唑来膦酸治疗类风湿关节炎继发骨质疏松患者的临床分析

Clinical analysis of the effect of zoledronic acid for the treatment of secondary osteoporosis in patients with rheumatoid arthritis

目的通过对类风湿关节炎继发骨质疏松患者,给予唑来膦酸的治疗,观察及分析治疗后的临床指标,评价唑来膦酸的疗效及安全性。方法所有患者均静脉输注5 mg唑来膦酸注射液,第6、12个月回访,复查DXA、ESR、血清RF、CRP,以及通过FRAX计算未来10年的髋部骨折概率。结果腰3、Ward区、大转子、股骨颈12个月时BMD与治疗前相比存在统计学差异,其余虽无统计学意义,但存在提高的趋势。未口服激素的RA病人在12个月时髋骨骨折概率与治疗前相比存在统计学差异。合并OP的RA病人在应用唑来膦酸后,随着治疗的进行,炎性指标下降,病情活动评分下降,血沉和C反应蛋白与治疗前对比有统计学意义。结论唑来膦酸能在短期内有效改善类风湿关节炎继发骨质疏松的骨质量,提高骨密度,减低骨折概率,并对类风湿病情活动有一定的抑制作用。

Objectives By using zoledronic acid for the treatment of secondary osteoporosis （OP） in patients with rheumatoid arthritis （RA）, to observe and analyze the clinic indexes of paitents after the treatment, and to evaluate the clinical efficacy and safety of zoledronic acid. Methods All the patients were given an intravenous infusion of 5mg zoledronie acid. The follow-ups were performed at the 6th month and the 12th month after the treatment. DXA, ESR, serum RF, and CRP was detected. The probability of the hip fractures in the next 10 years was calculated using FRAX. Result BMD of L 3, zone Ward, trochanter, femoral neck at 12 months compared with those before treatment is significant. The rest had no significant difference, but there is an increasing trend. In without oral hormone group with RA, hip fracture probability of 12 months compared with those before treatment is significant. For OP patients with RA zoledronic acid treatment would decrease disease activity score28, ESR and CRP, and it is significant compared with before treatment. Conclusion Zoledronie acid can significantly improve the bone quality, improve bone mineral density, and reduce the probability of fractures in RA paitents with secondary OP in a short term. It also has certain inhibiting effect on the activity of rheumatoid.