鲑降钙素鼻用喷雾剂辅助治疗对内分泌失调性骨质疏松症患者骨密度及骨转化标志物水平的影响

Effects of salmon calcitonin nasal spray adjuvant therapy on bone mineral density and bone turnover markers levels in patients with endocrine dysfunctional osteoporosis

目的探讨鲑降钙素鼻用喷雾剂辅助治疗对内分泌失调性骨质疏松症患者骨密度及骨转化标志物(BTMs)水平的影响。方法选取2019年5月至2020年5月四川省骨科医院收治的内分泌失调性骨质疏松症患者88例,根据随机数字表法分为对照组和观察组,各44例。对照组予碳酸钙D_(3)片、盐酸曲马多缓释片口服治疗,观察组在对照组基础上予鲑降钙素鼻用喷雾剂鼻腔喷入治疗,2组均治疗6个月。比较2组临床疗效,治疗前后骨密度、BTMs水平、疼痛视觉模拟量表(VAS)评分,骨折及不良反应发生情况。结果观察组总有效率明显高于对照组[95.5%(42/44)比77.3%(34/44)],差异有统计学意义(P=0.001)。治疗后,2组L_(1~4)、股骨颈及Ward三角骨密度均高于治疗前,且观察组均高于对照组[(0.84±0.11)g/cm^(2)比(0.79±0.10)g/cm^(2)、(0.75±0.09)g/cm^(2)比(0.70±0.08)g/cm^(2)、(0.61±0.08)g/cm^(2)比(0.59±0.07)g/cm^(2)](均P<0.05)。治疗后,2组Ⅰ型胶原氨基端前肽、Ⅰ型胶原羧基末端肽交联β特殊序列水平均低于治疗前,且观察组均低于对照组,25-羟基维生素D水平均高于治疗前,且观察组高于对照组,差异均有统计学意义(均P<0.05)。治疗后,2组疼痛VAS评分均低于治疗前,且观察组低于对照组,差异均有统计学意义(均P=0.001)。治疗期间2组骨折及不良反应发生率差异均无统计学意义(均P>0.05)。结论鲑降钙素鼻用喷雾剂辅助治疗内分泌失调性骨质疏松症患者,可有效调节BTMs表达水平并促进骨密度升高,且不增加不良反应的发生。

Objective To investigate the effects of salmon calcitonin nasal spray adjuvant therapy on bone mineral density(BMD)and bone turnover markers(BTMs)levels in patients with endocrine dysfunctional osteoporosis.Methods From May 2019 to May 2020,88 patients with endocrine dysfunctional osteoporosis admitted to Sichuan Province Orthopedic Hospital were enrolled.They were randomly divided into control group and observation group,with 44 cases in each group.The control group was treated with calcium carbonate and vitamin D_(3) tables and tramadol hydrochloride sustained-release tablets orally and the observation group was treated with calcitonin(salmon)nasal spray via nasal spray based on the control group.Both groups were treated for6 months.The clinical efficacy,BMD,BTMs levels and pain visual analogue scale(VAS)score before and after treatment,and incidences of fracture and adverse reactions were compared between the two groups.Results The total effective rate of observation group was significantly higher than that of control group[95.5%(42/44)vs77.3%(34/44)](P=0.001).After treatment,BMD of L1-4,femoral neck and Ward triangle of both groups were higher than those before treatment,and those of observation group were higher than those of control group[(0.84±0.11)g/cm^(2) vs(0.79±0.10)g/cm^(2),(0.75±0.09)g/cm^(2) vs(0.70±0.08)g/cm^(2),(0.61±0.08)g/cm^(2) vs(0.59±0.07)g/cm^(2)](all P<0.05).After treatment,the levels of procollagen typeⅠamino-terminal propeptide and carboxy-terminal telopeptide of typeⅠcollagen of both groups were lower than those before treatment,and those of observation group were lower than those of control group;25-hydroxy vitamin D levels of both groups were higher than those before treatment and that of observation group was higher than that of control group(all P<0.05).After treatment,the pain VAS scores of both group were lower than those before treatment and that of observation group was lower than that of control group(all P=0.001).There were no significant differences in incidences of fracture and adverse reactions between the two groups(both P>0.05).Conclusion Salmon calcitonin nasal spray adjuvant therapy can effectively regulate the expression levels of BTMs and promote the increase of BMD in the treatment of patients with endocrine dysfunctional osteoporosis without adverse reactions increase.