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绝经后女性骨量减少的综合临床研究

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目的 分析综合干预方案对绝经后女性骨量减少的临床疗效,为预防绝经骨量减少女性发生骨质疏松方案选择提供参考.方法 选择2014年3月~2015年3月绍兴市柯桥区中医医院收治的152例绝经骨量减少妇女作为研究对象,采用随机数字法将患者分为综合干预组与对照组,每组76例.对照组采用HRT激素补充治疗和补钙制剂治疗,综合干预组在对照组治疗基础上再予以阿仑膦酸钠治疗,并辅以健康生活指导,2组患者均治疗1年.比较2组患者治疗前、治疗后N端骨钙素(N-MID)、I型前胶原氨基端延长肽(PINP)、β-胶联降解产物(β-CTX)、碱性磷酸酶水平(ALP)、骨密度L2-L4(BMD)、E2、血清骨钙素(sOC)、降钙素(CT)、甲状旁腺激素(PTH),骨质疏松症发生率、骨折率,观察治疗过程中出现的药物不良反应.结果 2组患者治疗前BMD(L2-L4)值、β-CTX、N-MID、PINP、ALP、sOC比较差异无统计学意义;治疗1年后,2组患者BMD、sOC均较治疗前明显升高(P<0.05),β-CTX、N-MID、PINP、ALP均较治疗前有明显下降(P<0.05),综合组升高和下降程度均明显高于对照组,差异均具有统计学意义(P<0.05).2组患者治疗前E2、甲状旁腺激素(PTH)、降钙素(CT)比较差异无统计学意义;治疗1年后,2组患者上述指标均较治疗前明显升高,且组间差异无统计学意义.综合干预组患者治疗1年后有1例(1.32%)患者诊断为骨质疏松症,2例(2.63%)发生骨折,对照组11例(14.47%)骨质疏松症,9例(11.84%)骨折,综合干预组的骨折率及骨质疏松症率明显低于对照组(P<0.05);2组患者治疗过程中,综合干预组有6例发生药物不良反应,阿仑膦酸钠药量减半后自行消失,对照组未发现药物不良反应.结论 激素+钙尔奇+阿仑膦酸钠+健康生活指导综合干预方案对改善患者激素水平,提升绝经后骨量减少女性的骨重建标志物水平、提升患者骨组织抗吸收作用,使骨平衡向有利方向发展,对绝经后骨量减少女性具有较高的临床价值.
Clinical study of comprehensive intervention on bone mass reduction in postmenopausal women
Objective To analyze the clinical effect of comprehensive intervention on bone loss in postmenopausal women, and to provide reference for the prevention of osteoporosis in postmenopausal women .Methods 152 cases of postmenopausal bone mass in our hospital from March 2014 to March 2015 were selected as the research object, all patients were randomly divided into intervention group and control group,76 cases in each group.The control group was treated with HRT hormone replacement therapy and calcium supplement treatment , the intervention group based on the treatment in control group by alendronate treatment,supplemented by health guidance, two patients were treated for 1 years.Comparison of two groups of patients before and after treatment, N (N-MID), osteocalcin, procollagen type I amino terminal peptide (PINP), beta crosslinking degradation products (β-CTX), alkaline phosphatase (ALP), bone mineral density L2-L4 (BMD), E2, Serum Osteocalcin (sOC) and calcitonin (CT), parathyroid hormone (PTH), the incidence rate of fracture, osteoporosis, adverse drug reaction.Results There were no significant differences in BMD (L2-L4),β-CTX, N-MID, PINP, ALP and sOC between the two groups; After one year of treatment, BMD and sOC of the two groups were significantly higher than those before treatment (P<0.05), and the levels of β-CTX, N-MID, PINP and ALP were significantly decreased (P<0.05), and the difference between the two groups was statistically significant (P<0.05).There was no significant difference in E2, PTH and CT between the two groups before treatment.After one year of treatment, the above indexes of the two groups were significantly higher than those before treatment (P<0.05), and there was no statistically significant difference between the two groups.In the comprehensive intervention group, one patient ( 1.32%) was diagnosed as osteoporosis and two cases (2.63%) fractured after one year of treatment,In the control group, 11 cases (14.47%) were osteoporosis, 9 cases%). The fracture rate and osteoporosis rate in the intervention group were significantly lower than those in the control group (P<0.05).In the course of treatment,six patients in the comprehensive intervention group had adverse drug reactions, and the alendronate dosage decreased by half,and no adverse drug reaction was found in the control group.Conclusion hormone,Caltrate,alendronate and health guidance comprehensive intervention program to improve the hormone level in patients with osteopenia, bone reconstruction of women physical level and promote the bone tissue of patients with anti absorption to enhance the role of postmenopausal bone balance favorable development, for postmenopausal bone loss in women with a high clinical value.

postmenopausal bone mass reductioncomprehensive interventionhormone therapysodium hyaluronatehealth guidance

侯丽环、章义琴、李芳

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绍兴市柯桥区中医医院 妇科,浙江 绍兴 312030

绝经后骨量减少 综合干预 激素治疗 阿仑膦酸钠 健康指导

2017

中国生化药物杂志
南京生物化学制药研究所,全国生化制药情报中心站,中国生化制药工业协会,中国药品生物制品检定所

中国生化药物杂志

ISSN:1005-1678
年,卷(期):2017.37(2)
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