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[目的]分析骨代谢生化标志物在骨质疏松症治疗中对药物应用的指导意义,为骨质疏松药物治疗探索一条精准有效地治疗途径。[方法]采用自身前后对照临床研究,56例患者根据Ⅰ型前胶原N-端前肽(P1NP)与β-胶原特殊序列(β-cross Laps)测量值分为低骨转换组(30例)与高骨转换组(26例)。每组随机分别给予2种治疗方案:特立帕肽(20μg/d)与唑来膦酸注射液(5 mg/年),治疗时间为26个周,期间定期观察β-cross Laps、P1NP、腰椎、股骨颈骨密度(BMD)以及VAS疼痛评分的变化情况。[结果]在高、低骨转换组中,特立帕肽治疗后P1NP与β-cross Laps均较治疗前浓度升高(P<0.05),唑来膦酸治疗后P1NP与β-cross Laps均较治疗前浓度降低(P<0.05);低骨转换组特立帕肽治疗后腰椎BMD升高较唑来膦酸显著(P<0.05),高骨转换组唑来膦酸治疗后股骨颈BMD升高较特立帕肽显著(P<0.05);低骨转换组特立帕肽治疗后骨痛缓解优于唑来膦酸(P<0.05),高转换组中两种药物均能缓解骨痛,差异无统计学意义(P>0.05)。[结论]在原发性骨质疏松症治疗中,应以骨生化标志物作为药物选择的依据:低骨转换状态下以促成骨药物为主,高骨转换状态下以抑制骨吸收药物为主。
[Objective] To analyze the guiding significance of the application of biochemical markers of bone metabolism in the treatment of osteoporosis and explore a precise and effective therapeutic approach for the treatment of osteoporosis. [Methods] According to the clinical study of its own before and after, 56 patients were divided into low bone conversion group (30 cases) according to the measurement of type Ⅰ procollagen P1NP and β-cross Laps, With high bone turnover group (n = 26). Each group was randomly assigned to receive two treatment regimens: teriparatide (20 μg / d) and zoledronic acid (5 mg / year) for 26 weeks, with regular observation of β-cross Laps, P1NP, Lumbar, femoral neck bone mineral density (BMD) and VAS pain score changes. [Results] The levels of P1NP and β-cross Laps in both high and low bone conversion groups were significantly higher than those before treatment (P <0.05) after treatment with teriparatide. Both of P1NP and β-cross Laps (P <0.05). Compared with zoledronic acid, the BMD of lumbar spine in the low bone transition group was significantly higher than that of zoledronic acid (P <0.05) (P <0.05). The relief of osteoporosis was better than zoledronic acid (P <0.05) after treatment with teriparatide in the low-bone transition group, and both of the two drugs in the high-conversion group could relieve the bone loss Pain, the difference was not statistically significant (P> 0.05). [Conclusion] In the treatment of primary osteoporosis, the biochemical markers of bone should be taken as the basis of choice of drugs: the bone-dominated drugs should be used under the conditions of low-bone transition and the drugs that inhibit bone resorption should be the main ones under the condition of high-bone turnover .