特立帕肽治疗老年性骨质疏松症的疗效及生活质量改善

Efficacy and Improvement on Quality of Life in Senile Osteoporosis Treated with Teriparatide

目的研究特立帕肽治疗老年性骨质疏松症患者的骨密度(BMD)和骨标志物的变化,评估生活质量的改善。方法选取老年性骨质疏松症患者45例,给予特立帕肽20μg,每个月注射28 d,疗程12个月。在治疗前和治疗3,6和12个月分别检测BMD,抽血查生化指标和骨标志物;疼痛数字评分法(NRS)进行疼痛评分;采用简明健康状况调查表(SF-36量表)进行生活质量的评定。结果治疗前患者NRS评分为(4.96±2.25)分,治疗3,6及12个月后,患者NRS评分分别为(2.84±1.41),(1.56±1.16),(1.36±1.00)分(P<0.01)。患者治疗后总SF-36评分也较治疗前明显增高(P<0.05)。治疗3,6及12个月,腰椎BMD分别提高约7.7%,12.3%及15.4%;股骨颈BMD提高约3.0%,6.1%及7.6%;股骨粗隆BMD分别提高5.7%,8.6%及10.0%。治疗3,6和12个月后患者血清骨钙素、骨碱性磷酸酶、Ⅰ型前胶原N-端前肽较治疗前均明显增高(P<0.01),而β型胶原交联C端肽在治疗后12个月有明显降低(P<0.05)。治疗期间副作用少。结论特立帕肽治疗老年性骨质疏松1年后可明显减轻骨痛,增加腰椎和股骨粗隆BMD,改善患者生活质量。

Objective To explore the changes of bone mineral density（ BMD） and bone markers in senile osteoporosis patients treated with teriparatide,and evaluate the improvement on quality of life（ QOL） as well as the clinical significance.Methods Forty-five senile osteoporosis inpatients were treated with 20 μg of teriparatide for one year. BMD and bone markers were detected before treatment and also in the third,sixth and twelfth month during treatment. The level of numerical rating scale（ NRS） and QOL were assessed. Results The NRS before treatment was（ 4. 96 ± 2. 25）,and those after treatment of 3,6and 12 months were（ 2. 84 ± 1. 41）,（ 1. 56 ± 1. 16） and（ 1. 36 ± 1. 00）,respectively（ P 〈0. 01）. The total scores of SF-36 significantly increased after treatment（ P 〈0. 01）. After treatment of 3,6 and 12 months,BMD of lumbar vertebra had increased 7. 7%,12. 3% and 15. 4%,respectively; that of femoral neck had increased 3. 0%,6. 1% and 7. 6%,respectively;and that of intertrochanteric bone had increased 5. 7%,8. 6% and 10. 0%,respectively. Meanwhile,the serum levels of osteocalcin,bone alkaline phosphatase and N terminal propeptide of type I procollagen were significantly higher than those before treatment（ P 〈0. 01）,nevertheless beta collagen cross-linked C-terminal peptide（ β-CTX） only significantly decreased at the12 thmonth after treatment（ P〈 0. 05）. Conclusion Chronic teriparatide therapy could significantly relieve bone pain,improve the quality of life and increase lumbar vertebra BMD in senile osteoporosis.