阿仑膦酸钠对类风湿关节炎患者骨质疏松或骨量减少的疗效观察(1)
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【摘要】 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MTX 10 mg/周、叶酸片5 mg/d和钙尔奇-D 600 mg/d，治疗组加用阿仑膦酸钠70 mg/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。
【关键词】 阿仑膦酸钠；类风湿关节炎；骨质疏松；骨密度
The effects of Alendronate on bone mineral density in RA patients with osteoporosis or osteopenia
XU Bei, LIN Jin, XU Li-qin, et al.
Department of Rheumatology, the First Affiliated Hospital, College of Medicine in Zhejiang University, Hangzhou, 310003 China
【Abstract】 Objective To investigate the effects of alendronate on BMD in RA patients with osteoporosis or osteopenia. Methods Forty-two RA patients with standard treatment of Methotrexate 10 mg/w, Folic acid 5 mg/d, and vitamin D3 600 mg/d, were randomly divided into two grous. Compare to the control arm, the experimental arm added alendronate to standard treatment for 6 months. BMD of the spine (L1~4), femoral neck, trochanter, and Wards triangle region, as well as RA disease activity index, were evaluated and analyzed for correlation in both groups prior to the randomization and after completion of six-month treatment. Results Spine BMD in the experimental group after six-month treatment was significantly improved compared with the baseline measurement (P<0.05), which was also superior to the control group (P<0.05). BMD of the femoral neck, trochanter, and Wards triangle region were elevated without statistical significance compared to the baseline and control group. However, the improvement of BMD after six-month alendronate treatment in the experimental group had no correlation with RA disease activity index including ESR, CRP, RF, HAQ scale, number of swollen joints, number of painful/tender joints, and DAS28 score ......
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