他莫昔芬治疗女性维持性血液透析患者骨质疏松的疗效

【目的】观察雌激素他莫昔芬对维持性血液透析（MHD）女性患者骨质疏松的治疗作用。【方法】选取本院50例MHD女性患者按有／无骨质疏松分为A组（n＝26）与B组（n＝24），再将A组随机分为A1组（n＝13，服用他莫昔芬、骨化三醇和碳酸钙）与A2组（n＝13，不服用他莫昔芬，余同A1）；观察治疗后（12个月）患者的疗效、副作用，比较治疗前后患者血清雌二醇（E2）、骨形态发生蛋白‐2（BMP‐2）、全段甲状旁腺素（iPTH）等指标的变化；并以E2、BMP‐2水平对入组患者骨质疏松的诊断进行ROC曲线分析。【结果】治疗后A1组疗效显著优于A2组，且两组相比较差异有显著性（P＜0．05），两组副作用发生率相比较差异无显著性（P＞0．05）；治疗前A组E2、BMP‐2水平显著低于B组，治疗后A1组E2、BMP‐2水平显著高于A2组（P＜0．05），治疗前后各组iPTH、钙离子（Ca2＋）水平相比较差异无统计学意义（P＞0．05）；多元线性回归提示治疗前A组及治疗后A2组iPTH与骨密度（BMD）值呈负相关（P＜0．05），E2、BMP‐2、Ca2＋与BMD值呈正相关，且E2、BMP‐2对BMD值影响最大。B组及治疗后A1组各指标与BMD值无线性回归关系。ROC曲线提示E2、BMP‐2与入组患者BMD值关系密切。【结论】他莫昔芬可能是通过提高MHD女性患者体内E2、BMP‐2水平从而安全有效的治疗骨质疏松，且E2、BMP‐2是影响MHD女性患者骨质疏松的重要因子。

Efficacy of Tamoxifen for the Treatment of Osteoporosis in Female Patients with Maintenance He-modialysiss

Objective]To observe the efficacy of tamoxifen for the treatment of osteoporosis in female patients with maintenance hemodialysis （M HD） .Methods] According to with or without osteoporosis ,50 female patients with M HD in our hospital were chosen and divided into group A （n=26） and group B（ n=24） .Group A was randomly divided into group A1（ n=13 ,taking tamoxifen ,calcitriol and calcium carbonate） and group A2（ n=13 ,taking calcitriol and calci‐um carbonate without tamoxifen） .The efficacy and side effect at12 months after 12 months were observed .The changes of serum indicators such as estradiol（E2 ） ,bone morphogenetic protein（BMP‐2） and immunoreactive parathyroid hormone （iPTH） were compared before and after treatment .On the basis of E2 and BMP‐2 levels ,the diagnosis of osteoporosis in the enrolled patients was analyzed by ROC curve .Results]After treatment ,the efficacy in group A1 was much better than group A2 ,and there was significant difference between two groups （ P〈0 .05） ,but there was no significant differ‐ence in side effects between two groups （ P 〉 0 .05） .The levels of E2 and BMP‐2 in group A before treatment were markedly lower than those in group B ,but those in group A1 after treatment were markedly higher than those in group A2（ P〈0 .05） .There was no significant difference in the level of iPTH and Ca2＋ in each group between before and after treatment（ P〉0 .05） .Multiple linear regression analysis revealed that iPTH of group A before treatment and group A 2 after treatment had negative correlation with bone mineral density （BMD）（ P〈0 .05） ,but E2 ,BMP‐2 and Ca2＋ had pos‐itive correlation with BMD value（ P〈0 .05） .E2 and BMP‐2 had greatest influence on BMD value .All indexes in group B and group A1 after treatment had no linear regression correlation with BMD value .ROC curve revealed that E2 and BMP‐2 had close correlation with BMD value of the enrolled patients .Conclusion]Tamoxifen may be effe