重组人甲状旁腺素(1-34)与降钙素治疗绝经后骨质疏松临床观察

目的:观察对比重组人甲状旁腺素(1-34)Recombinant human parat-hyroid hormone,rhPTH(1-34)],后简称PTHI和降钙素(calcitionin,CT)对绝经后妇女骨质疏松症的疗效.方法:符合入选标准的56例绝经后妇女骨质疏松患者随机分为两组:PTH组(n=30)皮下注射重组人甲状旁腺素20 μg每天1次;CT组(n=26)肌肉注射降钙素20 Iu每周1次,两组均每日给予钙尔奇D 600mg/d,连续治疗6个月.比较治疗前后腰椎(L_(2～4))骨密度及T值,血钙磷及碱性磷酸酶(Alkaline phosphatase,AKP)等指标的变化及观察有无不良反应.结果:治疗后PTH组和CT组腰椎(L_(2～4))骨密度(Bone mineral density,BMD)均有明显增加PTH组:(-4.09±1.30 vs-3.70±1.17)SD;CT组:(-4.03±1.27 vs-3.74±1.19)SD,均P<0.01].但两组间比较无明显差异.PTH组治疗后AKP明显增高(88.2±28.2vs 123.2±34.2)U/L,P<0.05],而CT组无明显变化.另外,CT组治疗后血清胆固醇(Total cholesterol,TC)降低(5.64±0.61 vs 5.22±0.70)mmol/L,P<0.O1].两组均无严重不良反应发生.结论:rhPTH(1-34)与降钙素都能显著提高BMD和缓解骨质疏松症状,对于治疗骨质疏松安全有效.

A comparison of rhPTH(1-34) and calcitonin therapy for post-menopausal women with osteoporosis

Objective:To observe the therapeutic effects of recombinant human parathyroid hormonerhPTH(1-34)]and ealcitonin on post-menopausal women with osteoporosis.Methods:56 postmenopausal women with osteoporosis were randomly divided in to PTH (n=30) and CT (n=26) groups.The patients in PTH group were treated with rhPTH(1-34)20μs/d by subcutaneous injection,and those in CT group were treated with calcitonin 20 IU/week by intramuscular injection.All patients were given oral calcium (Ca 600 mg+Vit D3 125 U.QD).All the treatments lasted for six months.Lumbar spine(L_(2～4)) bone mineral density (BMD),T value,serum calcium,serum phosphate and serum alkline phosphatase were in two groups before and after treatment.Results:In two groups BMD was.remarkably increased after treatmentPTH:(0.74±0.09 vs 0.76±0.08)g/cm~2;CT:(0.74±0.09 vs 0.76 ±0.09)g/cm~2,P<0.01].T-Scores were also significantly increased after treatmentPTH:(-4.09±1.30vs-3.70±1.17)SD,CT:(-4.03±1.27 vs-3.74±1.19)SD,P<0.01].But there were no significant differences between two groups.After treatment,AKP levels were obviously increased in PTH group(88.2±28.2 vs 123.2±34.2)U/L,P<0.05],whereas serum cholesterol significantly decreased in CT group(5.64±0.61 vs 5.22±0.70)mmol/L,P<0.01].Conclusion:Both rhPTH(1-34) and calcitonin treatment can increase lumbar spine BMD and relievesymptoms in patients with osteoporosis.