| 摘要: |
| 目的：探讨唑来膦酸对老年女性骨质疏松性椎体压缩骨折患者骨密度、骨代谢及疼痛的影响。方法：将100例老年女性骨质疏松性椎体压缩骨折患者按照随机数字表法分成观察组和对照组各50例。两组均行经皮椎体成型术治疗，观察组手术后给予唑来膦酸治疗，对照组给予钙剂及维生素D治疗，连续治疗12个月，观察两组治疗前后视觉模拟疼痛评分（VAS）、Oswestry功能障碍指数评分（ODI）、骨密度（BMD）、血清25羟维生素D [(25-OH)D]、骨钙素（BGP）、骨特异性碱性磷酸酶（BALP）和神经生长因子（NGF）、前列腺素E2（PGE2）、神经肽Y（NPY）等指标变化。结果：治疗前两组间VAS和ODI评分比较差异无统计学意义（P > 0.05）；治疗后3 d及12个月时，两组VAS评分均较治疗前明显降低，观察组治疗后12个月时VAS和ODI评分均明显低于对照组（P<0.05）；两组治疗前BMD、（25-OH）D、BGP、BALP、NGF、PGE2、NPY各指标含量比较，差异无统计学意义（P > 0.05）；治疗后12个月，观察组腰椎BMD（L2-4）为（0.685±0.062）g/cm2，右股骨颈为（0.598±0.058）g/cm2，均明显高于对照组腰椎（L2-4）（0.659±0.048）g/cm2和右股骨颈（0.568±0.054）g/cm2， （P<0.05）；观察组（25-OH）D为（35.41±10.26）ng/mL，明显高于对照组（28.29±9.13）ng/mL（P<0.05）；观察组BGP为（10.15±2.01）ng/mL、BALP为（16.26±4.05）ng/mL，均明显低于对照组分别为（12.91±3.04）ng/mL、（18.01±3.75）ng/mL（P<0.05）；观察组NGF为（261.08±6.51）pg/mL，PGE2为（152.57±7.02）ng/mL，NPY为（142.03±9.68）ng/mL，均明显低于对照组分别为（277.42±9.74）pg/mL、（169.74±6.52）ng/mL、（156.24±8.95）ng/mL，（P<0.05）。结论：唑来膦酸能明显增加老年女性骨质疏松性椎体压缩性骨折骨密度，改善骨代谢水平，减轻疼痛，可做为本病的有效治疗药物推广应用。 |
| 关键词: 唑来膦酸 骨质疏松性椎体压缩性骨折 骨密度 骨代谢 疼痛 |
| DOI：10.3969/j.issn.1007-6948.2019.03.017 |
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| 基金项目: |
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| Therapeutic Effect of Zoledronic Acid on Osteoporotic Vertebral Compression Fracture in Elderly Women |
| ZHONG Jie-lin, CAI Ying, KIM Sung-ho, et al. |
| Orthopaedics Department Four of Tianjin Teda Hospital, Tianjin (300457), China |
| Abstract: |
| Objective To study the effects of zoledronic acid on osteoporosis, bone density and pain in elderly women with osteoporotic vertebral compression fracture. Methods One hundred elderly women with osteoporotic vertebral compression fractures were divided into observation and control groups, n=50. The patients in two groups were treated with percutaneous vertebral plasty. After operation, the patients in observation group were treated with zoledronic acid and those in control group were treated with calcium and vitamin D. The treatment lasted for 12 months, and the changes of visual simulation pain score (VAS), Oswestry functional index (ODI), bone mineral density (BMD), serum 25-hydroxyvitamin D [(25-OH)D], osteocalcin (BGP), bone specific alkaline phosphatase (BALP), nerve growth factor (NGF), prostaglandin E2 (PGE2), neuropeptide Y (NPY) and other indicators were compared before and after treatment. Results There was no statistically significant difference between the two groups before the treatment. After 3 d and 12 months of treatment, the VAS scores of the two groups were significantly lower than those before treatment, and the VAS and ODI scores were significantly lower than those of the control group after 12 months. There was no difference between the contents of BMD, VAS0, BGP, BALP, NGF, PGE2 and NPY of the two groups before treatment:. After 12 months of treatment, the BMD values of lumbar L2-4 and right femoral neck in observation group were (0.685±0.062) and(0.598±0.058) g/cm2, respectively, which were significantly higher than those in the control group [(0.659.048) and (0.568±0.054)g/cm2] (t=2.3916, 62422, P<0.05). The (25-OH) D was (35.41±10.26) ng/mL in observation group, which was significantly higher than that of control group [(28.29±9.13) ng/mL], (t=5.2240, P<0.05). The BGP was (10.15±2.01) ng/mL and the BALP was (16.26±4.05) ng/mL, which were significantly lower than those of the control group [(12.91±3.04) ng/mL and (18.01±3.75) ng/mL] (t=0.1037, 2.1980, P<0.05). The NGF was (261.08±6.51) pg/mL, the PGE2 was (152.57±7.02) ng/mL, and the NPY was(142.03±9.68) ng/mL, which were significantly lower than those of the control group [(277.42±9.74) pg/mL, (169.74±6.52) ng/mL and (156.24±8.95) ng/mL] (t=9.7006, 12.4039, 7.4598, P<0.05). Conclusion Zolephosphonic acid can obviously increase bone density of osteoporotic vertebral fractures in elderly women, improve bone metabolism level, relieve pain, and be used as an effective drug for treating this disease. |
| Key words: Zolephosphonic acid osteoporosis vertebral compression fracture bone density bone metabolism pain |
