长期使用质子泵抑制剂对老年患者骨代谢和骨密度的影响

摘要

Objective To investigate the effects of long-term use of proton pump inhibitors on bone metabolism and bone mineral density in elderly patients.Methods 50 elderly patients with reflux esophagitis who required long-term use of proton pump inhibitors were collected as the observation group,while 50 healthy elderly people were collected as the control group.Bone mineral density and bone metabolism were compared between the two groups.Results There was no significant difference in bone mineral density of neck of femur (0.80 ±0.10 vs 0.79 ±0.09 g · cm-2,P =0.708).At 3 months and 6 months after treatment,the bone mineral density of neck of femur in the observation group was lower than that in the control group [(0.73 ±0.10 vs 0.82 ±0.09 g · cm-2,P =0.000) and (0.68 ± 0.11 vs 0.79 ± 0.09 g · cm-2,P =0.000)].There were no significant differences between the two groups in calcitonin,osteocalcin,alkaline phosphatase and collagen carboxy terminal peptide of type Ⅰ when admission (P ＞ 0.05).At 6 months later,compared with the control group,the levels of calcitonin,osteocalcin,alkaline phosphatase [(221.87 ± 68.82 vs 251.53 ± 58.72 ng · L-1,P =0.023),(9.82±2.56vs 11.66±2.88 μg·L-1,P=0.001),(l0.47±2.18vs 12.66±1.75 μg· L-1,P=0.000)] in the observation group were decreased,but the level of collagen carboxy terminal peptide of type Ⅰ (253.85 ± 51.66 vs 225.39 ± 52.88 ng· L-1,P =0.008) was increased.Conclusions Long-term use of proton pump inhibitors can lead to increased bone destruction,which results in the development of osteoporosis.%目的 探讨长期使用质子泵抑制剂对老年患者骨代谢和骨密度的影响.方法 连续收集因反流性食管炎需要长期服用质子泵抑制剂的老年患者50例作为观察组,同期收集50例健康老年人作为对照组.比较两组的骨密度和骨代谢情况.结果 入组时,两组患者股骨颈骨密度差异无统计学意义(0.80 ±0.10 vs 0.79 ±0.09 g·cm-2,P=0.708).3个月和6个月时,观察组股骨颈骨密度均显著低于对照组[(0.73±0.10 vs 0.82±0.09 g·cm-2,P =0.000)和(0.68±0.11 vs 0.79 ±0.09 g·cm-2,P=0.000)].两组研究对象入组时降钙素、骨钙素、碱性磷酸酶和Ⅰ型胶原羧基末端肽均差异无统计学意义(P＞0.05).6个月时,观察组降钙素、骨钙素和碱性磷酸酶均显著低于对照组[(221.87 ±68.82 vs 251.53 ±58.72 ng·L-1,P=0.023)、(9.82 ±2.56 vs 11.66 ±2.88μg·L-1,P =0.001)、(10.47 ±2.18 vs 12.66 ±1.75μg·L-1,P =0.000)],Ⅰ型胶原羧基末端肽显著高于对照组(253.85 ±51.66 vs 225.39 ±52.88 ng·L-1,P=0.008).结论 长期使用质子泵抑制剂可导致骨破坏增加,进而导致骨质疏松.