阿仑膦酸钠、阿法骨化醇、碳酸钙联合应用治疗糖皮质激素诱发的骨质疏松症32例疗效分析

Evaluation of the effect of alfacalcidol plus calcium carbonate in combination with or without alendronate on 32 patients with glucocorticoid-induced osteoporosis

目的:评估阿法骨化醇、碳酸钙联合或不联合阿仑膦酸钠用于治疗糖皮质激素诱发的骨质疏松症的临床疗效。方法 :自2009年1月至2012年1月,对来我院就诊的32例糖皮质激素诱发的骨质疏松症患者,随机分为实验组(口服阿仑膦酸钠+阿法骨化醇+碳酸钙)及对照组(口服阿法骨化醇+碳酸钙)。两组共用药治疗1年。在治疗前、治疗6个月及1年后,分别测定两组患者的骨密度及骨转换指标,如骨源性碱性磷酸酶(BALP)、骨钙素(BGP)、空腹尿钙/尿肌酐比值(尿Ca/Cr),并进行统计学分析。结果 :实验组在治疗6个月和1年后,腰椎及髋部BMD改变率较对照组均有明显提高(P<0.05)。两组BALP、尿Ca/Cr均有下降,BGP升高,与治疗前比较有显著差异(P<0.05);与对照组相比,实验组BALP下降、BGP升高更为明显,两组之间的差别有显著性(P<0.05)。结论 :糖皮质激素诱发的骨质疏松症患者,给予口服阿仑膦酸钠+阿法骨化醇和钙剂能更好地增加骨密度,降低骨转换,降低骨折风险,其疗效优于单纯口服阿法骨化醇和钙剂。

Objective： To evaluate the effect of alfacalcidol plus calcium carbonate combined with or without alendronate on glucocorticoid-induced osteoporosis. Methods： From January 2009 to January 2012, 32 patients with glucocorticoid-induced osteoporosis in our hospital were randomly divided into an experimental group or a control group. The patients were treated for 1 year with alendronate, alfacalcidol and calcium carbonate in the experimental group while only with alfacalcidol and calcium carbonate in the control group. Bone mineral density（BMD） and bone turnover markers such as bone alkaline phosphatase （BALP）, osteocalcin （BGP）,urinary Ca/Cr were measured in two groups before treatment, after the treatment for 6 months or 1 year and the data were statistically analyzed. Results： After the treatment for 6 months or 1 year, the change rate of BMD in lumbar spine and hip was more obviously enhanced in the experimental group than in the control group （P〈0.05）. BALP and urinary Ca/Cr were decreased, while BGP increased in both groups and the differences were more significant after treatment （P〈0.05）. The decline in BALP and the rise in BGP were more significant in the experiment group than in the control group （P〈0.05）. Conclusion： The alfacalcidol plus calcium in combination with alendronate for the treatment of patients with glucocorticoid-induced osteoporosis can increase bone density, decrease bone turnover and reduce the risk of fracture, and the efficacy in the experiment group is superior to that in the control group.