鲑鱼降钙素联合糖皮质激素吸入治疗COPD合并骨质疏松的疗效及对血清PINP、β-CTX、MMP-9水平的影响

Effect of Salmon Calcitonin Combined with Glucocorticoid Inhalation on the COPD Complicated with Osteoporosis and Its Influence on the Serum PINP,Beta-CTX and MMP-9 Levels

目的:研究鲑鱼降钙素联合糖皮质激素吸入治疗慢性阻塞性肺疾病(Chronic obstructive pulmonary disease COPD)合并骨质疏松的疗效及对血清Ⅰ型前胶原氨基端肽(Amino terminal peptide of procollagen type I PINP)、β-胶原降解产物(β-Cterminal telopeptide of typeⅠcollagenβ-CTX)、基质金属蛋白酶(matrixmetalloproteinase-9 MMP-9)水平的影响。方法:选取2017年3月至2018年4月我院收治的97例COPD合并骨质疏松患者,按照随机数表法分为观察组(47例)和对照组(50例),两组均采用常规治疗,对照组在此基础上采用糖皮质激素吸入治疗,观察组在对照组的基础上采用鲑鱼降钙素治疗。观察和比较两组患者的疗效,治疗前后肺功能指标(一秒钟用力呼气量(forced expiratory volume in one second FEV1)、第一秒用力呼气容积占用力肺活量百分比(Forced expiratory volume in the first second is the percentage of forced vital capacity FEV1/FVC)、血清PINP、β-CTX、MMP-9水平、腰椎骨密度、股骨颈股密度的变化。结果:治疗后,观察组总有效率显著高于对照组[91.48%(43/47) vs. 70.00%(35/50)](P<0.05);FEV1、PO2、FEV1/FVC水平均显著高于对照组[(85.20±13.72)%vs.(70.62±11.37)%,(76.30±8.64)mmhg vs.(62.49±7.13)mmhg,(68.08±11.34)%vs.(60.84±9.75)%](P<0.05);PINP、β-CTX、MMP-9水平均显著低于对照组[(17.02±3.67)mg/L vs.(14.86±3.13)mg/L,(93.20±8.01)ng/L vs.(117.39±11.42)ng/L,(47.24±3.75)ng/mL vs.(60.26±4.67)ng/mL](P<0.05);腰椎骨密度、股骨颈股密度水平均显著高于对照组[(1.12±0.25)g/cm^2vs.(0.89±0.23)g/cm2,(1.14±0.23)g/cm^2vs.(0.90±0.21)g/cm^2](P<0.05)。结论:鲑鱼降钙素联合糖皮质激素吸入治疗COPD合并骨质疏松的疗效显著优于单用糖皮质激素吸入治疗,其能够更有效改善患者肺功能,调节血钙,提高骨密度,缓解骨痛,可能与其降低血清PINP、β-CTX、MMP-9的水平有关。

Objective:To study the effect of salmon Calcitonin combined with glucocorticoid Inhalation on the Chronic obstructive pulmonary disease(COPD)complicated with osteoporosis and Its Influence on the serum(Amino terminal peptide of procollagen type I PINP),(β-Cterminal telopeptide of typeⅠcollagen Beta-CTX)and(matrixmetalloproteinase-9 MMP-9).Methods:97 cases of COPD patients with osteoporosis admitted to our hospital from March 2017 to April 2018 were selected as the research objects.According to the random number table,those patients were divided into the observation group(n=47)and the control group(n=50).Both groups were treated with conventional treatment,the control group was additionally treated by glucocorticoid inhalation,while the observation group was treated by salmon-calcitonin on the basis of the control group.The therapeutic efficacy,the indexes of pulmonary function before and after treatment(forced expiratory volume in one second FEV1),(force expiratory volume in the first second is the percentage of forced vital capacity FEV1/FVC),the serum levels of PINP,beta-CTX,MMP-9,Lumbar bone mineral density and femoral neck femoral density were compared betweeen two groups.Results:After treatment,the total effective rate of observation group was statistically higher than that in the control group[91.48%(43/47)vs.70.00%(35/50)](P<0.05);the FEV1,PO2 and FEV1/FVC levels were significantly higher than those in the control group[(85.20±13.72)%vs.(70.62±11.37)%,(76.30±8.64)mmhg vs.(62.49±7.13)mmhg,(68.08±11.34)%vs.(60.84±9.75)%](P<0.05);the levels of PINP,beta-CTX and MMP-9 were significantly lower than those of the control group[(17.02±3.67)mg/L vs.(14.86±3.13)mg/L,(93.20±8.01)ng/L vs.(117.39±11.42)ng/L,(47.24±3.75)ng/mL vs.(60.26±4.67)ng/mL](P<0.05);the bone mineral density and femoral neck femoral density were significantly higher in the lumbar spine than those in the control group[(1.12±0.25)g/cm2 vs.(0.89±0.23)g/cm2,(1.14±0.23)g/cm2 vs.(0.90±0.21)g/cm2](P<0.05).Conclusion:Salmon calcitonin combined with glucocorticoid inhalation is more effective than glucocorticoid inhalation alone in the treatment of COPD complicated with osteoporosis.It can more effectively improve clinical symptoms and lung function,regulate the blood calcium,increase the bone mineral density and relieve the bone pain.It may be related to the reduction of serum PINP,beta-CTX and MMP-9 levels.