应用阿仑膦酸钠预防免疫性疾病糖皮质激素性骨质疏松症

Alendronate prevents steroid-induced osteoporosis in patients with rheumatic diseases

目的观察阿仑膦酸钠预防糖皮质激素性骨质疏松症的骨密度以及骨代谢指标的变化。方法选择140例患有风湿性疾病需长期应用糖皮质激素的非骨质疏松病人，包括系统性红斑狼疮、多发性肌炎、皮肌炎、干燥综合征等。将上述病人随机分为：阿仑膦酸钠组74例（阿仑膦酸钠10mg，1次／d，加上钙尔奇D0．6g，1次／d），单纯钙剂组66例（钙尔奇0．6g，1次／d），疗程24周。分别测定用药前，用药24周后的骨密度、血钙、血磷、血清碱性磷酸酶（AKP）、血清骨钙素（BGP）、尿I型胶原交联氨基末端肽（NTX）的水平。结果阿仑膦酸钠治疗组骨密度较治疗前有不同程度的增加，其中腰椎、股骨颈、大转子、WARD′S区的骨密度分别增加6．1％，6．3％，3．3％，2．2％，BGP较治疗前上升，但差异无统计学意义，尿NTX较治疗前下降（P〈0．05），而对照组的腰椎骨密度下降了8．7％，股骨颈下降9．1％（P〈0．01），大转子下降7．7％、WARD′S区下降6．4％（P〈0．05），血钙、磷、BGP、尿NTX变化差异无统计学意义。结论阿仑膦酸钠可以提高骨密度，具有预防糖皮质激素性骨质疏松的作用；单用钙剂并不能阻止激素诱导的骨质疏松的发生。

Objective To investigate the effects of alendronate （Alen） on the prevention of systemic glucocorticoid-induced osteoporosis in patients with rheumatic diseases. Methods 140 patients suffering from rheumatic diseases, including systemic lupus erythematosus, polymyositis, dermatomyositis, and Sjogren′s syndrome, with normal bone mineral density （BMD） and treated with oral glucocorticoids were randomly divided into 2 groups ： Alen ＋ calcium group （ n = 74 ） receiving Alen 10 mg once a day and caltrate D 600 0. 6 g once a day for 24 weeks and control group （ n = 66） receiving caltrate D 600 0. 6 g once a day for 24 weeks. The BMD and biomarkers of bone turnover were measured at baseline and 24 weeks after initiating glucocorticoid therapy. Results After 24 weeks, the BMD values at lumbar spine, femoral neck, major trochanter, and Ward′ s triangle increased by 6. 1%, 6. 3% , 3.3% , and 2.2% respectively compared with those at baseline （all P 〈0.05） , however, those of the control group decreased by 8. 7% , 9. 1% , 7.7% , and 6. 4% respectively （ P 〈 0.01, P 〈 0.05 ） , and the BMD levels at lumbar spine and femoral neck 24 weeks later of the Alen ＋ calcium group were both higher than those of the control group （P 〈0.01,P 〈0.05）. 24 weeks later the level of urine cross linked N-telopeptides of type Ⅰ collagen （NTX） of the Alen ＋ calcium group decreased （ P 〈 0. 05 ）, and the blood osteocalcin （BGP） of the Alen ＋ calcium group increased, however, not significantly （ P 〉 0. 05 ）. There were no significant differences in serum AKP and BGP and urine NTX 24 weeks later between these 2 groups. Conclusion Improving BMD, alendronate plays an important role in the prevention of glucocorticoid-induced osteoporosis. However, calcium treatment alone fails to prevent the loss of bone.