卢敏辉 郭娟 张清 徐鹏慧 叶彬 孔祥艳 周惠琼

【摘 要】目的：觀察静脉滴注唑来膦酸治疗风湿病合并骨质疏松患者的疗效及安全性。方法：选取2018年10月至2019年12月连续2年静脉滴注唑来膦酸治疗的风湿病合并骨质疏松患者70例，观察治疗前及治疗1年后骨代谢标记物、骨密度的变化值，以及骨折风险评估工具评估10年内重要部位骨质疏松性骨折和髋部骨折率的变化、疼痛视觉模拟评分法（VAS）评分，随访1年内发生骨折情况，血清钙、磷、C反应蛋白（CRP）、红细胞沉降率（ESR）变化情况。同时观察使用唑来膦酸后7 d内急性期不良反应发生情况。结果：经唑来膦酸治疗1年后，VAS评分有显著下降（P = 0.033），3例（4.29%）患者治疗期间发生骨折，血清钙、磷、CRP、ESR与治疗前比较，差异均无统计学意义（P > 0.05）。骨代谢指标中，Ⅰ型胶原羧基端肽β特殊序列、Ⅰ型前胶原氨基端前肽、骨钙素较1年前明显下降（P < 0.05），而25羟维生素D、甲状旁腺激素较1年前无明显变化（P > 0.05）。腰椎值、股骨颈、髋部的骨密度变化值分别为（0.03±0.12）g·cm-2、（-0.01±0.05）g·cm-2、（-0.01±0.07）g·cm-2，其与基线相比的变化率分别为2.21%、-0.08%、-0.27%。常见的急性期不良反应共31例，其中发热10例，消化道症状8例，关节疼痛6例，肌肉疼痛4例，头痛1例。结论：风湿病合并骨质疏松患者静脉滴注唑来膦酸（每年1次）治疗对骨密度有改善，能抑制骨转换。大部分风湿病患者静脉滴注唑来膦酸后出现急性期不良反应并不严重，且均为一过性。

【关键词】 风湿病;骨质疏松;唑来膦酸;骨转换标志物;安全性

【ABSTRACT】Objective：To observe the efficacy and safety of intravenous zoledronic acid in the treatment of rheumatism complicated with osteoporosis.Methods：Seventy patients with rheumatism complicated with osteoporosis treated by intravenous infusion of zoledronic acid for two consecutive years from February 2018 to December 2019 were included.The changes of bone metabolic markers and bone mineral density before and after treatment were observed，and the changes of osteoporotic fracture and hip fracture rate in important parts within ten years were evaluated by fracture risk assessment tool.Visual analogue scale（VAS）of pain，fracture，serum calcium，phosphorus，C reactive protein（CRP）and erythrocyte sedimentation rate（ESR）within one year of follow-up were observed.At the same time，the occurrence of acute adverse reactions within seven days after using zoledronic acid was observed.Results：After one year of treatment with zoledronic acid，the VAS decreased significantly（P = 0.033）.Three patients（4.29%）had fractures during treatment and there was no significant difference in serum calcium，phosphorus，CRP and ESR compared with those before treatment（P > 0.05）.Among bone metabolism indexes，β-CTX，P1NP and osteocalcin decreased significantly compared with those a year ago（P < 0.05），while 25 hydroxyvitamin D and parathyroid hormone had no significant changes compared with those a year ago.The BMD changes of L1～L4，femoral neck and hip were（0.033±0.118）g·cm-2，（-0.001±0.053）g·cm-2，（-0.01±0.7）g·cm-2 respectively，and the change rates compared with baseline were 2.21%，-0.08% and -0.27% respectively.There were 31 common acute reactions，including 10 cases of fever，8 cases of gastrointestinal symptoms，6 cases of joint pain，4 cases of muscle pain and 1 case of headache.Conclusion：Intravenous zoledronic acid（once a year）can improve bone mineral density and inhibit bone turnover in patients with rheumatism complicated with osteoporosis.Most patients with rheumatism had transient acute phase reaction after intravenous infusion of zoledronic acid.

【Keywords】 rheumatism;osteoporosis;zoledronic acid;bone turnover markers;safety

风湿病是一组累及骨与关节及其周围软组织（如肌肉、肌腱、滑膜、滑囊、韧带和软骨等）和其他相关组织的慢性疾病。近些……