新型雌激素对女性血透患者骨质疏松的临床干预

The clinical intervention using a new estrogen treatment for the hemodialysis female patients with osteoporosis

目的观察雌激素他莫昔芬对维持性血液透析(MHD)女性患者骨质疏松的治疗作用。方法选取50例MHD女性患者按有/无骨质疏松分为A组(n=26)与B组(n=24),再将A组随机分为A1组(n=13,服用他莫昔芬、骨化三醇和碳酸钙)与A2组(n=13,不服用他莫昔芬,余同A1);观察治疗前后(12个月)患者疗效、副作用及血清雌二醇(E2)、骨形态发生蛋白-2(BMP-2)、全段甲状旁腺素(iPTH)等指标的变化;并以E2、BMP-2水平对入组患者骨质疏松的诊断进行ROC曲线分析。结果A1组疗效显著优于A2组(P<0.05),两组副作用差异无统计学意义(P>0.05);治疗前A组E2、BMP-2水平显著低于B组,治疗后A1组E2、BMP-2水平显著高于A2组(P<0.05),治疗前后iPTH、Ca水平差异无统计学意义(P>0.05);多元线性回归提示治疗前A组及治疗后A2组iPTH与BMD值呈负相关(P<0.05),E2、BMP-2、Ca与骨密度(BMD)值呈正相关,且E2、BMP-2对BMD值影响最大。B组及治疗后A1组各指标与BMD值无线性回归关系。ROC曲线提示E2、BMP-2与入组患者BMD值关系密切。结论他莫昔芬可能是通过提高MHD女性患者体内E2、BMP-2水平从而安全有效的治疗骨质疏松,且E2、BMP-2是影响MHD女性患者骨质疏松的重要因子。

Objective To observe the curative effect of Tamoxifen on osteoporosis in female patients with maintenance hemodialysis （MHD）.Methods Fifty MHD female patients were divided into group A （n=26） and group B （n=25） according to whether they had/didn’ t have osteoporosis.Group A was further divided into Group A1 （ n =13, treated with Raloxifen, Alfacalcidol, and calcium carbonate） and Group A2 （n=13, treated with Alfacalcidol and calcium carbonate）.The curative effect, side effect and changes of E2, BMP-2, BMP-2, and iPTH were observed before and 12 months after the treatment.ROC curve of osteoporosis diagnosis on the basis of E2 and BMP-2 level was analyzed.Results The curative effect of group A1 was better than group A2 significantly （P〈0.05）, and there was no significant difference of side effects between two groups （P〉0.05）.Before the treatment, the levels of E2 and BMP-2 in group A were lower than those in group B.After the treatment, the levels of E2 and BMP-2 in group A1 were higher than those in group A2 （P〈0.05）.The levels of iPTH and Ca were not different before and after the treatment （P〉0.05）.Multiple linear regression analysis revealed that iPTH was negatively correlated with BMD in group A before the treatment and group A2 after the treatment （P〈0.05）.E2, BMP-2, and blood calcium had positive correlation with BMD （ P〈0.05 ） .E2 an BMP-2 had greatest influence in BMD.Indices in group B and group A1 had no linear regression correlation with BMD.ROC curves revealed that E2 and BMP-2 had close correlation with BMD in all patients selected. Conclusion Tamoxifen may treat osteoporosis safely and effectively by increasing the E2 and BMP-2 levels in female MHD patients.E2 and BMP-2 are important factors affecting hemodialysis female patients with osteoporosis.