阿仑膦酸钠治疗原发性骨质疏松症的疗效观察

发布时间：2018-04-06 23:14

本文选题：原发性骨质疏松症　切入点：阿仑膦酸钠　出处：《新乡医学院》2015年硕士论文

【摘要】：背景在世界范围,随着老龄化社会的到来,原发性骨质疏松症是一个逐渐被人们重视的疾病。目前,全世界原发性骨质疏松症的患病人数超过了两个亿,其发病率逐渐升高,已经给社会和家庭带来了巨大的负担,如何有效预防和治疗原发性骨质疏松症已经成为基础和临床医学领域的一个重要课题。目的通过检测血I型胶原N末端肽(NTX)、骨钙素(BGP)、血钙、血清胰岛素样生长因子1(IGF1)及其结合蛋白(IGFBP3)的水平来探讨阿仑膦酸钠治疗原发性骨质疏松症患者的疗效。方法将80例原发性骨质疏松症患者分为对照组和实验组,对照组和实验组的病例数均为40例。两组患者的疗程均为6个月。实验组和对照组的患者每天均口服钙剂,产品来自英国葛兰素史克公司,产品规格为0.6g/片,一次一片,一日一次,睡前服用。实验组患者在口服钙剂的基础上口服阿仑膦酸钠,产品来自中美杭州默沙东公司,产品规格为70mg/片,一次一片,一周一次,早晨空腹用200ml以上温开水吞服,半小时内不能进食和平躺。治疗前后两组患者均进行视觉模拟疼痛评分；治疗前后两组患者均用Prodigy骨密度仪测定腰椎(L2-4)及左股骨近端(股骨转子间)骨密度值；同时测定空腹血清NTX、BGP、IGF1、IGFBP3、血钙的含量,并进行统计学分析。结果治疗前两组视觉疼痛模拟评分相比差异均无显著性(P0.05),治疗6个月后两组视觉疼痛模拟评分较治疗前明显下降(P0.05)。通过6个月的治疗,实验组的骨密度水平与治疗前相比,有显著的提高,差异具有统计学意义(P0.05),其中腰椎(L2-4)骨密度与治疗前相比增加高达18.07%,左股骨近端(股骨转子间)骨密度与治疗前相比增加高达35.52%。通过治疗6个月后,对照组腰锥椎体的骨密度与治疗前比较明显下降(P0.05),对照组股骨近端骨密度与之前比较虽有所下降,但差异无统计学意义(P0.05)。与对照组比较,治疗6个月后实验组骨密度水平明显增高(P0.01)。治疗6个月后,实验组的血清BGP水平明显增高(P0.05),NTX水平明显下降(P0.01)；而对照组治疗后BGP水平明显下降(P0.05),NTX水平有所升高(P0.05),差异无统计学意义。与对照组比较,治疗6个月后,实验组BGP水平明显增高(P0.05),NTX水平显著降低(P0.05)。治疗6个月后,实验组血清IGF1和IGFBP3的水平显著增高(P0.05)。对照组血清IGF1、IGFBP3水平明显下降(P0.05)。与对照组比较,实验组IGF1、IGFBP3水平明显增高(P0.05)。治疗前,两组血钙水平比较差异无统计学意义(P0.05);治疗6个月后,两组血钙水平治疗前后都出现不同程度上升,差异具有统计学意义(P0.05)。结论(1)阿仑膦酸钠可显著改善患者的骨代谢,抑制骨骼的吸收,增强骨骼的合成,增强骨密度,最终可以提高患者的生活质量。(2)阿仑膦酸钠主要是通过降低体内NTX含量,提高体内BGP含量,促进IGF1及IGFBP3的表达,达到抑制破骨细胞和促进成骨细胞活性的作用,增强骨密度。
[Abstract]:Background in the world, with the arrival of aging society, primary osteoporosis is a disease that people pay more and more attention to.At present, the number of people suffering from primary osteoporosis in the world has exceeded 200 million, and the incidence of osteoporosis has gradually increased, which has brought a huge burden to society and families.How to effectively prevent and treat primary osteoporosis has become an important subject in the field of basic and clinical medicine.Objective to investigate the efficacy of alendronate sodium in the treatment of primary osteoporosis by detecting the levels of blood type I collagen N-terminal peptide (NTX), osteocalcin (BGP), serum calcium, serum insulin-like growth factor (IGF-1) and its binding protein (IGFBP3).Methods 80 patients with primary osteoporosis were divided into control group and experimental group.The course of treatment was 6 months in both groups.Patients in the experimental group and control group were treated with oral calcium daily, GlaxoSmithKline (GlaxoSmithKline), 0.6g/ tablets, one tablet at a time, once a day, before bedtime.The patients in the experimental group were treated with alendronate on the basis of oral calcium. The products were taken with 70mg/ tablets, one tablet at a time, once a week on an empty stomach in the morning with warm boiled water above 200ml.You can't eat and lie on your back for half an hour.Statistical analysis was carried out.Results there was no significant difference in visual pain simulation scores between the two groups before treatment. After 6 months of treatment, the visual pain analog scores of the two groups were significantly lower than those of before treatment.After 6 months of treatment, the bone mineral density in the experimental group was significantly higher than that before treatment.The difference was statistically significant (P 0.05). The bone mineral density of lumbar spine L2-4 increased as much as 18.07, and the bone density of left proximal femur (intertrochanteric femur) increased as much as 35.52% compared with that before treatment.After 6 months of treatment, the BMD of lumbar cone vertebrae in control group was significantly lower than that before treatment, and that of proximal femur in control group was lower than that before treatment, but the difference was not statistically significant.Compared with the control group, the bone mineral density of the experimental group was significantly higher than that of the control group after 6 months of treatment.After 6 months of treatment, the serum BGP level in the experimental group was significantly higher than that in the control group, and the level of BGP in the control group was significantly lower than that in the control group. There was no significant difference between the two groups.Compared with the control group, after 6 months of treatment, the level of BGP in the experimental group was significantly higher than that in the control group.After 6 months of treatment, the levels of serum IGF1 and IGFBP3 in the experimental group were significantly higher than those in the control group (P 0.05).In the control group, the level of IGF1 and IGFBP3 decreased significantly (P 0.05).Compared with the control group, the IGF1 IGFBP3 level in the experimental group was significantly higher than that in the control group (P 0.05).Before treatment, there was no significant difference in serum calcium level between the two groups before and after treatment, but after 6 months of treatment, the level of serum calcium in the two groups increased in varying degrees before and after treatment, and the difference was statistically significant (P 0.05).Conclusion (1) Alendronate can significantly improve bone metabolism, inhibit bone resorption, enhance bone synthesis, enhance bone density, and ultimately improve the quality of life of patients. Alendronate sodium is mainly by reducing the content of NTX in vivo.The content of BGP was increased, the expression of IGF1 and IGFBP3 was promoted, the activity of osteoclast and osteoclast was inhibited, and bone mineral density was enhanced.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R580

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