目的 探讨阿仑膦酸钠及替勃龙对更年期妇女骨质疏松症患者MMP -2、9及骨转换的影响.方法 选择2009年7月～2010年12月在笔者医院更年期门诊经BDM测量诊断为骨量减少或骨质疏松的围绝经期及绝经后年龄在46～75岁之间的86例女性,随机分为实验组46例,口服阿仑膦酸钠片70mg每周1次+替勃龙1.25mg/d+服用复方氨基酸整合钙口服1000mg/d;对照组40例,口服氨基酸螯合钙1000mg/d.两组妇女均连续服药48周.治疗前、后采用酶联免疫法检测血清基质金属蛋白酶-2(MMP -2)和基质金属蛋白酶-9(MMP-9)、骨碱性磷酸酶(BALP)、1型胶原C端肽(CTX)、25羟维生素D3[25(0H)D3].结果 86例中共9例(10.47％)未完成研究,具体原因如下:试验组退出5例(上腹部隐痛不适,烧灼感3例,恐癌2例).对照组4例(失访1例,自动退出3例),退出病例未纳入统计,退出病例未纳入统计.①骨代谢指标:BALP及CTX两组治疗后均较治疗前显著下降,差异有统计学意义(P＜0.05);25(OH)D3治疗后实验组较治疗前显著上升,对照组较治疗前显著下降,差异有统计学意义(P＜0.05);②MMP:MMP-2及MMP -9治疗后实验组较治疗前显著下降,对照组较治疗前显著上升,差异有统计学意义(P＜0.05).结论 阿仑膦酸钠及替勃龙可用于OP的治疗,可降低MMP -2、9及骨转换,对治疗骨质疏松症有理论依据和临床意义.%Objective To observe the influences of alendronate and tibolone combination treatment in osteoporosis menopause women on the levels of matrix metalloproteinase - 2 ( MMP - 2 ) , matrix metalloproteinase - 9 ( MMP - 9 ) and bone turnover markers. Methods Eighty - six perimenopause or postmenopause women who were diagnosed as osteopenia or osteoporosis by BDM test from July 2009 to December 2010 were studied and divided into 2 groups randomly. Forty - six women, as the experimental group,oraly took the bi-sphosphonates 70mg/w + Tibolone 1.25mg + Osteoform 1000mg/d for 48 weeks, while in the control group, only Osteoform 1000mg/d was taken. MMP -2,9 as well as biochemical bone turnover markers such as bone alkaline phosphatase(BALP),cross linked clelopeptide of type I collagen ( CTX) and 25 - hydroxychole calciferol [ 25 (OH) D, ] were measured before and after the treatment. Results The level of BALP and CTX decreased significantly after the treatment in both groups( P < 0.05). The level of 25 (OH) D, in the test group was significantly higher after the treatment, while in the control, it had a significant decrease( P < 0.05). Compared to the level of MMP - 2 and MMP-9 before the treatment, those in the test group decreased significantly, and increased in the control,(P <0.05) Conclusion Combined use of alendronate and tibolone can lower the level of MMP -2, MMP -9, and bone turnover markers. And base on this theory, it may be a clinical useful therapy for osteoporosis. Both of them can decrease the level of MMP -2、9 and bone turnover marker and are good for the theory and experiment of osteoporosis.
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