2022 年第 11 期 第 17 卷

绝经后骨质疏松症患者接受唑来膦酸治疗后骨密度变化与骨转换标志物关系的研究

Relationship between change of bone mineral density and bone turnover markers in postmenopausal osteoporosis patients after zoledronic acid treatment

作者：钟瑶1沈想想2边平达2应奇峰3陈锦平3

英文作者：Zhong Yao1 Shen Xiangxiang2 Bian Pingda2 Ying Qifeng3 Chen Jinping3

单位：1浙江省人民医院急诊重症中心重症医学科，杭州310024；2浙江省人民医院老年医学中心，杭州310024；3浙江省人民医院骨质疏松诊疗中心，杭州310014

英文单位：1Intensive Care Unit Emergency and Critical Care Center Zhejiang Provincial People′s Hospital Hangzhou 310024 China; 2Geriatric Medicine Center Zhejiang Provincial People′s Hospital Hangzhou 310024 China; 3Center for Diagnosis and Treatment of Osteoporosis Zhejiang Provincial People′s Hospital Hangzhou 310014 China

关键词：绝经后骨质疏松症；唑来膦酸；骨转换标志物

英文关键词：Postmenopausalosteoporosis；Zoledronicacid；Boneturnovermarkers

• 摘要：

• 目的 探讨绝经后骨质疏松症（PMOP）患者接受唑来膦酸治疗后骨密度变化与骨转换标志物（BTMs）的关系。方法 选取2020年6—12月浙江省人民医院收治的140例PMOP患者，所有患者予唑来膦酸5 mg静脉滴注。检测并比较患者接受唑来膦酸治疗前（基线）、治疗后12个月血清Ⅰ型胶原交联羧基端肽(CTX)、Ⅰ型原胶原氨基端前肽(PⅠNP)水平及股骨颈骨密度（FNBMD）、全髋骨密度（THBMD）和腰椎1~4节段骨密度（LSBMD）。计算治疗后12个月与治疗前骨密度的差值（ΔFNBMD、ΔTHBMD、ΔLSBMD），分析基线血清CTX、PⅠNP水平与骨密度变化的相关性。结果 治疗后12个月，患者血清CTX、PⅠNP水平均低于治疗前，FNBMD、THBMD和LSBMD均高于治疗前，差异均有统计学意义（均P＜0.001）。患者基线血清CTX水平与ΔFNBMD、ΔTHBMD呈正相关（r=0.213，P=0.015；r=0.255，P=0.004），与ΔLSBMD无明显相关性（r=0.091，P=0.317）；基线血清PⅠNP水平与ΔFNBMD、ΔTHBMD、ΔLSBMD呈正相关（r=0.222，P=0.012；r=0.185，P=0.036；r=0.186，P=0.038）。结论 基线血清BTMs水平在PMOP患者接受唑来膦酸治疗后的骨密度变化中具有预测价值，BTMs水平越高，骨密度增加越快。

• Objective To investigate the relationship between change of bone mineral density (BMD) and bone turnover markers (BTMs) in postmenopausal osteoporosis (PMOP) patients after zoledronic acid treatment. Methods From June to December 2020, in Zhejiang Provincial People′s Hospital, a total of 140 PMOP patients were recruited into the study. All patients were given 5 mg zoledronic acid intravenous drip. Serum levels of carboxy-terminal cross-linking telopeptide of type Ⅰ collagen (CTX), procollagen type Ⅰ N-terminal propeptide (PⅠNP), and femoral neck BMD（FNBMD）, total hip BMD（THBMD） and lumbar spine 1-4 segments BMD (LSBMD) were measured and compared before (baseline) and 12 months after zoledronic acid treatment. The differences of BMD 12 months after treatment and before treatment (ΔFNBMD, ΔTHBMD, ΔLSBMD) were calculated, and the relationship of baseline levels of serum CTX and PⅠNP with changes of BMD was analyzed. Results Twelve months after treatment, serum levels of CTX and PⅠNP decreased, while FNBMD， THBMD and LSBMD increased（all P＜0.001）. The baseline level of serum CTX was positively associated with ΔFNBMD and ΔTHBMD (r=0.213, P=0.015; r=0.255, P=0.004), while was not associated with ΔLSBMD(r=0.091, P=0.317). The baseline level of serum PⅠNP was posivitely associated with ΔFNBMD, ΔTHBMD and ΔLSBMD (r=0.222, P=0.012; r=0.185, P=0.036; r=0.186, P=0.038). Conclusions erum baseline levels of BTMs have predictive value in changes of BMD in PMOP patients after zoledronic acid treatment, and BMD would increase more quickly in PMOP patients with higher BTMs.