鲑鱼降钙素鼻喷剂结合脉冲电磁场治疗仪治疗骨质疏松性腰痛疗效观察

目的探讨和分析鲑鱼降钙素鼻喷剂结合脉冲电磁场治疗仪治疗骨质疏松性腰痛效果。方法选取本院2012年1月至2013年12月期间所收治的78例骨质疏松性腰痛患者作为研究对象。按照随机数字表法将其分组为对照组和治疗组。对照组：采用鲑鱼降钙素鼻喷剂治疗,200IU／d;治疗组：采用鲑鱼降钙素鼻喷剂,200IU／d＋脉冲电磁场治疗仪治疗。观察两组患者治疗前、后疼痛评分情况及不良反应。结果治疗前,治疗组患者疼痛评分为（6．75±1．12）分与对照组（6．74±1．15）分比较（t=0．159,P〉0．05）。治疗后,治疗组患者疼痛评分为（1．39±0．41）分,对照组为（3.58±0．49）分,两组患者均出现明显下降,但治疗组优于对照组（t=2．432,P〈0．05）。此外,治疗组不良反应率为2．56％（1／39）明显低于对照组10．26％（4／39）（P〈0．05）。结论骨质疏松性腰痛患者采用鲑鱼降钙素鼻喷剂结合脉冲电磁场治疗仪治疗,其可有效缓解患者疼痛,且不良反应少,值得推广与应用。     

鲑鱼降钙素对骨质疏松大鼠骨折愈合的影响

目的　探讨鲑鱼降钙素 (密盖息 )对骨质疏松大鼠胫骨骨折愈合的影响。方法　Wis tar雌性大鼠卵巢摘除后 3个月开始制作左胫骨中段骨折模型 ,从术前 1周至术后 8周 ,连续每天皮下注射密盖息 2IU/kg。分别于术后 2 ,4,8周行X片检查和骨折处骨痂的组织学检查。 9周后检测腰椎和左侧胫骨中段的BMD、左胫骨扭转实验、腰椎体生物力学凹入实验。观察鲑鱼降钙对骨折愈合的影响 ,并和卵巢摘除组、雌激素注射组及假手术对照组进行比较。结果　密盖息组治疗 9周后BMD值明显升高 (P <0 0 5) ,骨折局部BMD明显高于治疗前 (P <0 0 5)。X片及组织学检查提示密盖息组比骨质疏松组的骨痂量多 ,愈合时间提前。密盖息组的凹入力和凹入应力明显高于骨质疏松组 (P <0 0 5) ,最大扭矩、剪切应力明显高于骨质疏松组 (P <0 0 5)。结论　鲑鱼降钙素能减少骨量丢失 ,促进矿化 ,加快骨痂的形成 ,促进骨折愈合 ,同时能提高骨生物力学特性和抗骨折能力     

鲑鱼降素喷鼻剂治疗老年骨性疼痛临床观察

目的 观察鲑鱼降钙素喷鼻剂治疗老年骨性疼痛的疗效.方法 老年骨性疼痛60例,其中:骨质疏松症40例,癌性骨痛20例.应用鲑鱼降钙素喷鼻剂,每日1次,每次100IU,用药前后检测血清碱性磷酸酶(ALP)、骨钙素(BGP)、酸性磷酸酶(ACP).结果 用药后血清ALP、BGP、ACP显著下降,骨痛改善,总有效率87.7%.结论 鲑鱼降钙素喷鼻剂是治疗老年骨性疼痛安全、有效的药物.     

鲑鱼降钙素鼻喷剂治疗老年骨质疏松症的临床研究

目的 观察鲑鱼降钙素鼻喷剂对老年骨质疏松症患者的疗效和安全性.方法 本研究将伴有疼痛症状的老年骨质疏松症患者95例,分为治疗组47例;对照组48例,其中对照组维D钙咀嚼片+骨化三醇软胶囊;治疗组在对照组基础上,使用鲑鱼降钙素鼻喷剂.测量治疗前及治疗半年骨密度;抽血检查治疗前及治疗半年的生化指标和骨代谢标志物;评估治疗前及半年疼痛程度;同时观察两组间不良反应发生情况.结果 ①治疗组治疗半年与治疗前及对照组比较骨密度变化极显著差异(P＜0.01);②治疗组治疗半年疼痛缓解总有效率与对照组相比均有极显著差异(P＜0.01);③治疗组治疗前后与对照组治疗前后比较血钙水平及BALP水平无显著差异(P＞0.05);治疗组治疗前后和对照组治疗前后1,25(OH)2D3水平均有显著提高(P＜0.05);治疗后两组1,25(OH)2D3水平无显著差异(P＞0.05);治疗组治疗前后和治疗后两组TRACP5b水平极显著差异(P＜0.01);但治疗组治疗前后和治疗后两组IL-1水平均无显著改变(P＞0.05).④治疗组不良反应与对照组相比无统计学意义(P＞0.05).结论 鲑鱼降钙素鼻喷剂治疗老年骨质疏松症是有效和安全的.     

