阿仑膦酸钠治疗COPD患者骨质疏松症的疗效及对肺功能的影响

The effect for COPD patients with osteoporosis and on lung function using alondronate

目的 评价阿仑膦酸钠治疗慢性阻塞性肺疾病 (COPD)患者骨质疏松症的近期临床疗效及对肺功能的影响。方法 COPD患者 38例 ,经骨密度检查 ,并根据WHO诊断标准确诊为骨质疏松症 ,连续服用阿仑膦酸钠和碳酸钙 ,于治疗 6个月后复测患者骨密度、肺功能以及血清钙、磷、碱性磷酸酶 (ALP)、血清骨钙素 (BGP)和晨尿游离脱氧吡啶啉排泄率 (Dpd/Cr) ;在服药期间每月在门诊随诊 1次 ,观察患者临床症状、血常规及肝肾功能等生化指标。结果 治疗 6个月后患骨痛症状改善 ,FEV1及FEV1%有显著提高 ,腰椎正、侧位、左股骨颈、左股骨近端及Ward’s三角的骨密度均有不同程度增高。治疗前FEV1、治疗后FEV1变化值△FEV1与腰椎正、侧位骨密度变化值△APL1 4及△LatL2 4间呈正相关。治疗后血清钙、BGP水平升高 ;血清磷、ALP水平及晨尿Dpd/Cr值均下降。无严重的副作用及过敏反应。结论 阿仑膦酸钠是治疗COPD合并骨质疏松症的安全有效的药物 ,可提高患者骨密度 ,也有利于肺通气功能的改善 ,特别适合于病情较重或有骨折的患者。

Objective Evaluation of the effect for COPD patients with osteoporosis and on lung function using alondronate. Methods 38 COPD patients entered this study. Their bone mineral densities(BMD) were measured and osteoporosis was diagnosed according to the standard criteria of WHO. The patients took alondronate and calcium carbonate consecutively. The BMD, serum calcium and phosphorus, alkaline phosphatase, serum osteocalcin and the excretion rate of deoxypyridinaline (Dpd/Cr) in the morning urine were detected again after 6 months treatment. During the period of treatment, the patients were asked to come to the out-patient clinic once a month for observation of clinical syndrome, blood routine, liver and renal function. Results After 6 months treatment, bone pain of the patients improved. FEV 1 and FEV 1% increased significantly. The BMD of the frontal and lateral loin vertebraes, the neck and close end of the left femur and the Wards' triangle increased to varying degrees. The changed values △FEV 1 of pretreatment and posttreatment were correlative positively to the changed values of the BMD of loin vertebraes(△APL 1-4 and △LatL 2-4). The serum calcium and BGP level increased and the serum phosphorus, serum ALP and Dpd/Cr in the morning urine decreased after treatment. There were no severe side effect and allergy.Conclusion Alondronate is a safety and effective drug for COPD complicated by osteoporosis. At the time of increasing the patients BMD, the ventilation function of the lung can be increased. It is suitable specially for severe patients and patients with bone fracture.