维生素K_2对绝经后骨质疏松症的防治作用及血清组织蛋白酶K影响

The effect of vitamin K2 on the prevention and treatment of postmenopausal osteoporosis and serum cathepsin K

目的研究维生素K_2对绝经后女性骨质疏松患者骨密度、骨代谢及血清组织蛋白酶K(cathe K)的影响。方法选取自2014年5月至2016年1月我院骨质疏松患者,共有120例符合纳入标准。患者随机分为维生素K_2组、雷奈酸锶组和空白对照组(各N=40)。雷奈酸锶组每天口服2 g雷奈酸锶。维生素K_2组给予固力康胶囊:每次15 mg,每天3次。药物治疗前、术后6个月检测其骨密度,同时测量血清中血清骨钙素(BGP)、β-胶原降解产物(β-crosslaps)、Ⅰ型前胶原氨基端前肽(PINP)、血清组织蛋白酶K(cathe K)及抗酒石酸酸性磷酸酶(TRAP)水平。结果药物治疗前后,各组的骨密度,骨代谢指标和cathepsin K均有不同的变化;相对空白对照组,维生素K_2组、雷奈酸锶组髋部及腰椎密度都有不同程度的升高,其中雷奈酸锶组骨密度变化更明显,和其他组比较有明显的统计学意义(P<0.05);雷奈酸锶组破骨活性(β-crosslaps、TRAP)最低,成骨活性(BGP、PINP)较高,而维生素E组破骨活性降低(β-crosslaps、TRAP),成骨活性(BGP、PINP)也增高,各组比较有明显的统计学意义(P<0.05);相对于其他组,雷奈酸锶组cathepsin K下降的最明显,各组比较有明显的统计学意义(P<0.05)。结论适量维生素K_2可以通过促进成骨活性,降低破骨活性及cathepsin K表达来改善绝经后女性骨质疏松患者髋部及腰部的骨密度。

Objective To investigate the effect of vitamin K2 on bone mineral density,bone metabolism,and serum cathepsin K（ Cathe K） in postmenopausal women with osteoporosis. Methods A total of 120 postmenopausal osteoporosis patients who met the inclusion criteria from May 2014 to January 2016 in our hospital were enrolled. The patients were randomly divided into vitamin K2 group,strontium ranelate group,and blank control group（ N = 40 in each group）. Patients in strontium ranelate group received2 g of strontium ranelate daily. Patients in vitamin K2 group received 15 mg of menatetrenone soft capsules each time,3 times a day.BMD of the hip and lumbar spine were measured before and 6 months after drug treatment. The levels of serum osteocalcin（ BGP）,β-collagen degradation products（ β-crosslaps）,type I procollagen amino terminal propeptide（ PINP）,tartrate-resistant acid phosphatase（ TRAP）,and Cathe K were measured. Results BMD,bone metabolism,and Cathe K changed in each group after the treatment. Compared with that in the control group,BMD of the hip and lumbar spine in vitamin K2 group and strontium ranelate group increased in varying degree,and it was more obvious and statistically significant in strontium ranelate group（ P 〈0. 05）. Strontium ranelate group showed lowest osteoclastic activity（ β-crosslaps,TRAP） and higher osteogenic activity（ BGP,PINP）. Vitamin K2 group showed decreased activity of osteoclasts（ β-crosslaps,TRAP） and increased osteogenic activity（ BGP,PINP）. There was statistically different among the groups（ P 〈 0. 05）. Comparing to that in other groups,Cathe K in strontium ranelate group decreased most significantly,with statistically significance（ P 〈 0. 05）. Conclusion Vitamin K2 improves BMD of the hip and lumbar spine in postmenopausal women by promoting osteogenic activity and decreasing osteoclastic activity and Cathe K expression.