唑来膦酸联合透明质酸钠治疗绝经后骨质疏松合并膝骨关节炎的临床效果分析

Clinical effect of zoledronic acid combined with hyaluronic acid in the treatment of postmenopausal osteoporosis patients complicated with osteoarthritis

目的探究唑来膦酸联合透明质酸钠治疗绝经后骨质疏松(PMOP)合并膝骨关节炎(OA)的临床效果。方法收集2009年5月—2014年4月在金华市中心医院治疗并自愿参加本研究的105例PMOP合并膝OA的临床资料,随机分为唑来膦酸组和对照组,2组患者均采用膝关节腔内注射透明质酸钠,对照组在此基础上采用鲑鱼降钙素、钙剂、阿仑膦酸钠及骨化三醇等传统抗骨质疏松治疗,唑来膦酸组在对照组基础上采用唑来膦酸注射液5 mg配合0.9%生理盐水或5%葡萄糖溶液稀释后静脉滴注,每年1次。记录2组患者治疗前和治疗后3、6、12个月WOMAC评分、Lysholm膝关节评分、疼痛VAS评分、BMD以及血清β-CTX、BGP、B-ALP水平。结果唑来膦酸组患者治疗后WOMAC评分、Lysholm膝关节评分、疼痛VAS评分及BMD明显优于对照组(P<0.05),2组患者治疗后WOMAC评分、Lysholm膝关节评分、疼痛VAS评分及BMD均较治疗前有很大改善(P<0.05),治疗后12个月唑来膦酸组血清β-CTX、B-ALP、BGP水平低于治疗前(P<0.05),对照组患者治疗12个月后血清β-CTX、BGP、B-ALP与治疗前差异无统计学意义(P>0.05),唑来膦酸组与对照组血清β-CTX、B-ALP、BGP水平差异有统计学意义(P<0.05)。结论唑来膦酸联合透明质酸钠治疗PMOP合并膝OA能明显改善患者骨代谢状态,抑制骨吸收,提高患者骨密度及膝关节功能,减轻膝关节疼痛,提高患者生活质量,值得临床推广。

Objective To explore the effect of zoledronic acid combined with hyaluronic acid in the treatment of postmenopausal osteoporotic（ PMOP） patients complicated with osteoarthritis（ OA）. Methods One hundred and five patients of PMOP complicated with OA volunteering in May 2009 to April 2014 in our hospital were enrolled into this study and were randomly divided into two groups： the zoledronic acid group and the control group. They all received hyaluronic acid intra-articular injection for a cycle. The control group was given salmon calcitonin,calcium,alendronate and calcitriol and other traditional anti-osteoporosis therapy on the basis of those. The zoledronic acid group received intravenous 5mg zoledronic acid injections with 0. 9% saline or 5% glucose solution once a year on the basis of the control group. The Western Ontario and Mc Master American Universities Osteoarthritis Index score（ WOMAC score）,Lysholm knee score,VAS pain score,BMD and serum levels of β-CTX,BGP,B-ALP were recorded before and after the treatment. Results The WOMAC score,Lysholm knee score,VAS pain score and BMD of zoledronic acid group were superior than the control group（ P 〈 0. 05）. The WOMAC score,Lysholm knee score,VAS pain score and BMD of two groups were superior to those before the treatment（ P 〈 0. 05）. The serum levels of β-CTX,BGP,B-ALP after 12 months of treatment were lower than those before the treatment in zoledronic acid group（ P 〈 0. 05） but had no significance in the control group（ P 〉 0. 05）.The serum levels of β-CTX,BGP,B-ALP in zoledronic acid group were lower than those in the control group after 12 months of treatment（ P 〈 0. 05）. Conclusion Zoledronic acid combined with hyaluronic acid in PMOP patients complicated with OA can significantly improve the bone metabolism,inhibit bone desorption,increase BMD and knee function,reduce knee pain and improve the quality of life of patients which deserved a clinical promotion.