。結果（1）在註射唑來膦痠鈉後，骨吸收指標CTX在第2、7、30天明顯降低，併與註射前比較有統計學意義（ P＜0．01）；骨形成指標PINP在第2、7、30天降低，但隻在第7、30天與註射前比較有統計學意義（P＜0．01）。（2）在註射唑來膦痠鈉後，硬骨素在第2、7天急劇上升併有統計學意義（P＜0．01），在第30天後慢慢下降；硬骨素的變化與CTX的變化在第2天（r＝－0．518；P＜0．05）、第7天（r＝－0．571；P＜0．01）、第30天（r＝－0．484；P＜0．05）呈負性相關併有統計學意義；與PINP變化在第2天（r＝－0．927；P＜0．01）第7天（r＝－0．562；P＜0．01）、第30天（r＝－0．451；P＜0．05）呈負相關併有統計學意義。（3）在註射唑來膦痠鈉後，RANKL在第2、7天上升，在第30天後下降，但無統計學意義（ P＞0．05）；OPG呈上升趨勢，但無統計學意義（ P＞0．05）。結論由實驗結果可知，在運用唑來膦痠治療絕經後OP患者中，硬骨素的濃度早期急劇升高，而硬骨素對骨的形成起負性調節作用，因而在臨床治療中，可嘗試將硬骨素單剋隆抗體與唑來膦痠鈉聯閤用藥，增彊患者對藥物抗骨質疏鬆的能力，減輕患者病痛，提高老年患者生活質量。
목적：탐토재운용서래련산납치료절경후골질소송증（ OP）환자중경골소、골보호소（ OPG）급핵인자κB수체격활인자배기（ RANKL）재치료전후농도수평변화，종이탐색서래련산납적약물작용여골전환표체적관계，위림상연합용약제공일정적실험기출。방법수집본조60～88세진단위절경후OP환자22례，측정정맥주사서래련산납제0、2、7、30천환자혈청중경골소、RANKL、OPG、CTX（Ⅰ형효원교련최기단태）급PINP（Ⅰ형전효원안기단원태）적농도，병운용Pearson′s상관성분석，분석경골소、RANKL、OPG여CTX、PINP적상관성。결과（1）재주사서래련산납후，골흡수지표CTX재제2、7、30천명현강저，병여주사전비교유통계학의의（ P＜0．01）；골형성지표PINP재제2、7、30천강저，단지재제7、30천여주사전비교유통계학의의（P＜0．01）。（2）재주사서래련산납후，경골소재제2、7천급극상승병유통계학의의（P＜0．01），재제30천후만만하강；경골소적변화여CTX적변화재제2천（r＝－0．518；P＜0．05）、제7천（r＝－0．571；P＜0．01）、제30천（r＝－0．484；P＜0．05）정부성상관병유통계학의의；여PINP변화재제2천（r＝－0．927；P＜0．01）제7천（r＝－0．562；P＜0．01）、제30천（r＝－0．451；P＜0．05）정부상관병유통계학의의。（3）재주사서래련산납후，RANKL재제2、7천상승，재제30천후하강，단무통계학의의（ P＞0．05）；OPG정상승추세，단무통계학의의（ P＞0．05）。결론유실험결과가지，재운용서래련산치료절경후OP환자중，경골소적농도조기급극승고，이경골소대골적형성기부성조절작용，인이재림상치료중，가상시장경골소단극륭항체여서래련산납연합용약，증강환자대약물항골질소송적능력，감경환자병통，제고노년환자생활질량。
Objective To explore the variation in sclerostin , RANKL, OPG serum levels after zoledronic acid administration for postmenopausal osteoporosis in order to determine the correlation between the drug effects and the changes in bone turnover markers , and provide experimental reference for clinical medications.Methods Twenty-two postmenopausal women (aged between 60 and 88 years), who were admitted to the Center for the Prevention and Cure of Osteoporosis in the 2nd affiliated hospital of Guangzhou Medical University were enrolled in this study .The patients with secondary osteoporosis of other causes were previously excluded .The exclusion criteria included chronic renal or liver failure , heart failure, hypocalcemia or hypercalcemia , a prior cancer diagnosis or the patients previously received medications potentially involving bone and mineral metabolism .All the 22 women were treated with 5 mg of zoledronic acid administered intravenously in about 30 minutes at a constant speed .Before the infusion of zoledronic acid (baseline), then in two, seven and 30 days after the infusion, the levels of sclerostin, RANKL, OPG, c-telopeptide of typeⅠcollagen ( CTX) and Procollagen-I-N-Terminal-Propeptide ( PINP) were evaluated , and the changes of the sclerostin and RANKL , OPG were observed; the Pearson′s correlation analysis was carried out for the drug effects and bone resorption and formation .Results (1) After the zoledronic acid infusion , the CTX level decreased in day 2, day 7, and day 30 with significant difference (P<0.01); the PINP concentration decreased in day 2, day 7, and day 30, the differences between the pre-infusion data and the data in day 7 and day 30 were significant (P<0.01).(2) After the zoledronic acid infusion , the sclerostin level sharply increased in day 2 and day 7, and slowly declined in day 30;compared with the pre-infusion level , the difference was significant ( P<0.01 ) .The change of sclerostin showed a negative correlation with the change of CTX in day 2 (r=-0.518;P<0.05), day 7 (r=-0.571;P<0.01), and day 30 (r=-0.484;P<0.05).The change of sclerostin also showed a negative correlation with the change of PINP at day 2 (r=-0.927;P<0.01), day 7 (r=-0.562;P<0.01), day 30 (r=-0.451;P<0.05).(3) After the zoledronic acid infusion, the RANKL level rised in day 2 and day 7, then declined in day 30;compared with the data before the infusion , the difference was not significant ( P >0.05 ).The OPG level presented a tendency of increasing with no statistically significant difference ( P >0.05 ) .Conclusion The sclerostin level would sharply increase after the zoledronic acid infusion in the postmenopausal females .Thus, in the clinical treatment , combination of sclerostin monoclonal antibody with zoledronic acid sodium may increase the ability of the anti -osteoporosis , reduce pain, and improve the quality of life of patients .
