目的：唑来膦酸作为一种静脉的双磷酸盐类药物已被批准用于治疗骨质疏松症，尤其是对于口服双磷酸盐不耐受或依从性差的患者，但发热等不良反应影响了该药的使用，探讨有口服双膦酸盐史对骨质疏松症患者在首次静脉滴注唑来膦酸（密固达）5 mg 后发热率的变化及其影响因素。方法：对在就诊的骨质疏松患者进行双能 X线骨密度检查，根据世界卫生组织对骨质疏松的诊断标准，T 值≤－2．5被定义为骨质疏松。对其中113例首次静脉滴注唑来膦酸治疗的骨质疏松症患者进行分析，其中有口服阿仑膦酸钠史者35例，记为 A 组，无口服阿仑膦酸钠史者78例，记为 B 组。比较治疗前口服双膦酸盐治疗时间与治疗后发热发生率的关系及静脉滴注唑来膦酸后发热的影响因素。结果：35例有口服阿仑膦酸钠史者中，无高热，2例有中低度发热反应（5．71％）。78例无双膦酸盐用药史者中，33人出现发热（42．3％），其中低热15人、中度热14人、高热4人，卡方检验两组差异有统计学意义（P ＝0．002），另外，对在门诊与病房接受静脉滴注唑来膦酸患者发热情况进行分析，用药地点对发热发生率无影响。二元 Logistic 回归分析显示口服双磷酸盐用药史是发热的保护性因素，既往口服双膦酸盐每增加1个月，首次静脉滴注唑来膦酸的发热风险减少23．1％。结论：既往有口服含氮双膦酸盐阿仑膦酸钠用药史者，在首次接受静脉滴注唑来膦酸5 mg 治疗时，可显著减少急性炎性的发热反应发生率，即口服含氮双膦酸盐阿仑膦酸钠用药史是首次接受静脉滴注唑来膦酸发热不良反应的保护性因素。%Objective:To investigate the prevalence of fever after intravenous injection of for the first time in osteoporotic patients who have or haven’t taken bisphosphonates orally.Methods:Bone mineral density measurement was conducted of the osteoporotic patients using dual-energy X-ray absorptiometry method,and according to the WHO diagnostic criteria for osteoporosis,the patient whose T score was less than -2.5 was defined as osteoporosis.The data of 113 osteoporotic patients who received intravenous injection of zoledronic acid in our hospital for the first time were used for analysis.Among them,35 who had the history of oral bisphosphonates were defined as group A,and 78 who didn’t have the history of oral bisphosphonates were defined as group B (control group).Moreover,we also compared the preva-lences of fever between the patients.Pearson chi-square test was used to investigate the association be-tween oral bisphosphonates therapy and prevalence of fever,and binary logistic regression was used to an-alyze the impact factors of fever after intravenous injection of zoledronic acid.Results:Among the 35 pa-tients who had the history of oral bisphosphonates,nobody had high fever,and 2 patients had low or mo-derate degree of fever (5.71%).Among the 78 patients who didn’t have the history of oral bisphospho-nates,33 patients had fever (42.3%),15 with low fever,and 14 with moderate degree of fever,and 4 with high fever.Pearson chi-square test showed that the prevalence of fever between group A and group B had significant difference,and that differences of prevalence of fever between the outpatients and the inpa-tients was not statistically significant.Binary Logistic regression analysis showed that oral bisphosphonates medication history was a protective factor of fever,and with the increasing of previous oral bisphosphonates for one month,there was a reduction of fever for 23.1%.Conclusion:Patients who have the history of oral nitrogenous bisphosphonates alendronate have a significant reduction in prevalence of fever after intravenous injection of zoledronic acid for the first time.That is,oral nitrogenous bisphosphonates alendronate history is a protective factor of fever for patients with intravenous injection of zoledronic acid for the first time.
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