目的 比较甲状旁腺激素(1-34)(PTH)、雷奈酸锶(SR)、唑来膦酸(ZA)对绝经后妇女骨质疏松的疗效.方法 150例绝经后骨质疏松症患者被随机分为三组:PTH组、SR组和ZA组,进行开放、对比研究.SR组每天口服雷奈酸锶2 g/d;PTH组每天皮下注射20 μg的PTH(1-34);ZA组给予唑来膦酸5 mg静脉滴注.治疗前、后6个月及1年分别测定两组患者腰背部自发性疼痛的VAS评分、L1.4椎体、股骨颈、Wards三角的BMD值,并观察治疗期间三组骨质疏松性骨折的发生率及服药后的不良反应.结果 治疗后PTH组和SR组VAS评分明显改善,低于ZA组;PTH组L1-4椎体、股骨颈、Wards三角的BMD值在治疗后6月及12月较治疗前上升显著,明显优于SR组及ZA组(P＜0.05).骨质疏松脆性骨折的发生率PTH组低于SR组及ZA组.三组药品不良反应发生率比较,差异无统计学意义(P＞0.05).结论 PTH、SR和ZA都可以有效降低VAS评分,提高骨密度,降低骨质疏松脆性骨折的发生率,且药物副反应少,其中以PTH效果最佳.%Objective To evaluate the therapeutic efficacy of parathyroid hormone (1-34) (PTH),strontium ranelate (SR) and zoledronic acid (ZA) in postmenopausal osteoporotic women.Method 150 postmenopausal osteoporotic patients were randomly divided into three groups:PTH group,SR group and ZA group to perform open-label,controlled study.Patients in SR group received oral strontium ranelate 2 g/day;patients in PTH group received subcutaneously 20 μg of PTH (1-34) per day;patients in ZA group received zoledronic acid 5 mg intravenous infusion.VAS scores of back pain,BMDs of lumbar vertebra 1-4,femoral neck and Ward's triangle were measured at baseline,6 months and 1 year.The incidence of osteoporotic fracture and the side effects after drug administration in the treatment groups were also observed.Results The VAS score of PTH group and SR group decreased significantly after treatment,which was lower than that of ZA group (P ＜ 0.05).The BMD of L1-L4 vertebral body,femoral neck and Wards triangle in PTH group was significantly higher than that in SR group and ZA group at 6 months and 12 months after treatment (P ＜ 0.05).The incidence of osteoporotic brittle fracture in PTH group was lower than that in SR group and ZA group.There were no significant differences in the incidence of adverse drug reactions between the three groups (P ＞ 0.05).Conclusion PTH,SR and ZA can effectively reduce VAS score,improve bone density,reduce the incidence of osteoporotic fragile fracture,with little side effect,and parathyroid hormone showed a better clinical efficacy.
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