唑来膦酸联合钙剂治疗老年慢性阻塞性肺疾病患者骨质疏松症的临床疗效

摘要

目的 研究老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并骨质疏松症患者应用唑来膦酸结合钙尔奇对患者骨密度、生化与骨代谢相关指标的影响.方法 102例COPD合并骨质疏松症患者,按随机数字表法将其分为治疗组(n＝51)及对照组(n＝51).对照组给予钙尔奇治疗,治疗组给予唑来膦酸联合钙尔奇治疗,为期12个月.检测治疗后两组患者的腰椎1 ～4 (L1～4)、股骨颈骨密度及血钙(Ca)、血磷(P)、25 羟基维生素 D[25(OH)D3]、甲状旁腺素(parathyroid hormone,PTH)、骨钙素(osteocalcin,OC)、1型胶原羧基末端肽(type 1 collagen carboxy terminal peptide,β-CTX)、1型前胶原氨基端肽(type 1 procollagen amino terminal peptide,P1NP)、骨源性碱性磷酸酶(bone alkaline phosphatase,BALP)水平的变化情况,记录两组患者药物的不良反应.结果 治疗后12个月后,治疗组腰椎1～4 (L1～4)、股骨颈骨密度均显著高于同时期对照组(P＜0. 05);治疗后6个月后,治疗组患者血清PTH、OC、P1NP、BALP均显著高于治疗前(P＜0. 05),而25(OH)D3及β-CTX 均显著低于治疗前(P＜0. 05),而Ca、P差异无统计学意义(P＞0. 05).两组药品不良反应发生率比较,差异无统计学意义(P＞0. 05).结论 唑来膦酸联合钙剂提升COPD患者骨密度,改善骨代谢状态,可以安全有效地防治老年COPD合并骨质疏松症.%Objective To study the changes in bone mineral density, bone biochemistry and turnover markers in elderly patients with chronic obstructive pulmonary disease ( COPD) and osteoporosis before and after treated with zoledronic acid and calcium. Methods 102 patients with COPD and osteoporosis were divided into treatment group ( n ＝51) and control group ( n ＝51) according to random number table. The control group was treated with calcium and the treatment group was treated with zoledronic acid in combination with calcium for 12 months. After treatment, the bone mineral density of lumbar vertebrae 1-4 (L1-4), femoral neck, and the levels of blood calcium (Ca), blood phosphorus (P), 25-hydroxyvitamin D [25(OH)D3], parathyroid hormone (PTH), osteocalcin (BGP), type 1 collagen carboxy terminal peptide (β-CTX), Type 1 procollagen amino terminal peptide (P1NP) and bone alkaline phosphatase (BALP) were measured in the two groups. The adverse effects in the two groups of patients were recorded. Results After 12 months of treatment, the lumbar vertebrae 1-4 (L1-4) and femoral neck bone mineral density of the treatment group were significantly higher than those in the control group (P＜0. 05). In the treatment group, after 12 months of treatment, levels of serum PTH, BGP, P1NP and BALP were significantly higher than those before treatment (P＜0. 05), levels of 25(OH)D3and β-CTX were significantly lower than those before treatment (P ＜ 0.05), and levels of blood calcium and phosphorus did not change significantly. There were no significant differences in the incidence of adverse drug reactions between the two groups (P ＞0. 05). Conclusion Zoledronic acid combined with calcium could improve bone mineral density in elderly patients with COPD and osteoporosis, and improve bone biochemical and metabolic status.