鲑鱼降钙素联合恒古骨伤愈合剂治疗腰椎OPF疗效分析

目的 探讨鲑鱼降钙素联合恒古骨伤愈合剂治疗腰椎骨质疏松性骨折(OPF)的疗效.方法 自2007年11月至2009年12月简阳市人民医院骨科共收治82例腰椎骨质疏松性骨折,随机分成治疗组和对照组,治疗组42例给予鲑鱼降钙素和恒古骨伤愈合剂联合治疗,对照组40例仅给予鲑鱼降钙素治疗,比较2组的疼痛缓解效果.结果 82例治疗前用视觉模拟评分法(VAS)评分为6～9分,2组间的疼痛评分差异无统计学意义(P>0.05).治疗后3、5、8、15 d,2组疼痛VAS评分分别经秩和检验差异有统计学意义(P<0.01).治疗组不但疼痛缓解快,3个月后复查骨矿物密度改善程度亦明显优于对照组.结论 鲑鱼降钙素联合恒古骨伤愈合剂治疗腰椎骨质疏松性骨折具有良好止痛和促进成骨作用,是一种安全、有效的方法.     

鲑鱼降钙素治疗维持性血液透析骨量减少的患者

目的 观察长期应用鲑鱼降钙素对维持性血液透析（MHD）骨量减少患者的骨矿密度（BMD）、骨代谢生化指标及骨痛的作用。 方法 选择经双能X线诊断为骨量减少的MHD患者34例，给予鲑鱼降钙素皮下注射50 U/次，每周3次，连续12个月。比较治疗前后腰椎、髋部骨密度参数、血清骨代谢生化指标以及主观骨痛评分。同时观察该药的不良反应。结果 共有32例患者完成随访。与治疗前比较，治疗后第2腰椎Z值（-0.44±1.82 比0.06±1.63，P = 0.016）、腰椎总体Z值（-0.90±2.15比0.08±2.05，P = 0.002）、第3腰椎T值（-2.02±2.51比1.24±2.02，P = 0.033）、腰椎总体T值（-1.98±2.20比1.26±1.88，P = 0.009）、股骨大转子Z值（-0.65±1.11比0.48±1.12，P = 0.034）、粗隆间Z值（-0.58±0.94比0.02±1.12，P = 0.006）、髋部总体Z值（-0.66±0.80比0.08±1.08，P = 0.029）及髋部总体T值（-1.72±1.53比1.06±1.58，P = 0.016）显著增加，差异均有统计学意义。各项血清骨代谢生化指标治疗前后差异均无统计学意义。治疗1个月骨痛主观评分下降41.7%（P < 0.01）；6个月下降76.6%（P < 0.01）；12个月时保持6个月时的水平。该药的不良反应主要为恶心呕吐5例（14.71%，5/34），头晕、颜面潮红、心慌各1例（3.13%，1/32）。 结论 骨量减少的MHD患者长期皮下注射鲑鱼降钙素可改善BMD；有效缓解骨痛；但对血清骨代谢相关生化指标无明显影响。MHD患者长期应用鲑鱼降钙素是安全的，恶心呕吐较常见。     

鲑鱼降钙素联合口服钙剂治疗老年骨质疏松症的临床研究

目的：观察鲑鱼降钙素联合口服钙剂治疗老年骨质疏松症的治疗效果。方法将50例骨质疏松患者随机分为研究组和对照组,每组各25人,研究组用鲑鱼降钙素联合口服钙剂治疗,对照组单纯使用口服钙剂治疗。均为3个月的治疗期。两组治疗前后均记录患者骨痛、腰椎骨密度值。结果治疗3个月后,研究组骨痛改善明显高于对照组P＜0．01;而研究组腰椎骨密度均值在治疗后3个月有显著提高,P＜0．01,而对照组P＞0．05。结论鲑鱼降钙素联合口服钙剂治疗老年骨质疏松症能明显减轻患者疼痛、改善症状,提高患者骨密度,是一种疗效良好的安全方法。     

