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目的观察阿仑膦酸钠对类风湿关节炎(RA)合并骨质疏松或骨量减少的患者骨密度(BMD)的影响。方法将42例RA患者随机分成2组,所有患者均服用MTX10mg/周、叶酸片5mg/d和钙尔奇-D600mg/d,治疗组加用阿仑膦酸钠70mg/周,2组共服药6个月。使用双能X线吸收仪分别检测治疗前和治疗6个月后腰椎(L1~4)后前位、股骨颈、大转子、Ward区部位的BMD,评估RA疾病活动度并分析二者间的相关性。结果治疗6个月后治疗组RA患者的腰椎BMD与基线相比明显上升(P<0·05),并且高于对照组(P<0·05)。而股骨颈、Ward区和大转子部位的BMD有所增加,但与基线及对照组相比,差异无统计学意义。21例治疗组患者经过6个月治疗后腰椎BMD的变化与RA疾病活动性指标如ESR、CRP、RF、HAQ评分、关节肿胀个数、关节压痛个数和DAS28均无相关性(P>0·05)。结论与MTX联用,阿仑膦酸钠可增加骨质疏松或骨量减少RA患者的腰椎BMD,是治疗RA伴发骨质疏松或骨量减少的有效手段。
Objective To investigate the effect of alendronate on bone mineral density (BMD) in patients with rheumatoid arthritis (RA) complicated with osteoporosis or osteopenia. Methods Forty-two patients with RA were randomly divided into two groups. All patients received MTX10mg / week, folic acid tablets 5mg / d and calcium-D600mg / d. The patients in the treatment group were treated with alendronate sodium 70mg / 6 months. Dual-energy X-ray absorptiometry was used to measure the BMD of the anterior, femoral neck, greater trochanter, and Ward areas of the lumbar vertebrae (L1-4) before and 6 months after treatment, respectively. Correlation. Results The BMD of lumbar spine of RA patients in treatment group after 6 months treatment was significantly higher than that of baseline (P <0.05), and higher than that of control group (P <0.05). The BMD of femoral neck, Ward area and greater trochanter increased, but there was no significant difference compared with baseline and control group. The changes of lumbar spine BMD after treatment for 6 months in 21 patients in the treatment group had no correlation with activity index of RA disease such as ESR, CRP, RF, HAQ score, number of joint swelling, joint tenderness and DAS28 (P> 0 · 05). Conclusion In combination with MTX, alendronate can increase lumbar BMD in patients with osteoporosis or osteopenia. It is an effective treatment for RA with osteoporosis or osteopenia.