唑来膦酸治疗女性绝经后骨质疏松所致急性发热临床分析

Analysis of acute fever reaction in postmenopausal women with zoledronic acid treatment for osteoporosis

目的分析静脉用唑来膦酸治疗女性绝经后骨质疏松患者引起的急性发热反应及其相关因素。方法回顾性分析我科2010年6月至2012年4月使用静脉用唑来膦酸5mg治疗的绝经后骨质疏松患者共63人。观察急性期发热出现比例。按是否出现发热症状分为发热组与无发热组。比较两组患者年龄、静脉用唑来膦酸治疗前骨质疏松严重程度、甲状旁腺激素、血清钙差异,及治疗前使用抗骨质疏松药物差异。结果 63例患者中共观察到21例发热,占33.3%。71%(15/21)的患者治疗当天出现发热,于患者均为次日出现发热。66.7%(14/21)的患者发热持续1天,5例发热持续2天,发热时平均体温(38.8±0.5)℃。发热组与无发热组比较,发热组治疗前甲状旁腺激素水平显著高于无发热组(P值<0.05);骨质疏松严重程度、血清钙两组无显著差异。结论绝经后骨质疏松患者静脉用唑来膦酸治疗时出现急性期发热反应并不少见,但均为一过性。治疗前PTH水平与发热相关。

Objective To analyze the incidence of acute fever reaction after the treatment of intravenous zoledronic acid in postmenopausal women with osteoporosis, and to identify the related factors. Methods Clinical data of 63 postmenopausal women with osteoporosis, who were treated with intravenous infusion of 5mg zoledronic acid from June 2010 to April 2012, were analyzed retrospectively. The incidence of acute fever reaction in these patients was observed. All the patients were divided into fever group and non-fever group according to whether having fever symptoms or not. The age, severity of osteoporosis before zoledronic acid treatment, variations of parathyroid hormone and serum calcium, and the use of anti-osteoporosis drugs before the treatment were compared between the 2 groups. Results Twenty-one patients had acute fever reaction （33.3%）. Among these 21 patients, 71% patients （15/21） had fever on the day of zoledronic acid treatment, and the other patients had fever on the first day after the treatment. The fever lasted for 1 day in 66.7% of the patients （ 14/21 ） , and for 2 days in 5 patients. The average temperature was 38.8 ± 0. 5C. The patients with fever had higher parathyroid hormone level before treatment than those without fever （P 〈 0.05）. Serum calcium and bone mineral density showed no significant difference between the 2 groups. Conclusion Acute fever reaction is not rare in postmenopausal patients receiving intravenous zoledronic acid for the treatment of osteoporosis, but it is transient. Parathyroid hormone level before the treatment is associated with the fever.