鲑鱼降钙素对病毒性肝硬化合并骨质疏松症患者影响的临床研究

A clinical study of the effect of salmon calcitonin in patients with viral cirrhosis complicated with osteoporosis

目的观察鲑鱼降钙素对病毒性肝硬化合并骨质疏松症患者骨生化、代谢指标,细胞因子及骨密度影响的临床研究。方法将64例病毒性肝炎肝硬化合并骨质疏松症患者随机分为治疗组(n=32)及对照组(n=32)。对照组给予钙剂治疗,治疗组给予鲑鱼降钙素联合钙剂进行治疗,共12个月。测定治疗前后患者血清钙、磷及1,25(OH)2D3、降钙素、甲状旁腺素(parathyroid hormone,PTH)的水平;血清细胞因子白细胞介素-6(interleukin-6,IL-6)、IL-10、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)及胰岛素样生长因子(insulin-like growth factor,IGF-1)水平以及腰椎2~4(L2~4)、股骨颈及Ward’s三角区骨密度的变化情况。结果治疗前两组的血清钙、磷及1,25(OH)2D3、骨钙素、甲状旁腺素、IL-10,IL-6、TNF-α、IGF-1及骨密度比较差异无统计学意义(P>0.05);治疗12个月后治疗组患者的血清钙、1,25(OH)2D3、IL-10、IGF-1及腰椎2~4(L2~4)、股骨颈及Ward’s三角区骨密显著高于对照组;血清磷、PTH及骨钙素、IL-6、TNF-α均显著性低于对照组,差异有统计学意义(P<0.05),而对照组上述治疗的水平差异无统计学意义(P>0.05)。结论鲑鱼降钙素对病毒性肝硬化合并骨质疏松症有保护作用,可以有效提升患者的骨密度,改变骨代谢及细胞因子水平。

Objective To observe the effect of salmon calcitonin on bone biochemistry,metabolic index,cytokines and bone mineral density in patients with viral cirrhosis complicated with osteoporosis. Methods Sixty-four patients with viral hepatitis and cirrhosis complicated with osteoporosis were randomly divided into treatment group（ n = 32） and control group（ n = 32）. The control group was treated with calcium,the treatment group received salmon calcitonin combined with calcium for 12 months.Serum levels of calcium,phosphorus and 1, 25（ OH）2 D3,calcitonin,parathyroid hormone,serum cytokines including interleukin-6,10（ IL-10,IL-6）,TNF-α and insulin-like growth factor（ IGF-1）,and BMD of lumbar spine2-4（ L2-4）,femoral neck and Ward＇s triangular area were measured before and after treatment. Results There were no significant differences in serum calcium,phosphorus,1, 25（ OH）2 D3,calcitonin,parathyroid hormone,IL-10,IL-6,TNF-α,IGF-1 and bone mineral density between the two groups before treatment（ P〈0. 05）. After 12 months of treatment,the levels of Ca,1, 25（ OH）2 D3,IL-10,IGF-1 and the BMD of lumbar spine 2-4（ L2-4）,femoral neck and Ward＇s triangle of the treatment group were significantly higher than those of the control group（ P〈0. 05）,and the levels of P,PTH,BGP,IL-6 and TNF-α were significantly lower than those in the control group（ P〈0. 05）. There was no significant treatment effects in the control group（ P〈0. 05）. Conclusion Salmon calcitonin has protective effect on viral cirrhosis complicated with osteoporosis,and could effectively improve bone mineral density and modify bone metabolism and cytokine level.