阿仑膦酸钠改善类风湿关节炎患者骨密度水平及临床意义

Alendronate in the improvement of bone mineral density in patients with rheumatoid arthritis and its clinical significance

目的 :分析阿仑膦酸钠(福善美)是否能够改善类风湿关节炎(rheumatoid arthritis,RA)患者骨密度并探讨其临床意义。方法:收集2013年1月—2014年1月收治的RA合并骨质疏松患者60例,分为治疗组和对照组各30例。治疗组服用阿仑膦酸钠70 mg/周、阿法骨化醇0.5 g/d和钙片1片(含元素钙600 mg、维生素D 125 U),对照组服用阿法骨化醇0.5 g/d和钙片1片。治疗12个月后,采用双能X线吸收仪测定患者骨密度,用双手X线Sharp评分(SHS)评定患者骨侵蚀及狭窄程度,记录患者炎症指标(细胞沉降率、C反应蛋白、类风湿因子、肿瘤坏死因子-α和白细胞介素-1)。结果:治疗12个月时,治疗组骨密度显著高于对照组(P<0.05)。治疗组和对照组的健康评估问卷得分(1.4±0.7比1.7±0.7)、X线关节间隙狭窄评分(24±25比43±30)、X线骨侵蚀评分(20±24比40±35)和Sharp评分(45±67比84±63)差异有统计学意义(P均<0.05)。治疗12个月后,治疗组的细胞沉降率、C反应蛋白、类风湿因子、肿瘤坏死因子-α和白细胞介素-1水平均低于对照组。结论 :早期持续给予阿仑膦酸钠并联合阿法骨化醇和钙片,能有效改善RA患者的骨密度,控制骨侵蚀发展。

To analyze whether or not alendronate(famamy)could improve bone mineral density in patients with rheumatoid arthritis(RA)and to explore its clinical significance.Methods:From January2013to January2014,60cases of RA combined with osteoporosis were collected and divided into a treatment group and a control group with30cases each.The treatment group took alendronate70mg/week,alfacalcidol0.5g/d and1calcium tablet(containing elements of calcium600mg and vitamin D125U).The control group was treated with alfacalcidol0.5g/d and1calcium tablet.After12months of treatment,the bone density of the patients was measured by dual energy X-ray absorptiometer.Sharp-van der Heijde(SHS)for both hands was used to evaluate the degree of bone erosion and stenosis in patients.The inflammatory markers(cell sedimentation rate,C reactive protein,rheumatoid factor,TNF-alpha and interleukin-1)were recorded.Results:After12months of treatment,the bone mineral density in the treatment group was significantly higher than that in the control group(P<0.05).The statistical difference was found between treatment group and control group in health assessment questionnaire score(1.4±0.7vs1.7±0.7),the X-ray joint space stenosis score(24±25vs43±30),the X-ray bone erosion score(20±24vs40±35)and the Sharp score(45±67vs84±63).After12months of treatment,the cell sedimentation rate,C reactive protein,rheumatoid factor,TNF-alpha and interleukin-1level in the treatment group were all lower than those in the control group.Conclusion:Early continuous administration of alendronate combined with alfacalcidol and calcium can effectively improve the bone mineral density and control the development of bone erosion in RA patients.