活性维生素D联合锝（99Tc）亚甲基二膦酸盐治疗对强直性脊柱炎患者骨代谢的影响

摘要

ABSTRACT:Objective To explore the effect of a combination treatment of active vitamin D and 99 Tc-MDP on the bone metabolism of ankylosing spondylitis(AS)patients.Methods AS patients were divided into two groups:control group patients,treated with oral administration of meloxicam and sulfasalazine,and treatment group,treated with oral administration of meloxicam,sulfasalazine and active vitamin D 0.25 μg and intravenous drip of 99 Tc-MDP.Before and after treatment,the serum levels of bone alkaline phosphatase(BALP),tartrate resistant acid phosphatase 5b(TRACP-5b)and 25-(OH)D3 were determined using avidin biotin peroxidase complex enzyme-linked immunosorbent assay (ABC-ELISA).Bone mineral density (BMD)was measured using dual-energy X-ray absorptiometry.Clinical data including erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and others were recorded.Results Compared with the control group,the serum levels of BALP and 25-(OH)D3 in the treatment group increased significantly,(4.8 ±1.1)μg/L vs (4.3± 1.8)μg/L and (18.1 ±4.1)μg/L vs (12.5±3.9)μg/L(respectively P <0.05).BMD also increased in the treatment group,but the level of ESR decreased(respectively P < 0.05).Conclusion Combination treatment of active vitamin D and 99 Tc-MDP can be helpful to reduce the inflammatory reaction and improve the bone metabolism in AS patients.%目的：研究活性维生素 D 联合锝（99 Tc）亚甲基二膦酸盐（云克）治疗对强直性脊柱炎（AS）患者骨代谢的影响。方法 AS 患者分为两组，对照组口服美洛昔康联合柳氮磺吡啶；治疗组在此基础上加用活性维生素 D 0．25μg口服及云克静脉滴注。测定两组患者治疗前后血清骨特异性碱性磷酸酶（BALP）、抗酒石酸酸性磷酸酶同工酶5b （TRACP-5b）、25-羟化维生素 D3[25-（0H）D3]水平及双能骨密度值（BMD）；记录红细胞沉降率（ESR）、C 反应蛋白（CRP）等临床指标并进行比较。结果与对照组比较，治疗组 BALP、25-（OH）D3水平明显升高，分别为（4．8±1．1）μg／L vs （4．3±1．8）μg／L，（18．1±4．1）μg／L vs （12．5±3．9）μg／L，差异有统计学意义（均 P ＜0．05）；ESR 降低、BMD 提高，差异有统计学意义（均 P ＜0．05）。结论活性维生素 D 联合云克的治疗方案有助于 AS 患者缓解炎症及改善骨代谢。