唑来膦酸对老年骨质疏松性髋部骨折患者血清BGP、IGF-1、CTX、DPD和SHBG水平的影响

Effects of zoledronic acid on serum levels of BGP,IGF-1,CTX,DPD and SHBG levels in elderly patients with hip osteoporotic fractures

目的观察唑来膦酸(ZA)对老年骨质疏松性髋部骨折患者血清骨钙素(BGP)、胰岛素样生长因子(IGF-1)、Ⅰ型胶原交联羧基末端肽(CTX)、脱氧吡啶啉(DPD)和性激素结合球蛋白(SHBG)水平的影响。方法按随机数字表法将2015年1月至2017年1月自贡市第五人民医院86例行全髋关节置换术(THA)的老年骨质疏松性髋部骨折患者分成ZA组(研究组,n=43)和阿仑膦酸钠组(对照组,n=43)。于术前(T1)及术后1年(T2)时检测两组患者血清骨形成标志物(BGP、IGF-1)、骨吸收标志物(CTX、DPD、SHBG)、钙磷代谢调节指标[钙(Ca)、磷(P)]水平,比较两组患者T1、T2时假体周围平均骨密度(BMD)及髋关节功能(Harris)评分差异。结果 T2时,两组血清BGP、CTX、DPD、SHBG水平均较T1时降低,且研究组低于对照组(P<0.05);血清IGF-1水平均较T1时升高,且研究组高于对照组(P<0.05)。两组T1、T2时血清Ca、P水平比较差异无统计学意义(P>0.05)。T2时,研究组假体周围平均BMD与T1时比较差异无统计学意义(P>0.05),对照组假体周围平均BMD较T1时降低(P<0.05);两组Harris评分均较T1时升高(P<0.05),组间比较差异无统计学意义(P>0.05)。结论 ZA可有效改善老年骨质疏松性髋部骨折患者THA术后骨代谢情况,缓解假体周围BMD下降,同时并未影响患者髋关节功能的恢复,于病情转归有利。

Objective To observe the effects of zoledronic acid(ZA)on serum levels of bone gla protein(BGP),insulin-like growth factor(IGF-1)and typeⅠcollage cross-linked-telopeptide(CTX),deoxypyridinoline(DPD)and sex hormone binding globulin(SHBG)in elderly patients with hip osteoporotic fractures.Methods 86 cases of patients with hip osteoporotic fractures undergoing total hip arthroplasty(THA)in Zigong fifth people′s hospital from January 2015 to January 2017 were divided into ZA group(study group,n=43)and alendronate sodium group(control group,n=43)according to the random number table method.The levels of serum markers of bone formation(BGP,IGF-1),markers of bone resorption(CTX,DPD,SHBG)and regulation indexes of calcium phosphorus metabolism[calcium(Ca)and phosphorus(P)]were measured before operation(T1)and at 1 year(T2)after operation,and the mean bone mineral density(BMD)around the prosthesis and hip function(Harris score)were compared between the two groups at T1 and T2.Results At T2,the serum levels of BGP,CTX,DPD and SHBG in the two groups were lower than those at T1,and the levels in study group were lower than those in control group(P<0.05).Serum IGF-1 level was higher than that at T1,and the level in study group was higher than that in control group(P<0.05).There was no significant difference in the levels of serum Ca and P between the two groups at T1 and T2(P>0.05).At T2,there was no significant difference in the mean BMD around the prosthesis in the study group compared with that at T1(P>0.05),and the mean BMD around the prosthesis in control group was lower than that at T1(P<0.05).The Harris score of the two groups was higher than that at T1(P<0.05),and there was no significant difference between the two groups(P>0.05).Conclusion ZA can effectively improve the bone metabolism in elderly patients with hip osteoporotic fractures after THA,relieve the decrease of BMD around the prosthesis,and it does not affect the recovery of hip function,and it is beneficial to the outcome of disease.