Effects of Folic Acid Combined with Alendronate on Bone Metabolism，CCl4 and Fibroblast Growth Factor Levels in Postmenopausal Osteoporosis Patients
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摘要:
目的 探讨叶酸联合阿伦磷酸钠对绝经后骨质疏松患者骨代谢、CCL4及纤维细胞生长因子水平的影响。 方法 选取2017年1月至2019年1月中国人民解放军联勤保障部队第九二二医院收治的154例绝经后骨质疏松患者为研究对象，并随机分为观察组（77例）和对照组（77例）。对照组给予钙剂联合阿伦磷酸钠治疗，观察组在对照组基础上增加口服叶酸片。2组患者连续治疗6个月。比较2组患者总有效率。比较治疗前后2组患者骨密度、25-羟基维生素（25-OHD）、Ⅰ型胶原 C端肽（CTX）、骨碱性磷酸酶（BALP）、骨钙素（BGP）、巨噬细胞炎症蛋白-1β（CCL4）、纤维细胞生长因子21（FGF-21）、FGF-23、VAS疼痛评分及SF-36生活质量评分变化情况。 结果 观察组及对照组总有效率分别为89.61%、67.54%，2组比较差异有统计学意义（P < 0.05）。治疗前，2组L1-4、股骨颈、股骨粗隆骨密度、25-OHD、CTX、BALP、BGP、CCL4、FGF-21、FGF-23水平以及VAS、SF-36评分比较，差异无统计学意义（P > 0.05）。治疗后，2组L1-4、股骨颈、股骨粗隆骨密度、25-OHD水平及SF-36评分有所上升，而CTX、BALP、BGP、CCL4、FGF-21、FGF-23水平以及VAS评分有所下降（P < 0.05）。且相较于对照组，观察组L1-4、股骨颈、股骨粗隆骨密度、25-OHD水平及SF-36评分更高，而CTX、BALP、BGP、CCL4、FGF-21、FGF-23水平以及VAS评分更低（P < 0.05）。 结论 叶酸联合阿伦磷酸钠治疗绝经后骨质疏松患者临床效果显著，并能改善患者骨密度、骨代谢、CCL4以及纤维细胞生长因子水平。 Abstract:Objective To investigate the effects of folic acid combined with alendronate sodium on bone metabolism, CCL4 and fibroblast growth factor levels in postmenopausal osteoporosis patients. Methods A total of 154 postmenopausal osteoporosis patients admitted to our hospital from January 2017 to January 2019 were selected as the research objects and randomly divided into observation group （77 cases） and control group （77 cases）. The control group was given calcium combined with alendronate sodium treatment, and the observation group added oral folic acid tablets to the control group. The two groups of patients were treated continuously for 6 months. The total effective rate and fracture rate of the two groups were compared. The bone mineral density, 25-OHD, CTX, BALP, BGP, CCL4, FGF-21, FGF-23, VAS pain score and SF-36 quality of life score were compared between the two groups before and after treatment. Results The total effective rate and fracture rate in the observation group were 89.61% and 1.30%, respectively, and in the control group were 67.54% and 5.19%. The difference between the two groups was statistically significant （P < 0.05）. Before the treatment, there was no statistical difference between the two groups of L1-4, femoral neck, femoral tuberosity bone mineral density, 25-OHD, CTX, BALP, BGP, CCL4, FGF-21, FGF-23 levels, and VAS and SF-36 scores. （P > 0.05）. After the treatment, the two groups of L1-4, femoral neck, femoral tuberosity bone mineral density, 25-OHD levels and SF-36 score increased, while CTX, BALP, BGP, CCL4, FGF-21, FGF-23 levels and VAS score decreased （P < 0.05）. Compared with the control group, the observation group had higher L1-4, femoral neck, femoral tuberosity bone mineral density, 25-OHD level and SF-36 score, while CTX, BALP, BGP, CCL4, FGF-21, FGF-23 level and VAS score were lower （P < 0.05）. Conclusion Folic acid combined with alendronate sodium has a significant clinical effect in the treatment of postmenopausal osteoporosis patients, and can improve the bone mineral density, bone metabolism, CCL4 and fibroblast growth factor levels. -
Key words:
- Folic acid /
- Alendronate sodium /
- Postmenopausal /
- Osteoporosis /
- Bone metabolism /
- CCL4 /
- Fibroblast growth factor
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表 1 2组一般资料比较（
