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目的观察阿伦膦酸钠治疗绝经后骨质疏松症(PMO)患者,其骨密度(BMD)、IL-6、TNFα、胰岛素样生长因子-Ⅰ(IGF-Ⅰ)及骨代谢指标的变化。方法选择年龄55-60岁的PMO患者共185例,随机分为:阿伦膦酸钠组69例,替勃龙组66例,钙剂组50例和年龄相匹配的正常妇女20例作为对照组。各组均于用药前和用药后24、48周测定BMD(采用DEXA骨密度仪)、雌二醇(E2)、碱性磷酸酶(ALP,放免法)、骨钙素(BGP)、Ⅰ型胶原N末端肽(NTX)、IL-6、TNFα、IGF-Ⅰ(ELISA)。结果阿伦膦酸钠组和替勃龙组BMD较治疗前均有不同程度的提高,腰椎BMD增幅分别为2．53％、3．65％(P<0．05),非优势侧股骨近端增幅分别为7．17％、3．01％(P<0．001)。替勃龙组E2水平明显上升(P<0．01),IL-6、TNFα、NTX下降(P<0．01);阿伦膦酸钠组E2水平无变化(P> 0．05),ALP、BGP水平上升(P<0．05),NTX水平下降(P<0．05),IGF-Ⅰ、IL-6、TNFα水平无明显变化(P>0．05);钙剂组和对照组各部位BMD、E2、IGF-Ⅰ、ALP、BGP继续下降(P<0．05),而IL-6、TNFα、NTX升高(P<0．05)。结论阿伦膦酸钠组治疗PMO疗效显著,与替勃龙相仿。单纯服用钙剂不能治疗PMO,且继续骨量丢失。
Objective To observe the changes of bone mineral density (BMD), IL-6, TNFα, insulin-like growth factor-Ⅰ (IGF-Ⅰ) and bone metabolism in patients with postmenopausal osteoporosis (PMO) treated with alendronate. Methods A total of 185 patients aged 55-60 years with PMO were randomly divided into: alendronate group 69 cases, tibolone group 66 cases, calcium group 50 cases and age-matched normal women 20 cases as control group. BMD (using DEXA bone density meter), estradiol (E2), alkaline phosphatase (ALP), osteocalcin (BGP), type I Collagen N-terminal peptide (NTX), IL-6, TNFα, IGF-Ⅰ (ELISA). Results BMD of alendronate group and tibolone group increased to some extent before treatment, and the increase of BMD of lumbar vertebra was 2.53% and 3.65% respectively (P <0.05). The non-dominant side femur The end increases were 7.17%, 3.01% (P <0.001). E2 levels in tibolone group were significantly increased (P <0.01), IL-6, TNFα and NTX were decreased (P <0.01); there was no change in E2 level in alendronate group (P> 0.05) ALP, BGP levels (P <0.05), NTX level decreased (P <0.05), IGF-Ⅰ, IL-6 and TNFα levels did not change significantly (P> 0.05) BMD, E2, IGF-Ⅰ, ALP and BGP in all the groups continued to decline (P <0.05), but IL-6, TNFα and NTX increased (P <0.05). Conclusion The alendronate sodium group has a significant therapeutic effect on PMO, similar to tibolone. Simply taking calcium can not treat PMO, and continue bone loss.