生活质量指标在绝经后骨质疏松症医疗后果评价中的作用

目的：评价生活质量指标在评价绝经后骨质疏松症（postmenopausal osteoporosis，PMOP）的3种常见治疗方案即雌激素替代疗法，补充维生素D加钙和二膦酸盐治疗的医疗后果中的作用。方法：将 188例确诊为PMOP的病人分为4组，其中对照组38例，维生素D加钙治疗组50例，雌激素替代疗法（hormone replacement treatment，HRT）组50例，二膦酸盐治疗组50例。重复测量治疗前、治疗后3个月和治疗后12个月的骨密度（bone mineral density，BMD）和生活质量评分（Quality of Life Sale，QOLS）。比较各组之间各不同时间点QOLS的改变，并分析QOLS的改变与BMD改变的相关性。结果：二膦酸盐组和HRT组治疗一定时间后，QOLS总分以及疾病维度和生理维度的评分和对照组相比差别有统计学意义(F＝17.335，P<0.001)，而维生素D加钙组和对照组相比差异无统计学意义；其他3个维度，4个处理组之间比较差别均无统计学意义。4个处理组疾病维度评分随时间改变不一致，二膦酸盐组在治疗3个月后病人的生活质量（疾病维度评分）就开始改善，持续治疗12个月后，病人生活质量继续改善；HRT组在治疗12个月后病人生活质量才开始改善；维生素D加钙组在治疗12个月后，病人生活质量改善不明显。生活质量疾病维度评分的改变与各个部位BMD变化均有直线相关关系，相关系数为0.608～0.827。结论：生活质量指标可以作为绝经后骨质疏松症医疗后果评价的指标和依据之一。

Quality of life in the treatment assessment of postmenopausal osteoporosis

Objective To evaluate quality of life (QOL) in the treatment assessment of postmenopausal osteoporosis (PMOP) by comparing the QOL of three treatments: hormone replacement treatment, supplement of calcium and vitamin D and risedronate. Methods All patients with postmenopausal osteoporosis (PMOP) in this clinical trial had been allocated into 4 groups: placebo therapy group, vitamin D addition calcium therapy group,hormone replacement treatment(HRT)therapy group, and risedronate therapy group. We measured the bone mineral density(BMD)and quality of life sale(QOLS)of patients in three times,before the treatment,3 months after the treatment,and 12 months after the treatment. The differences of the QOL and BMD at the 4 groups and at different time, the linear correlation of the change of QOL and the change of BMD, were both compared after the measurement. Results The total score of QOL and the score of disease domain and physical domain of HRT therapy group and risedronate therapy group were higher than the placebo therapy group (F=17.335,P< 0.001), but vitamin D addition calcium therapy group was not different from that of the placebo therapy group. The score of other three domains had no statistically significant difference among the 4 groups. The score of disease domain of the patients of risedronate therapy group started to increase after 3 months of treatment, and continued to increase after 12 months of treatment. The score of disease domain of the patients of HRT therapy group started to increase only after 12 months of treatment. But the score of disease domain of the patients of vitamin D addition calcium therapy group did not increase after 12 months of treatment. The changes of the score of disease domain had the linar correlation with the changes of BMD, and the correlation coefficient was from 0.608 to 0.827. Conclusion QOL may become one of the indexes of medical treatment outcome assessment system for PMOP.