$\bar x \pm s$ ）Table 1. Comparison of general information between the two groups （
$\bar x \pm s$ ）指标 观察组（n = 77） 对照组（n = 77） t/χ2 P 年龄（岁） 57.4 ± 3.9 57.1 ± 4.2 0.459 0.647 绝经时间（a） 8.72 ± 3.34 8.41 ± 3.53 0.56 0.576 BMI（kg/m2） 20.56 ± 3.36 20.74 ± 3.45 0.328 0.743 BMD（g/cm3） 0.61 ± 0.09 0.62 ± 0.11 0.617 0.538 
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表 2 2组总有效率比较[n（%）]
Table 2. Comparison of the total effective rate between the two groups [n（%）]
组别（n = 77） 显效 有效 无效 总有效率 观察组 33（42.86） 36（46.75） 8（10.39） 89.61 对照组 18（23.34） 34（44.16） 25（32.47） 67.54 χ2 11.146 P 0.001* *P < 0.05。
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表 3 治疗前后2组骨密度水平比较（
$\bar x \pm s$ ）Table 3. Comparison of bone mineral density between the two groups before and after treatment （
$\bar x \pm s$ ）指标 时间 观察组（n = 77） 对照组（n = 77） t P L1-4 治疗前 0.57 ± 0.11 0.59 ± 0.14 0.986 0.326 治疗后 0.84 ± 0.15 0.75 ± 0.16 3.601 < 0.001* t 12.737 6.604 P < 0.001* < 0.001* 股骨颈 治疗前 0.62 ± 0.09 0.61 ± 0.11 0.617 0.538 治疗后 0.79 ± 0.13 0.71 ± 0.10 4.28 < 0.001* t 9.435 5.903 P < 0.001* < 0.001* 股骨粗隆 治疗前 0.59 ± 0.11 0.57 ± 0.08 1.29 0.199 治疗后 0.87 ± 0.14 0.76 ± 0.15 4.704 < 0.001* t 13.801 9.807 P < 0.001* < 0.001* *P < 0.05。
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表 4 治疗前后2组骨代谢指标水平比较（
$\bar x \pm s$ ）Table 4. Comparison of bone metabolism index levels between the two groups before and after treatment （
$\bar x \pm s$ ）指标 时间 观察组（n = 77） 对照组（n = 77） t P 25-OHD（ng/mL） 治疗前 9.24 ± 1.18 9.36 ± 1.45 0.563 0.574 治疗后 25.43 ± 3.37 19.44 ± 3.52 10.786 < 0.001* t 39.788 23.234 P < 0.001* < 0.001* CTX（ng/L） 治疗前 0.89 ± 0.12 0.85 ± 0.14 1.904 0.059 治疗后 0.46 ± 0.09 0.59 ± 0.11 8.026 < 0.001* t 25.155 12.814 P < 0.001* < 0.001* BALP（μg/L） 治疗前 26.57 ± 3.44 26.19 ± 3.52 0.677 0.499 治疗后 18.08 ± 3.22 21.03 ± 3.45 5.485 < 0.001* t 15.811 9.187 P < 0.001* < 0.001* BGP（μg/L） 治疗前 5.67 ± 1.02 5.59 ± 1.13 0.461 0.645 治疗后 2.32 ± 1.24 3.47 ± 1.33 5.551 < 0.001* t 18.308 10.659 P < 0.001* < 0.001* *P < 0.05。
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表 5 治疗前后2组CCL4、FGF-21及FGF-23水平比较（
$\bar x \pm s$ ）Table 5. Comparison of the levels of CCL4，FGF-21 and FGF-23 between the two groups before and after treatment （
$\bar x \pm s$ ）指标 时间 观察组（n = 77） 对照组（n = 77） t P FGF-21（pg/mL） 治疗前 194.41 ± 27.55 196.53 ± 29.31 0.462 0.644 治疗后 154.81 ± 21.29 170.67 ± 23.49 4.391 < 0.001* t 9.981 6.041 P < 0.001* < 0.001* FGF-23（pg/mL） 治疗前 201.94 ± 23.36 203.48 ± 24.51 0.399 0.69 治疗后 158.73 ± 29.42 177.62 ± 24.57 4.324 < 0.001* t 10.093 6.539 P < 0.001* < 0.001* CCL4（pg/mL） 治疗前 322.87 ± 45.62 324.50 ± 47.74 0.217 0.829 治疗后 221.34 ± 38.91 247.83 ± 36.54 4.355 < 0.001* t 14.859 11.191 P < 0.001* < 0.001* *P < 0.05。
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表 6 治疗前后2组VAS及SF-36量表评分比较（
$\bar x \pm s$ ）Table 6. Comparison of VAS and SF-36 scale scores between the two groups before and after treatment （
$\bar x \pm s$ ）指标 时间 观察组（n=77） 对照组（n=77） t P VAS 治疗前 4.47 ± 1.02 4.56 ± 1.13 0.519 0.605 治疗后 1.56 ± 0.74 2.38 ± 0.81 6.558 < 0.001* t 20.263 13.759 P < 0.001 < 0.001 SF-36 治疗前 71.88 ± 9.92 71.67 ± 10.04 0.131 0.896 治疗后 90.55 ± 9.45 84.21 ± 9.03 4.256 < 0.001* t 11.958 8.149 P < 0.001* < 0.001* *P < 0.05。
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