鲑鱼降钙素治疗维持性血液透析骨量减少的患者

Treatment on osteopenia of maintenance hemodialysis patients with salmon calcitonin

目的观察长期应用鲑鱼降钙素对维持性血液透析（MHD）骨量减少患者的骨矿密度（BMD）、骨代谢生化指标及骨痛的作用。方法选择经双能X线诊断为骨量减少的MHD患者34例，给予鲑鱼降钙素皮下注射50U／次，每周3次，连续12个月。比较治疗前后腰椎、髋部骨密度参数、血清骨代谢生化指标以及主观骨痛评分。同时观察该药的不良反应。结果共有32例患者完成随访。与治疗前比较，治疗后第2腰椎Z值（-0．44±1．82比0．06±1．63，P=0．016）、腰椎总体Z值（-0．90±2．15比0．08±2．05，P=0．002）、第3腰椎T值（-2．02±2．51比1．24±2．02，P=0．033）、腰椎总体T值（-1．98±2．20比1．26±1．88，P=0．009）、股骨大转子Z值（-0．65±1．11比0．48±1．12，P=0．034）、粗隆间Z值（-0．58±0．94比0．02±1．12，P=0．006）、髋部总体Z值（-0．66±0．80比0．08±1．08，P=0．029）及髋部总体T值（-1．72±1．53比1．06±1．58，P=0．016）显著增加，差异均有统计学意义。各项血清骨代谢生化指标治疗前后差异均无统计学意义。治疗1个月骨痛主观评分下降41．7％（P〈0．01）；6个月下降76．6％（P〈0．01）；12个月时保持6个月时的水平。该药的不良反应主要为恶心呕吐5例（14．71％，5／34），头晕、颜面潮红、心慌各1例（3．13％，1／32）。结论骨量减少的MHD患者长期皮下注射鲑鱼降钙素可改善BMD；有效缓解骨痛；但对血清骨代谢相关生化指标无明显影响。MHD患者长期应用鲑鱼降钙素是安全的，恶心呕吐较常见。

Objective To study the effect of long-term salmon calcitonin on bone mineral density （BMD）, bone metabolism biochemical indicators and subjective score of bone pain in maintenance hemodialysis （MHD） patients with osteopenia. Methods Thirty-four MHD patients diagnosed as osteopenia by dual-energy X-ray absorptiometry （DXEA） were enrolled in this study. All the patients were treated with hypodermic injection of salmon calcitonin （50 U, thrice a week） for 12 months. The detecting parameters were as follows： BMD with DEXA in lumbar spine （LI-IA）, femoral neck, troch, inter, and Ward＇s triangle before and after the study; serum bone metabolism biochemical indicators before and 6 and 12 months after the study; subjective scores of bone pain before and 1, 6, and 12 months after the study. Results Thirty-two patients were followed-up successfully. As compared to BMD parameters before study, the total T-score （-1.98± 2.20 vs 1.26±1.88, P=0.009） and total Z-score （-0.90±2.15 vs 0.08±2.05, P=0.002） of lumbar spine, the total T-score （-1.72±1.53 vs 1.06±1.58, P=0.016） and totle Z-score （-0.66±0.80 vs 0.08±1.08, P=0.029） of hip, the T-score of L3 （-2.02±2.51 vs 1.24±2.02, P=0.033）, the Z- score of L2 （-0.44±1.82 vs 0.06±1.63, P=0.016）, the Z-score of femoral troeh （-0.65±1.11 vs 0.48±1.12, P=0.034） and tile Z-score of inter （-0.58±0.94 vs 0.02±1.12, P=0.006） were increased significantly after study. But there were no significant differences in other examined regions and serum t）iochemical parameters. The subjective scores of bone pain were decreased rapidly for 41.7% after 1 month （P〈0.01） and 76.6% after 6 months （P〈0.01）. The subjective score of bone pain after 12 months was similar to 6 months. The side effects of sahnon calcitonin included nausea and vomitting in 5 cases （14.71%, 5/34）, dizziness, blushing and flustered in 1 case respectively （3.13% ,1/32）. Conclusions Lomg-term hypodermic injection of sahnon caleitonin can improve BMD and bone pain for MHD patients with osteopenia but has no significant effect on serum bone metabolism biochemical indicators. Sahnon calcitonin is safe fur MHD patients with seldom side effects, such as nausea and vomitting.