阿仑膦酸钠对原发性骨质疏松症患者血清IGF-1和IGFBP-3的影响

目的观察阿仑膦酸钠治疗原发性骨质疏松症患者的疗效,通过检测血Ⅰ型胶原N末端肽（NTX）、骨钙素（BGP）及血清胰岛素样生长因子-1（IGF-1）及其结合蛋白（IGFBP-3）的水平来探讨二磷酸盐的可能作用机制。方法选择80例原发性骨质疏松症患者,随机分为钙剂组40例（仅给予钙剂治疗）、阿仑膦酸钠组40例（在给予钙剂治疗的同时每周口服阿仑磷酸钠1片）。所有患者均连续治疗6个月。治疗前后都用DXA双能X线骨密度仪测定腰椎及左股骨近端骨密度（BMD）值,同时测定空腹血Ⅰ型胶原N末端肽（NTX）、BGP及IGF-1、IGFBP-3含量,并进行比较。结果阿仑膦酸钠组BMD较治疗前有明显升高,腰椎为3.08%,左股骨近端5.05%（P〈0.01）,其NTX水平下降（P〈0.05）,BGP水平升高,而IGF-1、IGFBP-3均有不同程度的升高;钙剂组BMD有下降（P〉0.05）,且NTX水平升高,BGP水平下降（P〈0.05）,而IGF-1、IGFBP-3均下降（P〉0.05）。结论阿仑膦酸钠治疗可明显升高BMD值,降低NTX,增加BGP的水平,并且可能通过提高IGF-1的活性达到促进成骨的作用。

Effects of alendronate for treating primary osteoporosis on serum IGF-1 and IGFBP-3

Objective To observe the effect of alendronate on treatment of patients with primary osteoporosis,and investigate the possible mechanism of bisphosphonate by measuring the levels of N-terminal peptide of typeⅠcollagen（NTX）,osteocalcin（BGP）,IGF-1,and IGFBP-3protein in serum.Methods We chose 80cases of primary osteoporosis,and randomly divided them into calcium treatment group（n=40）and alendronatetreatment group（calcium combined with a weekly oral alendronate）（n=40）.All the patients were treated for consecutive six months.BMD values of lumbar spine and left proximal femur were measured before and after treatment by DXA dual energy X-ray absorptiometry,and simultaneously,the levels of serum NTX,BGP,IGF-1,and IGFBP-3were measured for comparison.Results BMD of alendronate treatment group after treatment significantly increased by compared with pretherapy,BMD of lumbar spine increased 3.08%,and that of the left proximal femur increased 5.05%（P〈0.01）.NTX levels of alendronate treatment group decreased（P〈0.05）,and BGP levels elevated,while the levels of IGF-1and IGFBP-3increased to varying degree in alendronate treatment group.BMD of calcium treatment group decreased（P〈0.05）,NTX elevated,BGP decreased（P〈0.05）,whereas IGF-1and IGFBP-3decreased in calcium treatment group（P〈0.05）.Conclusion Alendronate treatment could significantly increased bone mineral density,reduced the level of NTX and increased the level of BGP,and alendronate might achieve the promotion of osteogenesis by increasing the activity of IGF-1.