鲑鱼降钙素联合金天格胶囊治疗老年性骨质疏松症的临床观察

目的观察鲑鱼降钙素联合金天格胶囊治疗老年性骨质疏松症的临床疗效。方法将46例骨质疏松的患者随机分为治疗组和对照组,每组23例,治疗组采用鲑鱼降钙素联合金天格胶囊治疗骨质疏松,连续3个月为1疗程,对照组单独采用鲑鱼降钙素肌肉注射治疗骨质疏松,连续3个月为1疗程;评价治疗前后的疼痛缓解情况和腰椎骨密度(BMD)变化。结果对照治疗2个疗程后总有效率与对照组比较差异有统计学意义(P0.05)。结论鲑鱼降钙素联合金天格胶囊治疗老年性骨质疏松症有效提高骨密度,缓解临床症状。     

鲑鱼降钙素联合葡萄糖酸钙对老年性骨质疏松骨代谢指标的影响

目的 探讨鲑鱼降钙素联合葡萄糖酸钙对老年性骨质疏松骨代谢指标的影响.方法 105例老年性骨质疏松患者随机分为两组:鲑鱼降钙素组56例,给予鲑鱼降钙素和葡萄糖酸钙治疗;对照组49例,单纯给予葡萄糖酸钙治疗.治疗24周后比较治疗前后血清钙、磷、碱性磷酸酶(ALP)、骨碱性磷酸酶(B-ALP)、骨钙素(BGP)及尿中钙/肌酐比值和骨密度的变化.结果 治疗24周后,鲑鱼降钙素组血清骨钙素和骨密度均明显升高(P<0.05),血B-ALP和尿钙/肌酐比值均显著下降(P<0.01),对照组均无显著改变.两组血ALP、钙、磷浓度无显著改变(P>0.05).结论 鲑鱼降钙素联合葡萄糖酸钙疗法治疗老年性骨质疏松、改善骨代谢优于单纯葡萄糖酸钙疗法;联合治疗能改善老年性骨质疏松骨代谢异常,影响骨矿化,促进骨形成.     

Intranasal absorption of salmon calcitonin

Summary Eight normal subjects and 4 children with osteogenesis imperfecta were administered salmon calcitonin (S-CT) intranasally, and the phamacokinetics of S-CT were studied. In the normal subjects, the plasma S-CT concentration showed a dose-dependent increase over a dosage range of 200–400 IU. Maximal plasma concentrations were reached 20–60 min after intranasal administration of S-CT. The plasma calcium concentration was significantly decreased 60 min after the administration. In the children. S-CT was also absorbed through the nasal mucosa. This suggests that nasal spraying may be an efficient method for administration of S-CT.     

The effect of rectal and nasal administration of salmon calcitonin in normal subjects

Summary In order to ascertain the blood levels and the biologic responses obtained after administration of two noninjectable forms of salmon calcitonin (SCT) (i.e., a nasal spray and a suppository), two doses of 200 IU each were administered at 3 hour intervals nasally to 8 normal subjects, and rectally to 9 normal subjects. Five untreated subjects served as controls. All were given a standardized diet for 2 days before the test. Plasma salmoncalcitonin, ionized calcium, phosphate, sodium, proteins, creatinine, and alkaline phosphatase were measured repeatedly after the administration of the drug. Modifications in fractionated urinary calcium, phosphate, sodium, and creatinine excretions (and hydroxyproline for the 8 subjects treated by the nasal spray) were compared with the values measured on the previous day. Plasma concentrations of SCT were found to increase sharply with both routes of administration, the peaks being high and short after rectal administration, low but more sustained after nasal application. Despite these differences, almost similar biologic effects could be demonstrated: transient hypocalcemia, increased calciuria, phosphaturia, and natriuria. Urinary hydroxyproline excretion decreased. Plasma sodium did not increase, whereas it did in the controls. In conclusion, nasal sprays and suppositories of SCT appear to exert the known biologic effects of SCT, and might be favored for long-term treatment in diseases representing indications for calcitonin therapy.     

