^(99)Tc-MDP联合钙剂、活性维生素D_3治疗甲亢继发骨质疏松症的疗效评价

Evaluation of the efficacy of combination treatment with ^(99)Tc-MDP,calcium,and active vitamin D3 for secondary osteoporosis of hyperthyroidism

目的评价99Tc-MDP治疗甲亢继发骨质疏松症的疗效。方法将89例甲亢继发骨质疏松患者按治疗方法分为联合治疗组(A组42例)和对照组(B组47例),两组均采用131I治疗甲亢,联合治疗组采用常规口服钙剂加活性维生素D3治疗,同时加用99Tc-MDP注射治疗,10d为1个疗程,连续3个疗程,每疗程之间间隔3~4 w;对照组常规口服钙剂加维生素D3治疗。分别观察2组治疗前及治疗后3、6、12个月骨密度(BMD)、血清骨钙素(BGP)、骨碱性磷酸酶(B-ALP)以及甲状腺功能各项指标(FT3、FT4、TSH)的变化。结果 (1)131I治疗6个月后联合治疗组BGP、B-ALP开始下降,治疗前后比较差异有统计学意义(P<0.05);(2)联合治疗组BMD值在治疗后12个月较治疗前增加,与对照组比较差异有统计学意义(P<0.05);(3)治疗3、6、12个月后两组间甲状腺功能指标变化无差异(P>0.05);(4)联合治疗组与对照组总有效率分别为92.8%,76.6%,联合治疗组优于对照组,差异有统计学意义(P<0.05)。结论99Tc-MDP与钙剂及活性维生素D3联用,对甲亢继发骨质疏松症有较好疗效,具有一定临床推广价值。

Objective To evaluate the efficacy of ^99Tc-MDP on the treatment hyperthyroid secondary osteoporosis.Methods Eighty-nine patients of hyperthyroid secondary osteoporosis were divided into combined treatment group（group A,42 patients） and control group（group B,47 patients）.Both groups were using131I to treat hyperthyroidism.Patients in combined treatment group received conventional oral calcium agents with active vitamin D3 as well as the ^99Tc-MDP treatment,10 d for a course of treatment.The treatment lasted consecutive 3 courses with a 3-4-week interval.Patients in the control group received routine oral calcium plus vitamin D3.The changes in BMD,BGP,B-ALP,and thyroid function indicators（FT3,FT4,and TSH） were observed in both groups before and after the treatment.Results（1） After 6-month treatment with 131I,BGP and B-ALP declined in combined treatment group and the difference was statistically significant before and after the treatment（P〈0.05）.（2） After 12-month treatment,BMD in combined treatment group increased,and the difference was statistically significant comparing to that in the control group（P〈0 05）.（3） After 3-,6-,and 12-month treatment,no difference of the thyroid function parameters was found between the 2 groups（P〈0.05）.（4） The total efficiency was 92.8%in the combined treatment group and 76.6%in the control group,respectively.The efficiency in combined treatment group was better than that in the control group（P〈0.05）.Conclusion The combination of ^99Tc-MDP,calcium and active vitamin D3 has good effect on the treatment of hyperthyroid secondary osteoporosis.It is worth of recommendation.