骨化三醇在类风湿关节炎合并骨质疏松中的作用研究

Study on effect of Rocaltrol in the treatment of rheumatoid arthritis with osteoporosis

目的探讨骨化三醇联合来氟米特及泼尼松治疗类风湿关节炎(RA)合并骨质疏松(OP)的效果及安全性。方法将186例RA合并OP患者,随机分为对照组(n=81)和治疗组(n=105)。对照组给予来氟米特及泼尼松,治疗组在对照组治疗基础上加用常规剂量骨化三醇,两组治疗各进行6个月。比较两组治疗前后血小板计数(PLT)、红细胞沉降率(ESR)、类风湿因子(RF)、C反应蛋白(CRP)、免疫球蛋白(Ig)、补体(C)及碱性磷酸酶(ALP)、血钙、血磷、肝肾功能等指标及骨密度(BMD),并观察不良反应。结果与对照组相比,治疗组IgG水平下降[(2.56±3.04)g/L vs.(2.52±1.98)g/L,t=1.01,P<0.05],C3[(0.37±0.12)g/L vs.(0.29±0.29)g/L,t=2.04,P<0.05]、C4[(0.17±0.04)g/L vs.(0.1±0.06)g/L,t=3.54,P<0.05]水平升高;治疗组降低炎症指标的效果明显[PLT:(96±10)×109/L vs.(59±5)×109/L,t=2.52,P<0.05;ESR:(51.2±1.7)mm/1 h vs.(32.3±1.1)mm/1 h,t=2.35,P<0.05;CRP:(51.5±1.3)mg/L vs.(39.4±1.1)mg/L,t=1.78,P<0.05;RF:(102±16)IU/ml vs.(90±20)IU/ml,t=2.31,P<0.05];治疗组增加ALP[(-42±7)U/L vs.(-9±6)U/L,t=2.27,P<0.05],改善BMD[腰椎:(0.400±0.014)g/cm2 vs.(0.030±0.015)g/cm2,t=2.78,P<0.05;髋部:(0.386±0.025)g/cm2 vs.(0.017±0.015)g/cm2,t=3.45,P<0.05]。结论常规剂量骨化三醇联合抗风湿药治疗RA合并糖皮质激素性OP效果良好,值得临床推广。

Objective To study the therapeutic effect and safety of Rocaltrol combined with leflunomide and prednisone in the treatment of rheumatoid arthritis（RA） with osteoporosis（OP）. Methods Patients were divided into two groups in random, the control group （n=81） and the treatment group （n=105）. To detect and compare PLT, ESR, CRP, RF, Ig, C, ALP, calcium, phosphorus, liver function, renal function and BMD before and after the treatment, and observe reaction. Results The treatment group decreased IgG [（2.56±3.04） g/L vs. （2.52±1.98） g/L, t=1.01, P〈0.05], increased C3 [（0.37±0.12） g/L vs. （0.29±0.29） g/L, t=2.04, P〈0.05], C4 [（0.17±0.04） g/L vs. （0.1±0.06） g/L, t=3.54, P〈0.05], and reduced PLT[（96±10）×109/L vs. （59±5）×109/L, t=2.52, P〈0.05], ESR[（51.2±1.7） mm/1 h vs. （32.3±1.1） mm/1 h, t=2.35, P〈0.05], CRP [（51.5±1.3） mg/L vs. （39.4±1.1） mg/L, t=1.78, P〈0.05], RF [（102±16） IU/ml vs. （90±20） IU/ml, t=2.31, P〈0.05], ALP [（-42±7） U/L vs. （-9±6） U/L, t=2.27, P〈0.05] and improved BMD [lumbar vertebra： （0.4±0.0144） g/cm2 vs. （0.030±0.015） g/cm2, t=2.78, P〈0.05; hip： （0.386±0.025）g/cm2 vs. （0.017±0.015）g/cm2, t=3.45, P〈0.05]. The effect of the treatment group was superior. Conclusion Rocaltrol combined with leflunomide and prednisone has marked improvement and value in clinic in the treatment of RA with OP.