短期大剂量糖皮质激素治疗对骨转换指标、骨密度和骨小梁评分的影响

Effects of short-term high-dose glucocorticoid therapy on bone turnover index,bone mineral density and trabecular bone score

目的观察短期使用大剂量糖皮质激素(glucocorticoid,GCs)对骨转换标志物、骨密度(bone mineral density,BMD)和骨小梁评分(trabecular bone scores,TBS)的影响。方法选取33例(女性19例,男性14例,平均年龄49岁)需要静脉注射(Iv)甲基强的松治疗的活动性Graves’眼病患者。所有患者均给予中位累积剂量4.5 g(范围1.5~5.25 g)iv甲基强的松。分别于基线、1周和第1、3、6、12个月测定骨代谢生化指标(25羟维生素D、PTH、P1NP、CTX和BALP)。在基线、6个月和12个月时通过X射线吸收测量法(DXA)获得受试者BMD和TBS。结果PTH、BALP、P1NP无明显变化。1个月时CTX显著下降(比基线下降49.31%,P=0.02),在3个月测量时恢复到基线。P1NP有改变(不显著),但持续下降。BMD或TBS无明显变化。结论短期大剂量GCs治疗可快速、短暂地抑制骨吸收,对BMD或骨微结构(TBS)无影响。

Objective To observe the effect of short-term,high-dose glucocorticoid(GCs)on bone turnover markers,bone mineral density(BMD),and trabecular bone scores(TBS).Methods 33 patients(19 females and 14 male;median age 49 years)with active Graves’orbitopathy(GO)who were candidates for treatment with intravenous(iv)methylprednisone were consecutively enrolled.All patients were given a median cumulative dose of 4.5 g(range 1.5-5.25 g)iv methylprednisone.Biochemical parameters of bone metabolism(25-hydroxyvitamin D,PTH,P1NP,CTX and BALP)were measured at the baseline,and then 1 week and 1,3,6 and 12 months.BMD and TBS were obtained by X-ray absorptiometry(DXA)at the baseline and at 6 and 12 months.ResultsThere were no significant changes in PTH,BALP or P1NP.A significant drop in CTX was seen at 1 month(down 49.31%from the baseline,P=0.02),with a return to the baseline at the 3-month measurement.There was a moderate(not significant),but persistent reduction in P1NP.There was no significant change in BMD or TBS.Conclusion Short-term high-dose GCs treatment can quickly and transiently inhibit bone resorption without affecting BMD or bone microstructure(TBS).