鲑鱼降钙素联合阿仑膦酸钠对老年血液透析患者肾性骨病的影响

Salmon Calcitonin Joint Alendronate Sodium Phosphate of Elderly Hemodialysis Patients with Renal Bone Disease Clinical Symptoms

目的研究鲑鱼降钙素联合阿仑膦酸钠对长期行血液透析的老年患者肾性骨病骨痛症状、骨代谢标记物、骨密度的影响。方法选择伴有不同程度骨痛、关节活动的功能减退、皮肤瘙痒等并发肾性骨病长期血液透析的老年患者60例,采用抽签法将纳入标准的患者随机分为鲑鱼降钙素组(A组,n=20)、阿仑膦酸钠组(B组,n=20)、鲑鱼降钙素+阿仑膦酸钠联合治疗组(C组,n=20)。所有患者均每周三次血液透析;A组第一周内选用皮下注射鲑鱼降钙素50IU每次,血液透析结束后每周三次;B组选用口服阿仑膦酸钠70 mg,每周一次;C组选用A+B联合治疗。分别记录各组在治疗前,治疗满4周、满8周时的骨痛分级评分情况;同时检测并记录当时的血钙、血磷、血甲状旁腺激素(parathyroid hormone,PTH)、骨密度水平及临床症状。结果 1A组、B组、C组在4周后骨痛等临床症状较治疗前都有所好转,C组明显优于A组与B组,有统计学意义(P<0.05),A组优于B组,有统计学意义(P<0.05),A组、C组用药一周后疼痛症状开始缓解,B组无明显缓解;8周后骨痛等临床症状均明显好转,C组明显优于A组与B组,A组优于B组,有统计学意义(P<0.05)。2A组、B组、C组血钙、血磷、血PTH、骨密度在4周后与治疗前比差异无统计学意义(P>0.05);8周时测血钙、血磷、血PTH、骨密度较治疗前、4周时好转,C组明显优于A组与B组,有统计学意义(P<0.05),A组与B组之间差异无统计学意义(P>0.05)。3C组出现3例恶心、呕吐,予以胃复安等对症处理后症状缓解;B组出现1例轻微恶心、干呕,密切观察后症状自行缓解;A组1例药物过敏,退出试验,对研究结果无影响。结论鲑鱼降钙素与阿仑膦酸钠联合用药能更好的缓解长期血液透析的肾性骨病患者骨痛等症状,能更好的调节血钙、血磷、血PTH水平,使骨密度有所改善,安全性高。

Objective To study the effect of salmon calcitonin alendronate on renal osteodystrophy pain,markers of bone metabolism,bone mineral density symptoms in elderly patients undergoing long-term hemodialysis. Methods A total of 60 elderly chronic hemodialysis patients with varying degrees of pain,impaired function of the joints,skin itching with renal osteodystrophy were selected. Balloting method was applied to divide the patients randomly into standard salmon calcitonin group( group A,n=20),alendronate group( group B,n=20),salmon calcitonin+alendronate combination therapy group( group C,n= 20). All patients were laws hemodialysis,tiw. Group A was treated using subcutaneous salmon calcitonin 50 IU each,qd( first week),after tiw( after hemodialysis); Group B was treated using oral alendronate 70 mg,qw; group C accepted A+B combination therapy. Each group pain grading score situation were recorded before treatment and at four and eight weeks after treatment.The time of calcium,phosphorus,serum PTH,bone density levels and clinical symptoms were simultaneously detected and recorded. Results 1In the treatment groups( A,B,C),the clinical symptoms such as pain were singificanlty alleviate after four weeks,which were better in group C than in group A and group B( P<0. 05),better in group A than group B( P<0.05). The pain was alleviated in group A and C after a week of medication,and not alleviated in group B. The clinical symptoms such as pain after 8 weeks were significantly alleviate in group C which was significantly better than in group A and group B,and better in group A than group B( P<0. 05). 2Calcium,phosphorus,serum PTH,bone mineral density in group A,group B,group C at four weeks after treatment were not significantly different compared with those before treatemnt( P>0. 05). These indexes measured at 8 weeks were significantly better in group C than in group A and group B( P<0. 05),and not significantly different between group A and group B( P>0. 05). 3In group C,3 cases had nausea,vomiting,metoclopramide be symptomatic treatment of symptoms; in group B,1 case had mild nausea,retching,and the symptoms were relieved after close observation. In group A,1 case had drug allergies and withdrew from the study.Conclusion 1Salmon calcitonin and alendronate combination therapy can better alleviate chronic hemodialysis patients with renal osteodystrophy,bone pain and other symptoms,better regulate serum calcium,phosphorus,serum PTH levels and improve bone density. 2Salmon calcitonin combined alendronate therapy in elderly patients with chronic hemodialysis renal osteodystrophy bone and joint pain and other symptoms has good clinical effect,can quickly relieve pain,itching and other symptoms,and is safe.