阿伦膦酸钠对绝经后骨质疏松症患者骨密度、细胞因子及骨代谢指标的影响

目的观察阿伦膦酸钠治疗绝经后骨质疏松症（PMO）患者,其骨密度（BMD）、IL-6、TNFα、胰岛素样生长因子-Ⅰ（IGF-Ⅰ）及骨代谢指标的变化。方法选择年龄55—60岁的PMO患者共185例,随机分为：阿伦膦酸钠组69例,替勃龙组66例,钙剂组50例和年龄相匹配的正常妇女20例作为对照组。各组均于用药前和用药后24、48周测定BMD（采用DEXA骨密度仪）、雌二醇（E2）、碱性磷酸酶（ALP,放免法）、骨钙素（BGP）、Ⅰ型胶原N末端肽（NTX）、IL-6、TNFα、IGF-Ⅰ（ELISA）。结果阿伦膦酸钠组和替勃龙组BMD较治疗前均有不同程度的提高,腰椎BMD增幅分别为2．53％、3．65％（P〈0．05）,非优势侧股骨近端增幅分别为7．17％、3．01％（P〈0．001）。替勃龙组E2水平明显上升（P〈0．01）,IL-6、TNFα、NTX下降（P〈0．01）;阿伦膦酸钠组E2水平无变化（P〉0．05）,ALP、BGP水平上升（P〈0．05）,NTX水平下降（P〈0．05）,IGF-Ⅰ、IL-6、TNFα水平无明显变化（P〉0．05）;钙剂组和对照组各部位BMD、E2、IGF-Ⅰ、ALP、BGP继续下降（P〈0．05）,而IL-6、TNFα、NTX升高（P〈0．05）。结论阿伦膦酸钠组治疗PMO疗效显著,与替勃龙相仿。单纯服用钙剂不能治疗PMO．且继续骨量丢失。

Effects of alendronate on bone mineral density, cytokines and indices of bone metabolism in postmenopausal osteoporotic patients

OBJECTIVE: To observe the effects of alendronate on bone mineral density (BMD), cytokines and indices of bone metabolism in postmenopausal osteoporotic (PMO) patients. METHODS: 185 PMO patients, aged from 55 to 60 years, were randomized into three groups. All of them received a kind of calcium preparation, 1.0 g/d. Group A, 69 patients, received alendronate, 10 mg/d; group B, 66 patients, received tibolone 1.25 mg/d. The remaining patients, group C, received calcium preparation only. 20 women of 55 - 60 (57.4 +/- 3.5) years old were taken as normal controls. Dual-energy X-ray absorptiometry and measurement of a series of biochemical indices were carried out before and after medication at 24th and 48th week. RESULTS: After medication, BMD increased in alendronate and tibolone group. The increment in spine BMD was 2.53% and 3.65% (P < 0.05) and that in nondominant proximal femur BMD was 7.17% and 3.01% (P < 0.001). In the tibolone group, the levels of estradiol (E(2)) increased rapidly (P < 0.01), but those of IL-6, TNFalpha and type I collagen cross-linked N-telopeptides (NTX) decreased (P < 0.01). In the alendronate group, no change of levels of E(2) happened, while levels of alkaline phosphatase (ALP) and osteocalcin (BGP) increased (P < 0.05) and levels of NTX decreased (P < 0.05). There was no change of the levels of other parameters. In the calcium preparation group and control group, the levels of BMD, E(2), ALP, BGP and insulin-like growth factor I decreased (P < 0.05), while those of IL-6, TNFalpha and NTX increased (P < 0.05). CONCLUSION: Alendronate can significantly improve BMD as tibolone do. Thus it plays an important role in the treatment of osteoporosis. However calcium tablet can not prevent the loss of bone.