早期减重支持训练对脑卒中后骨质疏松症患者骨保护素和核因子-κB受体活化因子配体的影响

Early body weight-supported treadmill training retards osteoporosis after a stroke

目的 观察早期减重支持训练对卒中后骨质疏松症患者骨保护素(OPG)和核因子-κB受体活化因子配体(RANKL)的影响。方法 将脑卒中后骨质疏松症患者60例随机分成治疗组和对照组,每组患者30例,对照组采用药物(密钙息、阿法骨化醇、福善美)联合常规康复训练进行治疗,治疗组在药物治疗方案的基础上增加早期减重支持训练。于治疗前、治疗3个月后、治疗6个月后和出院1年后(随访时)检测2组患者的腰椎BMD和骨转化调节指标(包括OPG、RANKL、RANKL/OPG)。结果 2组患者骨密度(BMD)、OPG、RANKL、RANKL/OPG在治疗后均有一定程度的改善,对照组在治疗6个月后,其OPG和RANKL分别为(11.9±9.7)pmol/L和(290.7±87.0 )pmol/L,与组内治疗前比较,差异均有统计学意义(P<0.05),对照组患者的OPG、RANKL和RANKL/OPG与组内治疗前比较,差异均有统计学意义(P<0.05)。治疗3、6个月后和出院1年后,治疗组患者的BMD、OPG、RANKL、RANKL/OPG均显著改善,且均显著优于组内治疗前和对照组相同时间点,差异均有统计学意义(P<0.05)。结论 早期应用减重支持训练可显著下调脑卒中后骨质疏松症患者OPG、RANKL的表达,提高RANKL/OPG比率,改善BMD及其骨质疏松状态。

Objective To observe any effect of early-stage body weight-supported treadmill training on the progression of osteoporosis after a stroke.Methods Sixty stroke survivors with osteoporosis were randomly divided into a treatment group and a control group,each of 30.Both groups were given routine medication including Miacal-cic,α-D3 and Fosamax,along with standard rehabilitation training.The treatment group was additionally subjected to body weight-supported treadmill training.The bone mineral density(BMD),serum osteoprotegerin(OPG)and ser-um NF-κB ligand receptor activator(RAKNL)levels were measured for both groups before and after 3,6 and 12 months of treatment.Results The average BMD,OPG and RAKNL levels and the RANKL/OPG ratio in both groups improved with treatment.After 3,6 and 12 months of treatment,all four average indicators were superior to those of the control group at the same time points.Conclusion Body weight-supported treadmill training can signifi-cantly retard the development of osteoporosis.