长期雌激素替代和维生素D_3治疗原发性骨质疏松妇女对尿吡啶啉和脱氧吡啶啉与骨密度影响

Effects of long term treatment with hormone replacement therapy and 1 αD 3 on urinary pyridionline,deoxyridinoline and bone mineral density in osteoporotic postmenopausal women

采用一新骨吸收指标尿吡啶啉（Ｐｙｒ）和脱氧吡啶啉（ＤＰｙｒ）以及骨密度（ＢＭＤ）观察日本４８例原发骨质疏松绝经后妇女，年龄为４９～８２岁，平均５６岁，绝经年限均在３年以上，平均１０年。进行雌激素替代治疗（ＨＲＴ，ｎ＝１３）及１αＤ３治疗（ｎ＝２０）３年，并与单纯钙剂治疗（ｎ＝１５）比较。结果可见治疗前尿Ｐｙｒ和ＤＰｙｒ与ＢＭＤ，及治疗６个月后的尿Ｐｙｒ和ＤＰｙｒ与治疗２４个月后的腰椎ＢＭＤ均有明显的负相关；ＨＲＴ组和１αＤ３组治疗后尿Ｐｙｒ和ＤＰｙｒ在不同时间均有明显下降；ＨＲＴ组腰椎、股骨颈和全身三个部位ＢＭＤ在治疗后不同时间有明显上升；且ＨＲＴ组尿Ｐｙｒ、ＤＰｙｒ治疗后的下降率和腰椎ＢＭＤ治疗后的上升率明显大于１αＤ３组。提示雌激素替代治疗和１αＤ３治疗均可明显抑制骨吸收，而前者作用优于后者并增加骨量。尿Ｐｙｒ及ＤＰｙｒ为目前骨吸收的特异、敏感指标，可作为骨质疏松治疗的反映指标。

Using new biochemical markers of bone turnover:pyridinoline and deoxypyridinoline,and lumbar spinal,femoral neck and total body BMD,we observed 48 osteoporotic Japanese women aged 49 82 years with an average of 56,with low bone mass and all postmenopausal more than 3 yr.They were hormone replacement therapy group (HRT,n=13),l αD 3 treatment group(n=20) and control treatment group(n=15).At 3 years affer the initiation of therapy,their effects were comopared.Results showed that marked increase in excreption of urinary Pyr and DPyr was associated with a significant decrease in the BMD of three parts,and highly significant negative correlations were found between percent change in U Pyr,DPyr at 6 months and percent change in L 2-4 BMD after 24 months of treatment.During the study period,the percentage change from baseline for U Pyr,decreased significantly and markedly from baseline after treatment in the two treatment group(HRT and l αD 3),compared to those in the control group.The percentage changes from baseline for the total body,L 2-4 and femoral neck BMD in HRT group was significantly higher after treatment than those in control group,but no BMC changes were found in l αD 3 and control group during the treatment.Comparison between HRT and l αD 3 showed the median percentage change from baseline in HRT group for U Pyr nad U DPyr was significantly lower,and for L 2-4 BMD was significantly higher than that in l αD 3 group.These findings suggest that long term treatment with hormone replacement therapy and vitamin D treatment in postmenopausal women could be prevent bone loss by decreasing bone turnover,hormone replacement therapy might be more effective in increasing bone mass than vitamin D,and Pyr and Dpyr could be used to predict response to osteoporosis therapy.