Clinical efficacy of salmon calcitonin in Paget's disease of bone

Clinical interest in salmon calcitonin began in 1972 when this peptide was shown to be effective in the treatment of Paget's disease. Salmon calcitonin is more potent than porcine calcitonin, with human calcitonin intermediate in potency. Salmon calcitonin is a highly effective therapeutic agent in the treatment of Paget's disease. During chronic treatment with salmon calcitonin, alkaline phosphatase activity and urinary hydroxyproline excretion decrease on an average of 50% in patients with Paget's disease. Patients may experience a variety of clinical benefits during chronic treatment, including relief of bone pain, a reversal of neurological deficits, stabilization or improvement of hearing loss, and improvement of vascularity of bone. Radiologic healing of osteolytic lesions is particularly striking with calcitonin treatment. Paget's disease patients prefer treatment with salmon calcitonin administered by means of a nasal spray. Salmon calcitonin has an excellent safety profile and produces mild side effects in a small percentage of patients. The most common side effects associated with salmon calcitonin administration are nausea and facial flushing. It is unusual to observe severe side effects. In about 20% of patients, production of antibodies may neutralize the effects of the exogenously administered calcitonin; these patients respond to human calcitonin. At this time salmon calcitonin should still be considered a valuable therapeutic agent in the treatment of Paget's disease, particularly in patients with osteolytic lesions.     

鲑鱼降钙素注射治疗骨痛90例疗效观察

目的 有研究显示鲑鱼降钙素的活性是人降钙素的40～50倍,本研究是应用鲑鱼降钙素注射治疗各种原因引起的骨痛,以观察其镇痛疗效和安全性.方法 给予鲑鱼降钙素50 IU皮下注射,每天1次,2周后50 IU,隔日1次注射,共4周,期间每周复诊1次,记录疼痛强度,并观察不良反应.结果 90例患者治疗前均有中度以上疼痛,其疼痛强度为6.57±1.52,用药2周后疼痛明显好转,其强度下降为1.25±1.15,治疗前后差异有显著性(P<0.001).疼痛完全缓解率达37例(41.1%),明显缓解率为30例(33.3%),中度缓解率为18例(20%),无效5例(6.6%).其主要不良反应是轻度恶心11例(12.2%),继续用药后消失.结论 鲑鱼降钙素能够迅速缓解各种原因引起的骨痛,安全性良好.     

Comparison of the acute effect of the intranasal and intramuscular administration of salmon calcitonin in Paget's disease

Summary On 7 patients with mild-to-moderately active Paget's disease, 200 IU of salmon calcitonin (SCT) nasal spray (NS), induced a significant decrease of the total urinary hydroxyproline excretion (THP) during the 8–16 hour and the 0–24 hour (P<0.05) periods after treatment as compared to control day. However, the administration of 100 IU of SCT intramuscularly (i.m.) caused a significantly greater effect than 200 IU-NS during the second 8 hour period after its administration (P<0.01) and on the over-all 24 hour effect (P<0.05). On 3 patients with severe Paget's disease, SCT-NS was essentially ineffective whereas the injection of SCT induced a marked diminution of the THP excretion.     

Randomised placebo-controlled trial on the effectiveness of nasal salmon calcitonin in the treatment of lumbar spinal stenosis

This is a double blind randomised controlled trial to assess the effectiveness of nasal salmon calcitonin in the treatment of lumbar spinal stenosis. The trial compared the outcome of salmon calcitonin nasal spray to placebo nasal spray in patients with MRI confirmed lumbar spinal stenosis. Lumbar spinal stenosis is one of the commonest conditions encountered by spine surgeons. It more frequently affects elderly patients and lumbar decompression has been used to treat the condition with variable success. Non operative measures have been investigated, but their success ranges from 15% to 43% in patients followed up for 1–5 years (Simotas in Clin Orthop 1(384):153–161, 2001). Salmon calcitonin injections have been investigated in previous trials and may have a treatment effect. Nasal salmon calcitonin has become available and if effective would have advantages over injections. Forty patients with symptoms of neurogenic claudication and MRI proven lumbar spinal stenosis were randomly assigned either nasal salmon calcitonin or placebo nasal spray to use for 4 weeks. This was followed by a ‘washout’ period of 6 weeks, and subsequent treatment with 6 weeks of nasal salmon calcitonin. Standard spine outcome measures including Oswestry disability index (ODI), low back outcome score, visual analogue score and shuttle walking test were administered at baseline, 4, 10 and 16 weeks. Twenty patients received nasal salmon calcitonin and twenty patients received placebo nasal spray. At 4 weeks post treatment there was no statistically significant difference in the outcome measures between the two groups. The change in ODI was a mean 1.3 points for the calcitonin group and 0.6 points for the placebo group (P = 0.51), the mean change in visual analogue score for leg pain was 10 mm in the calcitonin group and 0 mm in the placebo group (P = 0.51). There was no significant difference in walking distance between the two groups, with a mean improvement in walking distance of 21 m in the calcitonin group and 8 m in the placebo group (P = 0.78). At the end of the trial the ODI had improved by a mean of 3.7 points in the calcitonin group and 3.8 points in the placebo group (P = 0.44). This randomised placebo controlled trial has not shown any treatment effect in patients with lumbar spinal stenosis treated with nasal salmon calcitonin.     

