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背景钙离子通道同时存在于肌肉及骨骼细胞内,钙拮抗剂(CCB)在作用于动脉平滑肌细胞的同时,是否会影响骨细胞的钙代谢尚不清楚。目的观察不同CCB对老年原发性高血压患者骨质密度(BMD)及骨折发生率的影响。方法随机选择年龄60～81岁的老年原发性高血压患者650例,用药组病人服用CCB均在3年以上,按用药不同分为硝苯地平组(30mg/d,n=175),非洛地平组(5mg/d,n=182),苯磺酸氨氯地平组(5mg/d,n=198),未服用CCB者(n=95)设为对照组。分别比较各用药组与对照组间BMD、骨折发生率、血清钙、磷和碱性磷酸酶浓度的差异。结果各用药组与对照组间BMD差异无统计学意义[硝苯地平组(1.12±0.14)比非洛地平组(1.09±0.16)比氨氯地平组(1.13±0.15)比对照组(1.11±0.15)g/cm2,P>0.05];各用药组与对照组间骨折发生率差异无统计学意义[硝苯地平组(9.1%)比非洛地平组(9.3%)比氨氯地平组(8.6%)比对照组(10.5%),P>0.05];各用药组血清钙、磷、碱性磷酸酶浓度与对照组各相应数据比较,差异均无统计学意义(均P>0.05)。结论长期服用治疗剂量CCB(硝苯地平、非洛地平及苯磺酸氨氯地平)的老年原发性高血压患者的骨质疏松及骨折发病率没有明显增加,血清钙代谢没有受到影响。
Background Calcium channels exist in muscle and skeletal cells. Whether calcium antagonist (CCB) affects calcium metabolism in osteoblasts while acting on arterial smooth muscle cells is unclear. Objective To observe the effects of different CCB on bone mineral density (BMD) and the incidence of fractures in elderly patients with essential hypertension. Methods A total of 650 elderly patients with essential hypertension aged 60-81 years were enrolled in this study. Patients in the medication group were treated with CCB for more than 3 years and were divided into nifedipine group (30mg / d, n = 175) (5mg / d, n = 182), amlodipine besylate group (5mg / d, n = 198) and those without CCB (n = 95) as the control group. The difference of BMD, incidence of fracture, serum calcium, phosphorus and alkaline phosphatase in each drug group and control group were compared. Results There was no significant difference in the BMD between each treatment group and the control group [nifedipine group (1.12 ± 0.14) vs. felodipine group (1.09 ± 0.16) vs amlodipine group (1.13 ± 0.15) vs control group 0.15) g / cm2, P> 0.05]. There was no significant difference in the incidence of fractures between each treatment group and the control group [nifedipine group (9.1%) vs the amlodipine group 8.6%) than the control group (10.5%), P> 0.05]. There was no significant difference in the serum calcium, phosphorus and alkaline phosphatase concentrations between the two groups (P> 0.05). Conclusion Long-term treatment of elderly patients with essential hypertension with CCB (nifedipine, felodipine and amlodipine besylate) did not significantly increase the incidence of osteoporosis and fracture, and serum calcium metabolism was not affected.