絕經后骨質疏松癥應用阿倫膦酸鈉與阿法骨化醇聯合治療的效果及對患者疼痛癥狀和骨代謝指標的影響

陸銳均　鐘偉斌

【摘要】 目的：探討阿法骨化醇聯合阿倫膦酸鈉（ALN）治療絕經后骨質疏松癥（PMO）患者的臨床效果及對其疼痛癥狀和骨代謝指標的影響。方法：選取2015年2月-2017年3月本院門診收治的80例PMO患者，根據隨機數字表法將80例PMO患者分為對照組（n=40）和觀察組（n=40）。對照組予以常規鈣劑+阿法骨化醇治療，觀察組在對照組基礎上聯合ALN治療。連續治療12個月后觀察比較兩組治療總有效率、治療前后疼痛癥狀、相關骨代謝指標及不良反應發生率。結果：觀察組治療總有效率（95.00%）較對照組（80.00%）高（P<0.05）;兩組治療后翻身、前屈后伸及自發性腰背痛VAS評分均較治療前降低，且觀察組降低更明顯（P<0.05）;兩組治療后血清骨鈣素（BGP）、骨堿性磷酸酶（BALP）、Ⅰ型膠原C端肽（CTX）及抗酒石酸酸性磷酸酶5b（TRACP-5b）水平均較治療前降低，且觀察組降低更明顯（P<0.05）;兩組治療期間不良反應發生率對比，差異無統計學意義（P>0.05）。結論：阿法骨化醇聯合ALN治療PMO臨床效果顯著，可緩解疼痛不適，改善骨質疏松癥狀且安全可靠。

【關鍵詞】 阿法骨化醇 阿倫膦酸鈉 絕經后骨質疏松癥 骨代謝指標

Effect of Alendronate Combined with Alfacalcidol in the Treatment of Postmenopausal Osteoporosis and Its Effects on Pain Symptoms and Bone Metabolic Indexes/LU Ruijun， ZHONG Weibin. //Medical Innovation of China， 2020， 17（10）： 0-018

[Abstract] Objective： To investigate the clinical efficacy of Alfacalcidol combined with ALN in the treatment of PMO patients and its effects on pain symptoms and bone metabolism indexes. Method： A total of 80 patients with PMO admitted to our hospital from February 2015 to March 2017 were selected. Eighty patients with PMO were divided into the control group （n=40） and the the observation group （n=40） according to random number table method. The patients in the control group were treated with conventional calcium + Alfacalcidol， and the patients in the observation group were combined with ALN treatment on the treatment of the control group. After 12 months of continuous treatment， the total effective rate of treatment， pain symptoms before and after treatment， related bone metabolic markers and the incidence of total adverse reactions of two groups were observed. Result： The total effective rate of treatment in the observation group （95.00%） was higher than that in the control group （80.00%） （P<0.05）. The VAS scores of two groups after treatment were significantly lower than those of before treatment， and the observation group were more obvious （P<0.05）. The levels of BGP， BALP， CTX and TRACP-5b in the two groups were lower than those before treatment， and the observation group were more obvious （P<0.05）. There was no significant difference in the incidence of total adverse reactions between two groups （P>0.05）. Conclusion： Alfacalcidol combined with ALN in the treatment of PMO patients has significant clinical effects， can relieve pain and discomfort， improve osteoporosis symptoms and it is safe and reliable.

[Key words] Alfacalcidol Alendronate Postmenopausal osteoporosis Bone metabolism index

First-authors address： The Fifth Affiliated Hospital of Guangzhou Medical University， Guangzhou 510700， China

doi：10.3969/j.issn.1674-4985.2020.10.004

絕經后體內雌激素水平的降低易導致骨量大量流失而誘發骨質疏松，進而增加骨折危險，對患者生活質量造成嚴重影響[1-2]。鈣劑+維生素D及其衍生物是治療絕經后骨質疏松癥（PMO）的基礎方案，其中阿法骨化醇作為活性維生素D，雖然可以有效地調節患者體內鈣磷平衡，但作用時間短、對骨骼的重建和改建方面沒有明顯效果，導致長期治療效果不明顯，故需探求更為有效的長效藥物治療PMO[3-6]。阿倫膦酸鈉（ALN）是雙磷酸鹽骨代謝調節劑，可抑制破骨細胞生成，降低骨丟失速度，可產生類似雌激素物質對骨的增重作用持久且具有良好的耐受性[7-8]。基于此，2015年2月-2017年3月本院門診收治的PMO患者80例分別采用鈣劑+阿法骨化醇治療和在其基礎上聯合ALN治療，并對治療效果、患者疼痛癥狀等情況進行對比觀察，現報道如下。……