二膦酸盐应用于血液透析患者及其对胰岛素样生长因子的影响

中国临床药理学与治疗学 ›› 2011, Vol. 16 ›› Issue (10): 1153-1156.

二膦酸盐应用于血液透析患者及其对胰岛素样生长因子的影响

丁晓凯¹, 陈天新¹, 陈波¹, 薛增奇², 徐玉兰¹

¹温州医学院附属第一医院肾内科,温州 325003 浙江;
²温州医学院附属第三医院肾内科,温州 325003,浙江

收稿日期:2011-05-03 修回日期:2011-09-03 出版日期:2011-10-26 发布日期:2011-11-02
作者简介:丁晓凯,男,硕士,研究方向:糖皮质激素性骨质疏松和慢性肾脏病并发症诊治。Tel: 13857771492, E-mail: DXK7505@126.com
基金资助:
浙江省医学会临床科研基金资助项目(2008ZYC21)

Bisphosphonates used in hemodialysis patients and their effects on insulin-like growth factor

DING Xiao-kai¹, CHEN Tian-xin¹, CHEN Bo¹, XUE Zeng-qi², XV Yv-lan¹

¹Department of Nephrology, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325003, Zhejiang,China;
²Department of Nephrology, the Third Affiliated Hospital of Wenzhou Medical College, Wenzhou 325003, Zhejiang,China

Received:2011-05-03 Revised:2011-09-03 Online:2011-10-26 Published:2011-11-02

摘要/Abstract

摘要： 目的: 观察维持性血液透析(MHD)骨量异常患者使用二膦酸盐治疗前后骨密度和胰岛素样生长因子等骨代谢生化指标的变化。方法: 45例骨量异常(骨量减少或骨质疏松)血液透析患者,在补充钙剂和骨化三醇基础上,应用阿仑膦酸钠 70 mg/周治疗, 分别于治疗前和治疗12个月后检测骨密度及血胰岛素样生长因子-1(IGF-1)、Ⅰ型前胶原氨基端前肽(PINP)、I型胶原C末端肽(CTX),记录不良反应。结果: 治疗后血IGF-1水平较治疗前升高(P<0.05),髋部(股骨颈、大转子、全髋)骨密度值较治疗前升高(P均<0.01),血PINP、CTX水平较治疗前明显下降(P均<0.01),但腰椎部位骨密度值改变差异无统计学意义(P＞0.05),个别患者出现轻度消化道反应。结论: MHD骨量异常患者应用二膦酸盐治疗,可降低骨转换,有效减少骨量丢失,安全性好。二膦酸盐可能通过提高与骨形成密切相关的血IGF-1水平,提高MHD骨量异常患者的骨量。

关键词: 二膦酸盐, 血液透析, 骨质疏松, 骨密度, 胰岛素样生长因子

Abstract: AIM: To observe the change of bone mineral density, insulin-like growth factors and other biochemical markers of bone metabolism before and after treatment with bisphosphonates in maintenance hemodialysis (MHD) patients with osteoporosis. METHODS: 45 hemodialysis patients with abnormal bone mass (osteopenia or osteoporosis),in addition to the supplement of calcium and calcitriol, using alendronate 70 mg/weeks, before and after 12 months treatment, the bone mineral density(BMD), serum insulin-like growth factor-1, procollagen typeⅠN-terminal propeptide(PINP) and C-terminal telopeptide of type I collagen(CTX) were detected,respectively,and the adverse drug reactions were recorded. RESULTS: Compared with the pre-treatment,the levels of serum IGF-1,the hip (femoral neck,greater trochanter,total hip) BMD were increased(P<0.05 or P<0.01);and the levels of serum PINP,CTX were decreased in pre-treatment(P<0.01).There is no significant different in the change of the lumbar spine BMD pre-and post-treatment(P>0.05).Mild gastrointestinal symptoms were found in individual patients. CONCLUSION: In MHD patients with osteoporosis,the treatment of bisphosphonates can reduce bone turnover and bone loss with good safety.Bisphosphonates may improve MHD osteoporotic patients' bone mass by increasing the IGF-1 which is closely related to bone formation.

Key words: Bisphosphonates, Hemodialysis, Osteoporos, Bone mineral density, Insulin-like growth factor

中图分类号:

丁晓凯, 陈天新, 陈波, 薛增奇, 徐玉兰. 二膦酸盐应用于血液透析患者及其对胰岛素样生长因子的影响[J]. 中国临床药理学与治疗学, 2011, 16(10): 1153-1156.

DING Xiao-kai, CHEN Tian-xin, CHEN Bo, XUE Zeng-qi, XV Yv-lan. Bisphosphonates used in hemodialysis patients and their effects on insulin-like growth factor[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2011, 16(10): 1153-1156.

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