摘要
目的:观察具有直接抑制骨吸收、调节成骨细胞的活性和数量从而促进骨生成作用的鲑鱼降钙素对老年骨质疏松性椎体骨折患者骨代谢、骨折机愈合、腰背痛疼症状的治疗效果。方法:①选择2000-06/2003-06武汉大学人民医院骨科老年骨质疏松性椎体骨折患者138例。患者均知情同意。患者被随机分为2组:对照组65例,鲑鱼降钙素组73例。②对照组患者行卧硬板床、腰背部或胸背部垫软枕,并辅以中成药口服。鲑鱼降钙素组在对照组干预措施基础上给予鲑鱼降钙素,肌注1次/d,连续1个月,同时服用钙剂600mg/d。③分别于治疗前、治疗后1个月采用放射免疫分析法测定血骨钙素、收集晨起第2次尿,尿钙采用偶氮三胂法测定、尿羟脯氨酸采用化学发光免疫分析法测定、尿肌酐测定采用碱性苦味酸法测定,并计算尿钙/尿肌酐与尿羟脯氨酸/尿肌酐。④开始治疗后4和6及8周复查脊柱X射线平片,了解骨折愈合情况。⑤患者通过在本院门诊进行复诊的方式进行随访12个月,观察骨折愈合及腰背痛情况。⑥同组用药前后比较采用配对t检验。结果:骨质疏松患者138例中有3例因肌注密钙息出现面部潮红、头痛、恶心、呕吐、皮肤瘙痒等反应,于用药后1周左右终止治疗,最终进入结果分析135例。①所选患者治疗1个月后鲑鱼降钙素组血骨钙素明显高于治疗前犤(9.43±4.75),(7.41±3.03)μg/L,P<0.01犦;尿羟脯氨酸/尿肌酐明显低于治疗前犤(2.15±0.96),(3.32±0.96)mg/mmol,P<0.01犦。②开始治疗后4～6周复查X射线平片示鲑鱼降钙素组骨折愈合率达99%,对照组愈合率为86%。对照组患者有9例于治疗8周后骨折愈合。③鲑鱼降钙素组、对照组分别有43和8例患者于治疗2周后腰背疼痛消失,分别有19和29例患者于用药后1个月腰背痛消失;对照组有13例患者在骨折愈合后1年仍有腰痛。结论:鲑鱼降钙素能抑制骨质疏松患者的骨代谢,抑制骨吸收;鲑鱼降钙素能够促进骨质疏松性椎体骨折的愈合,并能迅速改善腰背痛症状。
AIM： To observe the therapeutic effects of salmon calcitonin, which can directively inhibit bone absorption, adjust the activity and number of osteoblasts, and accelerate osteogenesis, on the bone metabolism, fracture healing and low back pain in elderly patients with osteoporotic vertebral fracture. METHODS： ①A total of 138 elderly patients with osteoporotic vertebral fracture, who were selected from the Department of Orthopaedics, Renmin Hospital of Wuhan Univemity between June 2000 and June 2003, were randomly divided into two groups： control group （n=65） and salmon caleitonin group （n=73）. ② All the patients lay on the bed with a soft pillow at lower back or upper back, and assisted by oral mid-patent medicine, besides, those in the salmon calcitonin group were treated by intramuscular injection of Miacalcic, once a day for a month continuously, they also took calcium 600 mg per day. ③ Before treatment and 1 month after treatment, blood osteocalcin was determined with radioimmunoassay, the second urine after get-up in the morning was collected, urinary calcium was detected with the azo three amine method, urinary hydroxyproline with chemiluminoimmunoassay, urinary creatinine with the basic bitter acid method, and the urinary calcium/urinary creatinine ratio and urinary hydroxyproline/urinary creatinine ratio were calculated. ④ The spinogram was reexamined at 4, 6 and 8 weeks after treatment to investigate the condition of fracture healing. ⑤ The patients were followed up for 12 months by means of reexamination, the fracture healing and low back pain were observed. ⑥ The difference before and after medication in the same group was compared with the paired t test. RESULTS： Of the 138 patients with osteoporosis, 3 cases stopped the treatment at about 1 week after medication because of the occurrence of facial flush, headache, nausea, emesis and itch of skin after intramuscular injection of Miacalcic, and finally 135 cases were involved in the analysis of results. ① In the salmon calcitonin group at 1 month after treatment, the blood osteocalcin was obviously higher than that before treatment [（9.43±4.75）, （7.41±3.03） μg/L, P〈 0.01], urinary hydroxyproline/urinary creatinine ratio was obviously lower than that before treatment [（2.15±0.96）,（3.32±0.96） mg/mmol, P 〈 0.01]. ② The reexamination of spinogram at 4, 6 and 8 weeks after treatment indicated that the healing rate of fracture was 99% in the salmon calcitonin group and 86% in the control group. The fracture healed in 9 cases at 8 weeks after treatment in the control group. ③ The low back pain disappeared at 2 weeks after treatment in 43 cases and 8 cases respectively in the salmon calcitonin group and control group, that disappeared at 1 month after medication in 19 cases and 29 cases respectively in the salmon calcitonin group and control group. Ten cases in the control group still had lumbag at 1 year after the healing of fracture. CONCLUSION： Salmon calcitonin can inhibit the bone metabolism and bone absorption of patients with osteoporosis. Salmon calcitonin can accelerate the healing of osteoporotic vertebral fraction, and rapidly improve the symptoms of low back pain.
出处
《中国临床康复》
CSCD
北大核心
2005年第27期156-157,共2页
Chinese Journal of Clinical Rehabilitation
