唑来膦酸治疗原发性胆汁性胆管炎合并骨质疏松症的临床疗效研究

Clinical Efficacy of Zoledronic Acid in the Treatment of Primary Biliary Cholangitis with Secondary Osteoporosis

摘要: 目的：唑来膦酸作为第三代双膦酸盐，在临床上虽已广泛应用于绝经后骨质疏松的治疗，但在原发性胆汁性胆管炎(primary biliary cholangitis, PBC)继发骨质疏松症(osteoporosis, OP)患者中的治疗效果尚未得到评估。本研究旨在通过比较PBC继发骨质疏松症患者治疗前和治疗6个月后骨密度(bone minaral density, BMD)及骨代谢标志物的变化，探究唑来膦酸的治疗效果。方法：选择2012年10月至2019年10月期间于青岛大学附属医院风湿免疫科就诊的40例PBC合并继发性骨质疏松症者，应用5 mg (100 ml)唑来膦酸(密固达)进行静脉注射治疗一次，6个月后复查BMD、血清总Ι型胶原氨基酸延长肽(total N-terminal propeptide of type Ι procollagen, t-P1NP)、β胶原特殊序列(β collagen specific sequences, β-CTX)和25羟维生素D3 (25 hydroxy vitamin D3, 25-OH-VD₃)，并与治疗前进行比较。结果：应用唑来膦酸治疗6个月后PBC继发骨质疏松患者的腰椎BMD和血清25-OH-VD₃水平较治疗前明显升高，血清t-P1NP和β-CTX水平明显降低，而左股骨颈BMD无显著改善。结论：唑来膦酸能改善PBC继发骨质疏松症患者的腰椎BMD，降低血清骨转换标志物的水平，对PBC患者有显著的治疗效果。

Abstract: Objective: Zoledronic acid, as the third generation bisphosphonate, has been widely used in the clinical treatment of postmenopausal osteoporosis, but its efficacy has not been evaluated in patients with primary biliary cholangitis (PBC) secondary to osteoporosis (OP). The purpose of this study was to investigate the effect of zoledronic acid on bone density (BMD) and bone metabolism markers in patients with PBC secondary osteoporosis before and after 6 months of treatment. Methods: A total of 40 patients admitted to the Rheumatology Department of the Affiliated Hospital of Qingdao University from October 2012 to October 2019 were diagnosed as PBC complicated with OP and were treated by intravenous injection of 5 mg (100 ml) zoledronic acid (migoda). BMD, serum total N-terminal propeptide of type Ι procollagen (t-P1NP), beta collagen specific sequences (β-CTX) and 25-OH-VD₃ were reviewed 6 months after treatment and were compared with the results before treatment. Results: After 6 months of treatment with zoledronic acid, the lumbar BMD and serum 25-OH-VD₃ levels in patients with PBC were significantly higher than those before treatment, and the serum t-P1NP and β-CTX levels were significantly lower, while the left femoral neck BMD was not significantly improved. Conclusion: Zoledronic acid can improve lumbar BMD, reduce the level of serum bone conversion markers, and has a significant therapeutic effect on patients with PBC secondary osteoporosis.