不同剂量阿托伐他汀对高胆固醇血症伴骨质疏松患者骨代谢的影响

目的研究不同剂量阿托伐他汀对高胆固醇血症伴骨质疏松患者骨密度及骨代谢的影响。方法将252例高胆固醇血症伴骨质疏松患者分为3组,分别予小剂量阿托伐他汀(A组,n=84)、小剂量阿托伐他汀加依折麦布(B组,n=84)和中剂量阿托伐他汀(C组,n=84)治疗,并在治疗前及治疗后分别检测血胆固醇、骨合成代谢指标骨钙素(BGP)、骨吸收代谢指标尿脱氧吡啶啉和尿肌酐比值(DPD/Cr)和骨密度(BMD)。结果失访7例,245例患者纳入统计,平均治疗周期(5.38±0.79)个月。C组治疗后总胆固醇(TC)、低密度脂蛋白(LDL-C)明显降低,同时BGP增高、DPD/Cr降低,BMD增高。A组治疗后TC、LDL-C降低,BGP增高,但DPD/Cr和BMD较治疗前无明显改变。B组治疗后TC、LDL-C和BGP水平与中剂量他汀组无统计学差异,但与后者相比,前者DPD/Cr明显增高,而BMD明显降低。结论较大剂量阿托伐他汀具有促进骨合成、抑制骨吸收和增加BMD的作用,原因可能与他汀剂量相关,而与胆固醇降低程度无关。

Effects of different doses of atorvastatin on osteoclastic anabolism in osteoporosis patients with hypercholesterol- emia

Objective To study the effects of different doses of atorvastatin on osteoclastic anabolism in osteoporosis patients with hyper- cholesterolemia. Methods Two hundred and fifty-two patients were recruited and divided into low dose of atorvastatin group （group A）, low dose of atorvastatin adding ezetimibe group （group B ）, and moderate dose of atorvastatin group （group C ）. Before and after treated with medi- cine,the patients were measured in eholesterin, bone synthesis marker BGP, bone absorption marker DPD/Cr, and bone mineral density （BMD）. Results Two hundred and forty-five patients were included in the statistics, and the average treatment period was （ 5.38± 0.79 ） months. The level of TC and LDL-C was decreased after treatment with moderate dose of statin. At the same time, the level of BGP and BMD was increased, and that of DPD/Cr was decreased. The level of TC and LDL-C was decreased, and that of BGP was increased after treatmentwith low dose of statin,while DPD/Cr and BMD had no obvious change compared with those before treatment. Compared with that of group C, the level of TC, LDL-C and BGP in group B showed no significant difference, but the level of DPD/Cr was higher and that of BMD was lower. Conclusion Moderate dose of atorvastatin have positive effect to increase BMD though increasing bone synthesis and decreasing the bone absorption. This effect may be associated with the dose of statin, but the level of cholesterin.