阿仑膦酸钠对骨质疏松胸腰椎骨折患者术后相关指标的影响

Effects of Alendronate Sodium on the Postoperative Indexes in the Osteoporosis Patients with Thoracolumbar Fracture

目的:探讨阿仑膦酸钠对骨质疏松胸腰椎骨折患者术后相关指标的影响。方法:选择2018年1-12月核工业四一六医院收治的170例骨质疏松胸腰椎骨折患者,按随机数字表法分为对照组(85例)和观察组(85例)。所有患者均行皮椎体成形术或经皮椎体后凸成形术。术后,对照组患者给予常规对症支持治疗;观察组患者在对照组基础上给予阿仑膦酸钠片70 mg,口服,每周1次。两组患者的疗程均为1年。观察两组患者治疗前及治疗1、3、6、12个月后的疼痛视觉模拟(VAS)评分、骨代谢指标[血磷(P)、血钙(Ca)、骨钙素(OST)、骨型碱性磷酸酶(BAP)],骨保护素(OPG)、核因子κB受体活化因子配体(RANKL)含量和细胞因子[肿瘤坏死因子α(TNF-α)、干扰素γ(IFN-γ)、白细胞介素10(IL-10)]水平,并记录不良反应的发生情况。结果:治疗前,两组患者VAS评分、骨代谢指标,OPG、RANKL含量,细胞因子水平比较,差异均无统计学意义(P>0.05)。治疗后,两组患者VAS评分均显著低于同组治疗前,且观察组(治疗1、3、6个月后)显著低于对照组同期(P<0.05);观察组患者治疗3、6、12个月后OST、BAP含量,治疗1、3、6、12个月后OPG、RANKL含量和TNF-α、IFN-γ水平均显著低于同组治疗前及对照组同期,治疗3、6、12个月后IL-10水平均显著高于同组治疗前及对照组同期(P<0.05)。两组患者治疗前后P、Ca以及对照组患者治疗前后OST、BAP含量,OPG、RANKL含量,细胞因子水平比较,差异均无统计学意义(P>0.05)。两组患者总不良反应发生率比较,差异无统计学意义(P>0.05)。结论:阿仑膦酸钠可明显缓解骨质疏松胸腰椎骨折患者术后的疼痛程度,改善细胞因子、骨代谢指标,并抑制相关通路的表达,且安全性较好。

OBJECTIVE:To investigate the effects of alendronate sodium on postoperative indexes in the osteoporosis patients with thoracolumbar fracture.METHODS:Totally 170 patients with osteoporotic thoracolumbar fracture admitted in 416 Hospital of Nuclear Industry during Jan.-Dec.2018 were divided into control group(85 cases)and observation group(85 cases)according to random number table.All patients underwent percutaneous vertebroplasty or percutaneous kyphoplasty.After operation,control group received symptomatic and supportive treatment.Observation group was additionally given Alendronate sodium tablets 70 mg orally,once a week,on the basis of control group.Treatment course of 2 groups lasted for one year.VAS score,bone metabolism indexes[serum phosphorus(P),calcium(Ca),osteocalcin(OST),bone alkaline phosphatase(BAP)],contents of osteoprotegerin(OPG)and nuclear factor-κB receptor activator ligand(RANKL),cytokines(TNF-α,IFN-γ,IL-10)levels were observed in 2 groups before and after 1,3,6,12 months of treatment,and ADR were recorded.RESULTS:Before treatment,there was no significant difference in VAS score,bone metabolism indexes,contents of OPG and RANKL and cytokines levels between 2 groups(P>0.05).After treatment,VAS scores of 2 groups were significantly lower than before treatment,the observation group was significantly lower than the control group after 1,3,6 months of treatment(P<0.05).OST and BAP contents of observation group after 3,6,12 months treatment as well as OPG and RANKL contents,TNF-αand IFN-γlevels after 1,3,6,12 months of treatment were significantly lower than before treatment and control group at the same period;IL-10 level was significantly was higher than before treatment and control group at the same period(P<0.05).There was no statistical significance in P or Ca of 2 groups before and after treatment,OST,BAP,OPG,RANKL contents and cytokines levels of control group before and after treatment(P>0.05).There was no statistical significance in total incidence of ADR between 2 group(P>0.05).CONCLUSIONS:Alendronate sodium can significantly relieve the pain and improve cytokines,bone metabolism indexes,and inhibit expression of releated pathways in osteoporosis patients with thoracolumbar fracture,with good safety.