高剂量维生素D补充剂对骨质疏松症患者骨代谢标志物的影响

Effect of high-dose vitamin D supplements on bone metabolism markers in patients with osteoporosis

目的探讨高剂量维生素D补充剂治疗前、后骨质疏松症患者骨代谢标志物水平变化及意义。方法骨质疏松症患者100例,随机分为对照组和维生素D组各50例,对照组口服钙尔奇D 600mg/d;维生素D组在对照组基础上口服维生素D滴剂,1滴/d;2组均连续治疗6个月。分别于治疗前,治疗3、6个月时检测2组L_(2-4)、股骨颈及大转子骨密度(bone mineral density,BMD),采用电化学发光法检测血清Ⅰ型胶原羧基端肽β特殊序列(βisomer of C-terminal telopeptide of typeⅠcollagen,β-CTX)和Ⅰ型前胶原氨基端肽(procollagenⅠN-terminal peptide,PⅠNP)水平,并进行比较。结果维生素D组、对照组治疗前BMD在L_(2-4)[(0.683±0.006)、(0.681±0.007)g/cm^2]、股骨颈[(0.559±0.009)、(0.555±0.021)g/cm^2]、大转子[(0.421±0.011)、(0.418±0.011)g/cm^2]比较差异均无统计学意义(P>0.05);治疗6个月时维生素D组BMD在L_(2-4)、肢骨颈、大转子[(0.784±0.172)、(0.679±0.007)、(0.507±0.091)g/cm^2],对照组BMD在L_(2-4)、肢骨颈、大转子[(0.701±0.080)、(0.611±0.163)、(0.457±0.079)g/cm^2]均高于治疗前,且维生素D组高于对照组(P<0.05);2组治疗3个月时L_(2-4)、股骨颈、大转子BMD与治疗前比较差异均无统计学意义(P>0.05);维生素D组治疗前血清β-CTX[(0.74±0.05)μg/L]、PⅠNP[(42.10±3.50)μg/L]与对照组[(0.76±0.12)、(42.40±3.60)μg/L]比较差异无统计学意义(P>0.05);维生素D组及对照组治疗3个月β-CTX[(0.57±0.11)、(0.63±0.14)μg/L]、PⅠNP[(30.20±6.50)、(36.90±10.30)μg/L],治疗6个月β-CTX[(0.33±0.12)、(0.54±0.11)μg/L]、PⅠNP[(24.50±0.90)、(29.60±2.40)μg/L]均低于治疗前(P<0.05),且维生素D组低于对照组(P<0.05)。结论骨质疏松症患者应用高剂量维生素D补充剂治疗可增加BMD,降低血清PⅠNP、β-CTX水平,有助于延缓骨吸收,减少骨量丢失。

Objective To investigate the changes of serum biochemical markers of bone metabolism in patients with osteoporosis before and after treatment with high-dose vitamin D supplements.Methods One hundred patients with osteoporosis were randomly divided into control group and vitamin D group,with 50 patients in each group.Control group received oral administration of Caltrate D 600 mg,once a day,and vitamin D group was given oral administration of vitamin D one drop per day besides the treatment in control group,totally for 6 months.Before treatment,and after3-and 6-month treatment,the bone mineral density（BMD）was detected at L2-4,femoral neck and greater trochanter.Electrochemiluminescence assay was used to detect the levels ofβisomer of C-terminal telopeptide of type Ⅰ collagen（β-CTX）and procollagen Ⅰ N-terminal peptide（PⅠNP）.Results There were no significant differences in BMD values between vitamin D group and control group before treatment at L2-4（（0.683±0.006）g/cm^2 vs（0.681±0.007）g/cm^2）,femoral neck（（0.559±0.009）g/cm^2 vs（0.555±0.021）g/cm^2）,and greater trochanter（0.421±0.011）g/cm^2 vs（0.418±0.011）g/cm^2）（P〈0.05）.The BMD values were significantly higher after 6-month treatment at L2-4,femoral neck and great trochanter（vitamin D group：（0.784±0.172）,（0.679±0.007）,（0.507±0.091）g/cm^2;control group：（0.701±0.080）,（0.611±0.163）,（0.457±0.079）g/cm^2）than those before treatment（P〈0.05）,and were significantly higher in vitamin D group than those in control group（P〈0.05）.There were no significant differences in the BMD values at L2-4,femoral neck and greater trochanter between two groups after 3-month treatment（P〈0.05）.There were no significant differences in serumβ-CTX and PⅠNP between vitamin D group（（0.74±0.05）,（42.10±3.50）μg/L）and control group（（0.76±0.12）,（42.40±3.60）μg/L）before treatment（P〉0.05）.The levels ofβ-CTX and PⅠNP in vitamin D group and control group were significantly lower after 3-month treatment（β-CTX：（0.57±0.11）,（0.63±0.14）μg/L;PⅠNP：（30.20±6.50）,（36.90±10.30）μg/L）and after 6-month treatment（β-CTX：（0.33±0.12）,（0.54±0.11）μg/L;PⅠNP：（24.50±0.90）,（29.60±2.40）μg/L）than those before treatment（P〈0.05）,which was more obvious in vitamin D group than control group（P〈0.05）.Conclusion High-dose vitamin D supplements can increase the BMD in patients with osteoporosis,reduce serum levels of PⅠNP andβ-CTX,help to delay bone resorption,and reduce bone loss.