鲑鱼降钙素鼻喷剂治疗绝经后骨质疏松患者骨密度及骨转换指标的变化

Changes in bone mineral density and bone turnover in postmenopausal osteoporotic patients treated with salmon calcitonin nasal spray

目的观察鼻喷鲑鱼降钙素（calcitonin）治疗绝经后骨质疏松症（postmenopausal osteoporosis，PMO）患者6个月和12个月后骨密度及骨转换指标的变化。方法选择PMO患者共67例，给予鼻喷降钙素治疗37例；其余30例PMO患者单纯服用钙剂和维生素D作为对照组。各组分别于用药前和用药后6个月和12个月采用DEXA骨密度仪测定骨密度；定量夹心酶联免疫法（ELISA）测定Ⅰ型胶原N末端肽（NTX）、骨特异性碱性磷酸酶（BALP）、抗酒石酸酸性磷酸酶（TRACP-5b）、25-羟维生素D，化学发光法测定骨钙素（BGP）。结果5例患者因医疗费用、拒绝坚持治疗退出试验，鼻喷降钙素组共32例完成试验。鼻喷降钙素治疗6个月后可见患者股骨颈和腰椎骨密度均较前有所增加，但仅在腰椎差异有统计学意义（P〈0．05），而在股骨颈治疗前后骨密度的差异无统计学意义（P〉0．05）。治疗12个月时股骨颈和腰椎骨密度较前均明显升高，差异有统计学意义（P〈0．05）。对照组在治疗6个月时的腰椎和治疗12个月时的股骨颈和腰椎部位骨密度均较治疗前降低，差异有统计学意义（P〈0．05）。鼻喷降钙素治疗6个月和12个月时，股骨颈和腰椎骨密度均较对照组升高（P〈0．05）。鼻喷降钙素治疗6个月后，TRACP-5b、NTX／Cr较治疗前降低，差异有统计学意义（P〈0．05）；治疗12个月后，除TRACP-5b、NTX／Cr较前降低更加明显以外（P〈0．01），BALP较治疗前有升高，差异有统计学意义（P〈0．05）。对照组在治疗12个月时，BALP较前有降低，差异有统计学意义（P〈0．05）。25-羟维生素D在各组经治疗后，均明显升高，差异有统计学意义。结论本研究结果显示鼻喷降钙素治疗6个月有效，12个月效果显著，可预防骨丢失，增加骨量。

Objective To study the changes of bone nfineral density （BMD） and bone turnover in postmenopausal osteoporotic patients treated with salmon calcitonin nasal spray. Methods Sixty-seven postmenopausal osteoporotic patients were enrolled in our trial. All of them received calcium and vitamin D; 37 patients were treated with salmon calcitonin nasal spray for 12 months and the other 30 patients received calcium and vitamin D only. Dual-energy X-ray absorptiometry （DEXA） and measurements of a series of bone turnover indices were performed before and after medication for 6 and 12 months. Results After treatment with salmon calcitonin nasal spray for6 months, BMD in lumbar spine 2-4 increased but no change occurred in femoral neck. However, after treatment for 12 months, BMD in both lumbar spine 2-4 and femoral neck increased. In the control group, BMD in lumbar spine 2-4 decreased after treatment for 6 and 12 months, but BMD in femoral neck decreased only after 12 months. Comparing with the control group, after treatment with salmon calcitonin nasal spray, BMD in lumbar spine 2- 4 and femoral neck were increased obviously. The level of TRACP-5b and NTX/Cr decreased after treatment with salmon calcitonin nasal spray for6 months and 12 months, while BALP increased only after treatment for 12 months. In the control group, BALP decreased after treatment for 12 months. The level of 25-（OH） vitamin D increased after treatment for 6 months and 12 months in both groups. Conclusions Long-term treatment with salmon calcitonin nasal spray prevents bone loss and may increase bone mass.