联合性运动疗法对绝经后骨质疏松症患者骨代谢的影响

摘要

目的 观察联合性运动疗法(有氧运动加抗阻训练)对绝经后骨质疏松症(PMOP)患者骨密度(BMD)和骨代谢相关指标的影响及其对患者疼痛的缓解作用.方法 52例PMOP患者按简单抽签法随机分为训练组(n=26)及对照组(n=26),两组均予常规抗骨质疏松药物治疗,训练组在此基础上结合联合性运动疗法,治疗3个月后分别比较治疗前后两组患者BMD、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、胰岛素样生长因子(IGF)-1、25-羟基维生素D(25-OH-D)、碱性磷酸酶(ALP)、Ⅰ型原胶原N端前肽(PINP)和抗酒石酸酸性磷酸酶(TRACP)及疼痛的视觉模拟评分(VAS)的变化.结果 治疗3个月后,训练组腰椎及左股骨颈BMD值均高于对照组(P＜0.05),TNF-α和IL-6水平均低于对照组(P＜0.05),IGF-1和25-OH-D均明显高于对照组(P＜0.05).ALP、PINP和TRACP水平治疗后较治疗前明显下降(P＜0.05),但仅训练组TRACP水平低于对照组(P＜0.05).两组患者治疗后VAS均降低,且训练组VAS低于对照组(P＜0.05).结论 联合性运动疗法可有效增加PMOP患者BMD,抑制细胞因子表达,调节骨代谢及骨转换状态,抑制骨吸收,同时能有效缓解患者的疼痛症状,为更安全、有效、可持续地治疗PMOP患者提供了新方向.%Objective To investigate the effect of combined exercise therapy, namely, aerobic and resistance training, on bone mineral density (BMD), bone metabolism related indicators and pain relief in patients with postmenopausal osteoporosis (PMOP).Methods Fifty-two patients were randomly divided into two groups:Training group (n=26) and Control group (n=26).All patients received the routine antiosteoporosis treatment, while the Training group additionally received the combined exercise therapy.The values of BMD, tumor necrosis factor (TNF) -α, interleukin (IL) -6, insulin-like growth factor (IGF) -1, 25-hydroxyvitamin (OH) D, alkaline phosphatase (ALP), N-terminal procollagen of typeⅠ (PINP), tartrate resistant acid phosphatase (TRACP) and visual analogy score (VAS) were compared after 3 months treatment.Results The BMD in lumbar vertebra and left femoral neck in the Training group were higher than that of the Control group;the levels of TNF-αand IL-6 in the Training group were lower than those in the Control group (P＜0.05);the levels of IGF-1 and25- (OH) D in the Training group were significantly higher than those in the Control group (P＜0.05).Moreover, the levels of bone formation and bone resorption markers, ALP, PINP and TRACP, were significantly lower than those before treatment (P＜0.05) in the two groups, while the levels of TRACP in the Training group were lower than that in the Control group.VAS in both groups were decreased significantly, and VAS in the Training group were lower than those in the Control group (P＜0.05).Conclusion The combined exercise therapy can effectively increase the BMD of patients with PMOP, inhibit the expression of cytokines, adjust the balance of bone metabolism and bone transformation, inhibit bone absorption, and effectively relieve the pain symptoms of patients.It may provide a new therapeutic direction for safer, more effective and sustainable treatment of PMOP patients.