伊班膦酸钠对糖皮质GCs诱导骨质疏松患者骨代谢指标的影响

The effect of ibandronate intervention on bone metabolism index in patients with glucocorticoid-induced osteoporosis.

目的观察伊班膦酸钠对糖皮质GCs诱导骨质疏松患者骨代谢指标的影响。方法以本院2017年1月至12月期间收治的48例糖皮质GCs诱导骨质疏松患者为受试对象。随机分为对照组(24例)和观察组(24例),两组患者均给予阿法骨化醇胶囊(0.5μg/次,2次/d,共12周)治疗,试验组加用伊班膦酸钠注射液(首次2 mg,此后3 mg/月,共3个月)静脉滴注治疗。比较两组患者治疗前后血清PTH、BALP、BGP、CTX-1、tPINP等骨代谢指标差异。结果对照组和试验组患者治疗前的PTH、BALP、BGP、CTX-1、tPINP表达水平比较无差异性(P均>0.05)。与治疗前比较,试验组和对照组患者治疗后的BALP、PTH表达水平显著上调,BGP、CTX-1、tPINP表达水平均显著下调(P均<0.05)。与对照组治疗后比较,试验组患者治疗后的BALP、PTH表达水平上调幅度更大,BGP、CTX-1、tPINP表达水平下调幅度更大(P均<0.05)。结论伊班膦酸钠治疗糖皮质GCs诱导骨质疏松患者,可显著改善患者血清PTH水平的异常表达,促进骨吸收和骨形成,这可能是伊班膦酸钠治疗糖皮质GCs诱导骨质疏松临床机制中的靶点。改善糖皮质GCs诱导骨质疏松患者生活质量和治疗预后均有重要的意义。

Objective To observe the effect of ibandronate intervention on glucocorticoid-induced bone metabolism index in patients with osteoporosis.Methods Forty-eight patients with glucocorticoid-induced osteoporosis treated in our hospital from January to December 2017were as subjects.They were randomly divided into comparison group(24 cases)and observation group(24 cases).The patients in two groups received Caltrate treatment(0.5 μg/twice a day,for 12 weeks).Patients in observation group received additional intravenous ibandronate(initiate 2 mg,then 3 mg/month,for 3 months).The differences of serum PTH,BALP,BGP,CTX-1,and tPINP were compared between the two groups before and after the treatment.Results There was no difference of PTH,BALP,BGP,CTX-1,and tPINP between the comparison group and the observation group before the treatment(P >0.05).Compared with those before treatment,the expression levels of BALP and PTH in the observation group and the comparison group were significantly up-regulated,and the expression levels of BGP,CTX-1,and t PINP were significantly down regulated(P<0.05).Compared with the comparison group,the expression levels of BALP and PTH increased significantly in the observation group after treatment,and the expression levels of BGP,CTX-1,and tPINP decreased significantly(P<0.05).Conclusion Ibandronate treatment significantly releases the abnormal expression of serum PTH,promotes bone resorption and bone formation,in patients with glucocorticoid-induced osteoporosis.This may be the target of the treatment of glucocorticoidinduced osteoporosis.