目的 探讨阿法骨化醇联合唑来膦酸治疗绝经后骨质疏松症的临床价值。方法 选取2016年2月—2017年5月河南大学第一附属医院收治的绝经后骨质疏松症患者116例，根据不同的治疗方式分为对照组和治疗组，每组各58例。对照组静脉滴注唑来膦酸注射液，5 mg加入生理盐水100 mL，滴注时间不少于15 min，1次/年。治疗组在对照组的基础上口服阿法骨化醇软胶囊，0.25 μg/次，2次/d。两组患者均连续治疗1年。观察两组患者临床疗效，同时比较治疗前后两组患者骨痛症状评分、骨代谢指标和骨密度（BMD）水平。结果 治疗后，对照组和治疗组的总有效率分别为77.59%、94.83%，两组比较差异均具有统计学意义（P<0.05）。治疗后，两组患者骨痛症状评分水平显著降低（P<0.05），且治疗组患者骨痛症状评分明显低于对照组（P<0.05）。治疗后，两组患者骨钙素（BGP）、碱性磷酸酶（ALP）、β胶原降解产物（β-CTX）、Ⅰ型原胶原氨基端前肽（PINP）水平明显降低（P<0.05），且治疗组患者这些骨代谢指标明显低于对照组（P<0.05）。治疗后，两组全髋关节、股骨颈和腰椎的BMD水平显著升高（P<0.05），且治疗组患者全髋关节、股骨颈和腰椎的BMD水平明显高于对照组（P<0.05）。结论 阿法骨化醇联合唑来膦酸治疗绝经后骨质疏松症临床疗效显著，可有效的缓解患者骨痛症状，改善骨代谢，提高BMD。

Objective To investigate the clinical value of alfacalciferol combined with zoledronic acid in treatment of postmenopausal osteoporosis. Methods Patients (116 cases) with postmenopausal osteoporosis in the First Affiliated Hospital of Henan University from February 2016 to May 2017 were divided into control and treatment groups based on different treatments, and each group had 58 cases. Patients in the control group were iv administered with Zoledronic acid Injection, 5 mg added into 100 mL normal saline, and the drip time was more than 15 min, once a year. Patients in the treatment group were po administered with Alfacalcidol Soft Capsules on the basis of the control group, 0.25 μg/time, twice daily. Patients in two groups were treated for 1 year. After treatment, the clinical efficacy was evaluated, and the bone pain symptom scores, the level of bone metabolism and BMD levels in two groups before and after treatment were compared. Results After treatment, the clinical efficacy and in the control and treatment groups was 77.59% and 94.83%, respectively, and there were differences between two groups (P < 0.05). After treatment, the bone pain symptom scores in two groups were significantly decreased (P < 0.05), and which in the treatment group were significantly lower than that in the control group (P < 0.05). After treatment, the BGP, ALP, β-CTX, and PINP levels in two groups were significantly decreased (P < 0.05), and these bone metabolism indexes levels in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the BMD levels of total hip joint, femoral neck, and lumbar vertebra in two groups were significantly increased (P < 0.05), and these BMD levels in the treatment group were significantly higher than those in the control group (P < 0.05). Conclusion Alfacalciferol combined with zoledronic acid has significant clinical effect on postmenopausal osteoporosis, can effectively alleviate the symptoms of bone pain, ameliorate the bone metabolism and BMD.

河南省高等学校重点科研计划项目（18B310011）