Acute effects of nasal salmon calcitonin on calcium and bone metabolism

Summary Effects of a single dose of 200 IU of nasal salmon calcitonin (SCT) on calcium metabolism and biochemical markers of bone turnover were investigated in 12 healthy male volunteers in a randomized, placebo-controlled, crossover design. The nasal spray was given in the morning, and subsequently blood and urine samples were collected for 26 hours. There was a significant decrease in serum ionized calcium with a nadir 4 hours after administration of nasal SCT accompanied by a significant increase in serum parathyroid hormone (P = 0.01) and serum calcitriol (P = 0.04). Nasal SCT did not reduce urinary hydroxyproline/creatinine. Urinary deoxypyridinoline/creatinine was lowered significantly 2 hours after administration of nasal SCT and throughout the first 24 hours, but remained unchanged for the last 2 hours. On a 24-hour basis, urinary deoxypyridinoline/creatinine decreased from 14.1 (3.5) nmol/mmol to 11.7 (3.2) nmol/mmol after nasal SCT (P = 0.04). Nasal SCT did not change the serum levels of alkaline phosphatase, osteocalcin, and the carboxyterminal propeptide of type 1 procollagen. The results indicate that nasal SCT given as a single dose provokes a modest decrease in bone resorption lasting several hours, but leaves bone formation unaffected.     

鲑鱼降钙素对病毒性肝硬化合并骨质疏松症患者影响的临床研究

目的观察鲑鱼降钙素对病毒性肝硬化合并骨质疏松症患者骨生化、代谢指标,细胞因子及骨密度影响的临床研究。方法将64例病毒性肝炎肝硬化合并骨质疏松症患者随机分为治疗组(n=32)及对照组(n=32)。对照组给予钙剂治疗,治疗组给予鲑鱼降钙素联合钙剂进行治疗,共12个月。测定治疗前后患者血清钙、磷及1,25(OH)2D3、降钙素、甲状旁腺素(parathyroid hormone,PTH)的水平;血清细胞因子白细胞介素-6(interleukin-6,IL-6)、IL-10、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)及胰岛素样生长因子(insulin-like growth factor,IGF-1)水平以及腰椎2~4(L2~4)、股骨颈及Ward’s三角区骨密度的变化情况。结果治疗前两组的血清钙、磷及1,25(OH)2D3、骨钙素、甲状旁腺素、IL-10,IL-6、TNF-α、IGF-1及骨密度比较差异无统计学意义(P0.05);治疗12个月后治疗组患者的血清钙、1,25(OH)2D3、IL-10、IGF-1及腰椎2~4(L2~4)、股骨颈及Ward’s三角区骨密显著高于对照组;血清磷、PTH及骨钙素、IL-6、TNF-α均显著性低于对照组,差异有统计学意义(P0.05),而对照组上述治疗的水平差异无统计学意义(P0.05)。结论鲑鱼降钙素对病毒性肝硬化合并骨质疏松症有保护作用,可以有效提升患者的骨密度,改变骨代谢及细胞因子水平。     

Future horizons for calcitonin: A U.S. perspective

Injectable salmon calcitonin has been in use in the United States for more than a decade for the treatment of patients with postmenopausal osteoporosis, Paget's disease, and hypercalcemia, Sandoz Pharmaceuticals Corp. is currently in the process of developing a nasal formulation of salmon calcitonin. Studies are in progress to compare the efficacy of this nasal formulation with that of the injectable hormone in preventing bone loss and restoring bone, as well as in reducing pain associated with bone diseases. The rationale for development of a nasal formulation is to attempt to reduce the incidence of systemic side effects, inconvenience, and resulting noncompliance associated with the injectable product. In studies to date, the nasal form of calcitonin has been well tolerated by most subjects and was not notably associated with nasal irritation. The tolerability seen within the context of clinical trials suggests that a nasal formulation might be well accepted, even among asymptomatic osteoporotic patients. Asymptomatic patients with secondary osteoporosis due to steroid administration or solid organ transplantation may also be studied as possible candidates for the prophylactic use of this drug. Additional future research includes the development of an oral calcitonin agent.