重组人PTH（1-34）与依降钙素对绝经后女性骨质疏松患者骨代谢和血清SPARC的影响

Effects of recombinant human parathyroid hormone （1-34） and elcatonin on bone metabolism and serum SPARC in postmenopausal women with osteoporosis

目的 观察重组人甲状旁腺素（1-34）[ rhPTH（1-34）]和依降钙素对绝经后女性骨质疏松患者骨密度和骨代谢及血清富含半胱氨酸的酸性蛋白（ SPARC）水平的影响.方法 124例绝经后女性骨质疏松症患者随机分为PTH组（n=89）,给予rhPTH （1-34）200 U皮下注射每日一次和CT组（n=35）,给予依降钙素20U肌肉注射每周一次,共12个月.于治疗前、治疗后6个月、12个月测定各组一般生化指标,腰椎L2-4、左股骨颈、大转子及Ward三角的骨密度、血清钙、磷水平.采用酶联免疫法（ELISA）测定血清骨碱性磷酸酶（BSAP）、富含半胱氨酸的酸性蛋白（SPARC）等骨代谢相关指标水平情况.结果 rhPTH治疗12个月后腰椎L2-4骨密度较基线增加了7.9％（P＜0.05）；血清钙和BSAP水平12个月时较治疗前分别增加了8.3％和93.4％（均P＜0.05）；血清SPARC水平12个月时较基线增加了12.6％（P＜0.05）；与治疗前相比,依降钙素治疗12个月时腰椎L2-4骨密度增加了3.2％（P＜0.05）；血清钙、BSAP和SPARC水平均无显著改变.结论 rhPTH （1-34）能显著促进骨合成代谢,其疗效优于依降钙素；血清SPARC水平的增加可能在rhPTH促进成骨过程中起重要作用.

Objective To investigate the effect of rhPTH （1-34） and elcatonin on bone metabolism and serum secreted protein acidic and rich in cysteine （ SPARC ） in postmenopausal women with osteoporosis.Methods One hundred and twenty-four postmenopausal women with osteoporosis were randomly divided into 2 groups：One group was treated with recombinant human parathyroid hormone （ 1-34 ） [ rhPTH （ 1-34 ） ] 200 U/d by subcutaneous injection （PTH group,n =89 ）and another group was treated with elcatonin 20 U/week by intramuscular injection （CT group,n =35 ） for 12 months.All patients received a basic therapy with oral calcium （ Ca 600 mg＋ Vit D3125 U,q..d.）.The bone mineral density （ BMD ） of lumbar spine（ L2-4 ）,the left femoral neck,greater trochanter,and Ward＇s triangle,serum calcium and phosphate were measured by baseline,6 months＇ and 12 months.Levels of serum bone-specific alkaline phosphatase（ BSAP）,serum secreted protein acidic and rich in cysteine （SPARC）were determined by an ELISA assay.Results By 12 months,rhPTH （ 1-34 ） treatment significantly increased the lumbar spine L2-4 BMD 7.9% （P〈0.05）,serum calcium 8.3 % （ P〈 0.05 ）,serum BSAP 93.4% （ P〈 0.05 ）,serum SPARC by 12.6%[ （ 195.68±59.57 vs 173.81 ±81.33 ） pμg/L,P〈0.05 ].Elcatonin therapy increased the lumbar spine L2-4 BMD by 3.2% （P〈0.05） at the end of 12 months,but elcatonin did not influence serum calcium,BSAP and SPARC.The rhPTH（ 1-34 ） increased lumbar spine L2-4 BMD more than elcatonin did at 12 months（ P〈0.05 ）.Conclusion rhPTH （1-34） could promote the bone anabolism more effectively than elcatonin did.Serum SPARC may play an important role in promoting osteogenesis by rhPTH.