依那普利联合碳酸钙D_3治疗老年高血压合并骨质疏松的效果

Effect of Enalapril combined with calcium carbonate vitamine D_3 on bone mineral density of elderly patients with essential hypertension and osteoporsis

目的 对比研究老年高血压并骨质疏松患者口服依那普利联合碳酸D3对骨密度的效果。方法 选择2014年5月~2015年12月我院老年高血压并骨质疏松患者63例为研究对象,随机、双盲分为A组（n=32）和B组（n=31）。A组患者口服依那普利＋碳酸钙D3,B组口服碳酸钙D3。两组观察1年,测定治疗前及治疗后3、6、9、12个月的血清25-羟维生素D[25（OH）D]水平、血钙、磷、碱性磷酸酶（ALP）、甲状旁腺激素（PTH）、骨钙素水平,测定治疗前后的骨密度值[腰椎L1~4和股骨颈（Neck）]。结果 两组各血清参数基线值比较,差异无统计学意义（P〉0.05）。治疗后12个月两组的总血清25（OH）D水平均呈上升趋势,治疗后9、12个月较基线值显著升高,但两组25（OH）D水平均低于正常值30 ng/ml;两组25（OH）D水平比较,差异无统计学意义（P〉0.05）。治疗后12个月,两组血清Ca2＋水平均有不同程度升高,均在正常范围内,无高钙血症发生;A组、B组治疗后6、9、12个月较基线值显著升高（P〈0.05）;两组血清Ca2＋水平比较,差异无统计学意义（P〉0.05）。骨钙素、PTH、ALP、P较基线值均无明显变化,两组间比较差异无统计学意义（P〉0.05）。A组治疗后1年的L1~4骨密度值较治疗前显著升高（P〈0.01）;B组治疗后1年的L1~4骨密度值较治疗前无明显变化,差异无统计学意义（P〉0.05）;两组治疗后1年的L1~4骨密度值比较,差异有统计学意义（P〈0.05）。Neck组内组间比较,差异无统计学意义（P〉0.05）。结论 老年高血压并骨质疏松患者给予口服依那普利和碳酸钙D3治疗后1年,较单纯口服碳酸钙D3骨密度值显著上升。

Objective To observe the effect of Enalapril combined with calcium carbonate vitamine D3 on bone mineral density （BMD） of the elderly patients with essential hypertension and osteoporosis.nethods From May 2014 to December 2015,a total of 63 elderly patients with essential hypertension and osteoporosis in our hospital were selected as study objectand randomly and double-blindly divided into group A （n=32） treated by Enalapril with calcium carbonate vitamine D3 and group B （n=31） without EnalaprihThe two groups were observed for one year,the levels of 25-OH-vitamin D,serum calcium （Ca2＋）,serum phosphorus （P）,alkaline phosphatase （ALP）,parathyroid hormone （PTH）,osteocalcin were measured before and 3,6,9,12 months after treatment.Bone mineral density （BMD） of lumbar vertebrae and neck were measured before and after treatment.Results There was no significant difference in baseline values of serum parameters between two groups （P〉0.05）.The total serum 25-OH-vitamin D levels in two groups were increased 12 months after treatment,and which 9 and 12 months after treatment was significantly higher than the baseline values,however,the levels of 25-OH-vitamin D in two groups were lower than normal value（30 ng/ml）,there was no significnt statistical dif- ference in the levels of 25-OH-vitamin D between two groups （P〉0.05）.12 months after treatment,serum Ca^2＋ levels of two groups were elevated and within the normal range,no hypercalcemia occurred;serum Ca^2＋ levels of two groups 6,9 and 12 months after treatment compared to the baseline values were significantly increased （P〈0.05）;there was no statistically significant difference in serum Ca^2＋ levels of two groups （P〉0.05）.Osteocalcin,PTH,ALP,P compared with baseline values did not change significantly,there was no significant difference between two groups （P〉0.05）.BMD （L1-4） value after treatment for one year in group A was significantly higher than that before treatment （P〈0.01）;BMD value after treatment for one year in B group compared with before treatment had no obvious change （P〉0.05）;after treatment for one year, BMD （L1-4） between two groups were compared,and the difference was statistically significant （P〈0.05）.BMD （neck） values after treatment for one year in two groups were no higher than before,and there was no statistical difference in BMD （neck） between two groups （P〉0.05）. Conclusion BMD value was obviously increased in the elderly patient with essential hypertension and osteoporosis who have taken Enalapril and calcium carbonate vitamine D3 after treatment for one year.