目的 比较鲑鱼降钙素喷鼻剂或阿仑膦酸钠片联合戊酸雌二醇片治疗绝经后骨质疏松的临床疗效和安全性。方法 选取2012年1月—2015年6月就诊于天津市河西区康复医院并进行治疗的120例绝经后骨质疏松患者,随机分为对照组和治疗组,每组各60例。对照组患者口服戊酸雌二醇片1 mg,1次/d,用药3周后停药1周;口服阿仑膦酸钠片10 mg,1次/d。治疗组患者口服戊酸雌二醇片1 mg,1次/d,用药3周后停药1周;鲑鱼降钙素喷鼻剂20 μg喷鼻,1次/d或分次给药。两组患者均连续治疗6个月。观察两组的临床疗效,同时比较骨密度值、血钙、血磷和血清骨钙素水平以及疼痛评价。结果 治疗后,对照组患者总有效率88.33%,治疗组患者总有效率90.00%,两组总有效率比较差异无统计学意义。两组患者治疗后L2、L3、L4及股骨颈骨密度值均较治疗前明显提高,同组治疗前后比较差异具有统计学意义(P<0.05),但是组间比较差异无统计学意义。治疗后两组患者血清骨钙素较治疗前明显升高,差异具有统计学意义(P<0.05)。两组患者治疗后VAS评分较治疗前明显降低,差异具有统计学意义(P<0.05),组间比较差异无统计学意义。结论 戊酸雌二醇片联合阿仑膦酸钠片或鲑鱼降钙素喷鼻剂治疗绝经后骨质疏松均安全有效,提高骨密度值和血清骨钙素水平,降低疼痛,且不良反应发生率较低,具有一定的临床推广应用价值。

Objective To compare the clinical curative and safety of Salmon Calcitonin Nasal Spray or Sodium Citrate Tablets combined with Estradiol Valerate Tabletes in treatment of postmenopausal osteoporosis. Methods Patients (120 cases) with postmenopausal osteoporosis in Rehabilitation Hospital of Hexi District in Tianjin City from January 2012 to June 2015 were randomly divided into control and treatment groups. Each group had 60 cases. Patients in the control group were po administrated with Estradiol Valerate Tabletes 1 mg, once daily, and stopped for one week after treatment for three weeks, and also po administrated with Sodium Citrate Tablets 10 mg, once daily. Patients in the treatment group were po administrated with Estradiol Valerate Tabletes 1 mg, once daily, and stopped for one week after treatment for three weeks, but were given Salmon Calcitonin Nasal Spray by nasal spray, 1 time/d or graded administration. Two groups were treated for six months. After treatment, the efficacy was evaluated, and the bone mineral density, serum calcium, serum phosphorus, serum bone gla protein, and pain score were compared. Results After treatment, the efficacies in the control and treatment groups were 88.33% and 90.00%, respectively, and there were no significant difference between two groups. After treatment, the bone mineral densities of L2, L3, L4, and femoral neck bone in two groups was significantly increased, and the difference was statistically significant in the same group (P< 0.05), but there were no significant difference between two groups. After treatment, the levels of serum bone gla protein in the treatment group were significantly higher than those in the control group, with significant difference between two groups (P< 0.05). After treatment, VAS scores in two groups were significantly decreased, and the difference was statistically significant in the same group (P< 0.05), but there were no significant difference between two groups. Conclusion Salmon Calcitonin Nasal Spray or Sodium Citrate Tablets combined with Estradiol Valerate Tabletes has safety and good efficacy in treatment of postmenopausal osteoporosis, and can significantly improve the bone mineral density and levels of serum bone gla protein, and relieve pain with lower incidence of adverse reactions, which has a certain clinical application value.