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中度慢性阻塞性肺病患者吸入沙美特罗替卡松对骨代谢的影响

韩雪梅,赖雁平,杨夏   

  1. 天津医科大学第二医院呼吸科
  • 收稿日期:2014-02-12 修回日期:2014-04-21 出版日期:2014-10-15 发布日期:2014-10-15
  • 通讯作者: 韩雪梅

Effects of Salmeterol/Fluticasone on Bone Metabolism and Bone Density in the Patients with Moderate Chronic Obstructive Pulmonary Disease(COPD)

HAN Xue mei,LAI Yan ping,YANG Xia   

  1. Department of Respiratory,the Second Hospital, Tianjin Medical University, 300211,China
  • Received:2014-02-12 Revised:2014-04-21 Published:2014-10-15 Online:2014-10-15
  • Contact: HAN Xue mei

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摘要：

【摘要】目的 了解中度慢性阻塞性肺疾病（COPD）患者吸入沙美特罗替卡松对骨代谢的影响及其与吸入时间长短的关系。方法 60 例COPD 患者按照随机数字表法分为试验组和对照组，各30 例。对照组每日进行常规治疗，不使用任何形式的糖皮质激素。试验组吸入沙美特罗替卡松，每日2 次，每次1 吸，连续用药12 个月，其余治疗同对照组。采用双能X 线骨密度仪（DXA）在治疗前、治疗3 个月、治疗12 个月分别测定2 组患者股骨三角的骨密度（BMD），同时用酶联免疫吸附试验测定血骨钙素（BGP）和碱性磷酸酶（ALP）。结果 2 组患者治疗前和治疗3 个月后，BMD、BGP、ALP 比较差异无统计学意义（P＞0.05）。治疗12 个月后，试验组BMD 低于对照组，BGP 和ALP 高于对照组，差异有统计学意义（P＜0.05）。试验组治疗3 个月与治疗前BMD、BGP、ALP 比较差异无统计学意义，治疗12 个月比治疗前BMD 降低，治疗12 个月比治疗前ALP 和BGP 增加，差异有统计学意义（P＜0.05）。对照组治疗前后BMD、ALP、BGP 比较差异无统计学意义。结论 沙美特罗替卡松短期吸入对老年COPD 患者的骨密度无不良影响，但长期吸入会导致COPD 患者骨密度下降。

关键词: 慢性阻塞性肺病, 沙美特罗替卡松, 骨密度, 骨钙素, 碱性磷酸酶

Abstract:

[Abstract]  Objective To observe the effects of salmeterol/fluticasone on the bone metabolism and bone density of the patients with moderate COPD and whether the effects is relate with inhaled corticosteroid course. Methods Sixty patients with COPD were divided into 2 groups by random digit table. Patients in experimental group (n=30) were given conventional therapy with salmeterol/fluticasone one inhale（bid) for continuously 12 months while patients in control group (N=30) were given conventional therapy without any glucocorticoid．The bone mineral density (BMD) of the femoral triangle in all patients were measured by DXA before therapy, 3 months and 12 months after therapy. At the same time, biochemical indicators that are correlated with bone metabolism include bone gla protein (BGP) and alkaline phosphatase (ALP) were measured by radioimmunoassay.  Results The BMD, BGP and ALP of patients in experimental group and in control group before therapy, 3 month and 12 month after therapy were compared. There is no significant difference (P＞0.05) between these two groups before therapy and after 3 month but significant difference was shown after 9 months (P＜0.05). Conclusion  Short period inhaling salmeterol/fluticasone in patients with COPD is safe. But long-term inhaling salmeterol/fluticason may lead to decline of the bone density in patients with COPD.

Key words: Chronic obstructive pulmonary disease, salmeterol/fluticason, Bone Density, osteocalcin, Alkaline Phosphatase