阿仑膦酸钠对维持性血液透析骨质疏松患者骨密度的影响

目的 观察口服阿仑膦酸钠对维持性血液透析（MHD）患者骨密度的影响。 方法 选取MHD伴肾性骨病骨质疏松患者28例，随机分为服药组（n＝13）和未服药组（n＝15）。服药组患者口服阿仑膦酸钠片70 mg，1次/周。观察服药组患者服药后6、12、18个月与未服药组随访18个月时的临床情况。应用双能X线骨密度仪测定腰椎正位（L1～L4）、左股骨近端、左股骨颈骨密度，计算T值及Z值。测定透前肝肾功能、血常规、血钙、血磷、血全段甲状旁腺素、碱性磷酸酶，计算Kt/V。记录新骨折发生情况。 结果 （1）骨密度：服药组治疗18个月后L1～L4、左股骨近端及左股骨颈骨密度有所下降，但与治疗前差异无统计学意义。未服药组随访18个月时，L1～L4、左股骨近端及左股骨颈骨密度显著低于治疗前（P < 0.01）；左股骨近端骨密度及T值显著低于同期服药组（P < 0.01）。（2）骨折：服药组新发生骨折1例 （1/13）；未服药组新发生骨折5例（5/15）。（3）不良反应：服药组1例首次服阿仑膦酸钠片后出现上腹部不适，2周后缓解。 结论 口服阿仑膦酸钠治疗有助MHD肾性骨病患者骨密度的稳定，且耐受性较好。

Effects of alendronate sodium on bone mineral density in maintenance hemodialysis patients with osteoporosis

Objective To evaluate the effects of alendronate sodium on bone mineral density (BMD) in maintenance haemodialysis (MHD) patients with osteoporosis. Methods Twenty-eight MHD patients with osteoporosis diagnosed by dual energy X-ray absorptiometry were randomly divided into control group (n=15) and treatment group (n=13). Patients in treatment group were treated with oral 70 mg alendronate sodium once a week for 18 months. BMD of hip and lumbar spine was measured by dual energy X-ray absorptiometry at baseline and the end of the 6th, 12th and 18th month. Parathyroid hormone, calcium, phosphorous, alkaline phosphatase levels, blood routine, hepatic and renal function were assayed at baseline and the end of the 18th month, Kt/V was calculated, new bone fracture was recorded. Results The BMD, T-scores and Z-scores in the lumbar spine and specific regions of the hip were stable in the treatment group and obviously decreased in the control group (P<0.01). New bone fracture was found in 1 patient of the treatment group and 5 patients of the control group. The side-effect of alendronate sodium was epigastric discomfort in 1 cases. Conclusions Oral alendronate sodium appears to be well tolerated in MHD patients and keep the BMD stable in the lumbar spine and specific regions of the hip.