辛伐他汀对合并骨量减少的老年高胆固醇血症患者骨代谢的临床研究

Effect of simvastatin on bone metabolism in hypercholesterolic patients with osteopenia

目的短期观察他汀类药物辛伐他汀对合并骨量减少的老年高胆固醇血症患者骨代谢指标的影响。方法入选老年高胆固醇血症合并骨量减少患者55人,平均年龄(66.8±4.7)岁,男性和女性分别为24人和31人,随机分两组分别给予辛伐他汀(20 mg.d-1)和饮食控制,所有患者每天补充钙剂1000 mg。所有受试者在治疗前后检查血脂和骨代谢指标,并进行骨密度测定。结果经过治疗6个月后,治疗组患者总胆固醇、低密度脂蛋白胆固醇、甘油三脂明显低于治疗前,骨代谢指标治疗组总碱性磷酸酶、骨钙素无明显变化,尿脱氧吡啶啉肌酐比值明显降低,相应的对照组各项骨代谢指标治疗前后均无明显变化。治疗前后腰椎和股骨骨密度虽然有所增加,但未达统计学意义。结论辛伐他汀对老年高胆固醇合并骨量减少患者骨代谢的影响可能主要通过抗骨吸收作用,对骨合成代谢无明显影响。进一步扩大研究样本数量和研究时间以了解他汀类药物是否可以真正增加骨密度从而减少骨折发生风险是必要的。

Objective To investigate the short-term effect of simvastatin on the bone metabolism in hypercholesterolic patients with osteopenia. Methods 55 hypercholesterolic patients with osteopenia （mean age 66.8 ± 4.7 years, male 24 and female 31 ）were enrolled and assigned into two groups randomizedly. One group received simvatatin （20 mg/day）, another with diet control. All subjects received 1000mg calcium tablets each day. In all subjects, at baseline and after 6-months serum lipids, bone metabolism markers and BMD were measured. Results After 6-months treatment of simvastatin, total cholesterol and low density lipoprotein cholesterol and（ P 〈 0.01 for both parameters）. Alkaline phosphatase （ALP） and bone gla protein（BGP） did not change significantly. However, urine deoxypyddinoline/creatinine （Dpd/Cr） levels decreased signicantly（6.32 ± 1.36 vs 5.04 ± 1.32, P 〈 0.01 ）. Meanwhile, in the control group all metabolic markers did not change significantly. Although there was a tendency of increase of BMD in both lunar spine and femoral bone in the treatment group, none of them reached statistical significance. Conclusion Simvastatin may have potentially beneficial effects on bone metabolism in hypercholesterolic patients with osteopenia mostly by reducing bone resorption rather than by stimulating bone formation. Further studies with more patients and longer duration are necessary to evaluate its effects on prevention of osteoporosis and subsequent fractures.