姚建平　钟晓敬　金月萍　毛伟　高丽亮　姬亚锋　邱蔚

[關键词] 慢性阻塞性肺疾病;骨质疏松;骨密度;骨代谢;肺功能

[中图分类号] R592.1          [文献标识码] B          [文章编号] 1673-9701（2021）17-0034-04

Impacts of alfacalcidol on bone metabolism in patients with chronic obstructive pulmonary disease complicated with osteoporosis

YAO Jianping1   ZHONG Xiaojing1   JIN Yueping1   MAO Wei2   GAO Liliang2   JI Yafeng3   QIU Wei1

1.Department of Endocrinology， Huzhou Central Hospital in Zhejiang Province， Huzhou   313000， China; 2.Department of Respiratory， Huzhou Central Hospital in Zhejiang Province， Huzhou   313000， China; 3.Department of Orthopaedics， Huzhou Central Hospital in Zhejiang Province， Huzhou   313000， China

[Abstract] Objective To explore the impacts of alfacalcidol on bone metabolism in patients with chronic obstructive pulmonary disease （COPD） complicated with osteoporosis （OP）. Methods A total of 80 patients with COPD complicated with OP treated in our hospital from December 2017 to December 2019 were selected and divided into the control group（n=40） and the observation group（n=40） according to the random number table method. The control group was treated with conventional treatment scheme， while the observation group was treated with alfacalcidol on the basis of the conventional treatment. Both groups were treated continuously for 6 months. The bone mineral density （BMD）， bone metabolism indices， pulmonary function indices and the incidence of adverse reactions （ADRs） were compared between the two groups before treatment and after 6 months of treatment. Results Before treatment， there were no statistically significant differences in BMD level，bone metabolism indices and pulmonary function indices between the two groups of patients（P>0.05）. After 6 months of treatment， BMD levels of lumbar vertebrae and femoral neck increased， while bone gla-protein （BGP） and β-C-terminal telopeptide of type-Ⅰ collagen（β-CTX） levels decreased in the two groups. Meanwhile， BMD levels of lumbar vertebrae and femoral neck were higher and BGP and β-CTX levels were lower in the observation group， with statistically significant differences（P<0.05）. After 6 months of treatment， there were no statistically significant differences in forced expiratory volume （FEV1） and forced vital capacity （FVC） in the first second between the two groups（P>0.05）. There was no statistically significant difference in the total incidence of ADRs between the two groups as well（P>0.05）. Conclusion For patients with COPD complicated with OP， therapeutic efficacy of alfacalcidol is effective. It can remarkably improve BMD and bone metabolism.

[Key words] Chronic obstructive pulmonary disease; Osteoporosis; Bone mineral density; Bone metabolism; Pulmonary function

慢性阻塞性肺疾病（Chronic obstructive pulmonary diseas，COPD）是一种以不完全可逆气流受限为特征，呈进行性、发展性的疾病[1]，临床表现为胸闷、气促以及慢性咳嗽咳痰等，若治疗不及时，可进展为呼吸衰竭等疾病[2]。骨质疏松（Osteoporosis，OP）多发于老年群体，临床表现为腰背痛、压缩性骨折以及活动受限等[3-4]。临床上，COPD患者由于高龄、吸烟、低体重、糖皮质激素应用等危险因素常合并OP，国内外研究显示COPD患者中合并OP高达40%以上[5-6]。目前，临床常采用糖皮质激素与补钙治疗COPD合并OP，其中糖皮质激素可干扰气管内花生四烯酸分化，阻斷炎症因子迁移[7];而补钙治疗仅可对OP起到缓解作用，临床疗效有限。阿法骨化醇作为一种可改善机体钙磷水平，促进钙吸收的药物，已作为治疗OP的基础方式[8]。然而临床上将其用于治疗COPD合并OP的相关报道较少。鉴于此，本研究通过将阿法骨化醇用于治疗COPD合并OP患者，以研究其对于患者骨代谢水平的影响，现报道如下。

1 资料与方法

1.1 一般资料

选取2017年12月至2019年12月在我院接受治疗的80例COPD合并OP患者，依据随机数字表法分为对照组（n=40）与观察组（n=40）。对照组男23例，女17例;年龄51～75岁，平均（67.13±3.29）岁;病程4～11年，平均（6.59±1.30）年;身体质量指数（BMI）16.3～25.8 kg/m2，平均（20.47±1.62）kg/m2。观察组男24例，女16例;年龄52～73岁，平均（67.07±3.48）岁;病程4～10年，平均（6.53±1.24）年;BMI 16.2～26.1 kg/m2，平（20.58±1.63）kg/m2。两组患者基线资料比较，差异无统计学意义（P>0.05），具有可比性。

1.2 纳入及排除标准

纳入标准：（1）均符合《慢性阻塞性……