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| 新型雌激素对女性血透患者骨质疏松的临床干预 |
| The clinical intervention using a new estrogen treatment for the hemodialysis female patients with osteoporosis |
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| DOI：10.3969/j.issn.1006.7108.2014.11.012 |
| 中文关键词: 他莫昔芬 血液透析 骨形态发生蛋白-2 雌二醇 骨质疏松 |
| 英文关键词:Tamoxifen Hemodialysis Bone morphogenetic protein-2 Estrogen Osteoporosis. |
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| 中文摘要: |
| 目的 观察雌激素他莫昔芬对维持性血液透析（MHD)女性患者骨质疏松的治疗作用。方法 选取50例MHD女性患者按有/无骨质疏松分为A组(n =26)与B组(n = 24)，再将A组随机分为A1组（n = 13，服用他莫昔芬、骨化三醇和碳酸钙）与A2组(n = 13，不服用他莫昔芬，余同A1)；观察治疗前后（12个月）患者疗效、副作用及血清雌二醇(E2)、骨形态发生蛋白4 (BMP~2)、全段甲状旁腺素（iPTH)等指标的变化；并以E2、BMP-2水平对人组患者骨质疏松的诊断进行ROC曲线分析。结果 A1组疗效显著优于A2组(P <0. 05)，两组副作用差异无统计学意义(P >0. 05);治疗前A组E2、BMP-2水平显著低于B组，治疗后A1组E2、BMP-2水平显著高于A2组(P <0.05)，治疗前后iPTH、Ca水平差异无统计学意义(P >0. 05);多元线性回归提示治疗前A组及治疗后A2组iPTH与BMD值呈负相关（P < 0. 05)，E2、BMP-2、Ca与骨密度（BMD)值呈正相关，且E2、BMP-2对BMD值影响最大。B组及治疗后A1组各指标与丽D值无线性回归关系。ROC曲线提示E2、BMP-2与入组患者 BMD值关系密切。结论 他莫昔芬可能是通过提高MHD女性患者体内E2、BMP-2水平从而安全有效的治疗骨质疏松，且 E2、BMP-2是影响MHD女性患者骨质疏松的重要因子。 |
| 英文摘要: |
| Objective To observe the curative effect of Tamoxifen on osteoporosis in female patients with maintenance hemodialysis (MHD). Methods Fifty MHD female patients were divided into group A (n =26) and group B (n =25) according to whether they had/didn’ t have osteoporosis. Group A was further divided into Group A1 (n = 13，treated with Raloxifen，Alfacalcidol，and calcium carbonate) and Group A2 (n = 13，treated with Alfacalcidol and calcium carbonate). The curative effect，side effect and changes of E2，BMP-2，and iPTH were observed before and 12 months after the treatment. ROC curve of osteoporosis diagnosis on the basis of E2 and BMP-2 level was analyzed. Results The curative effect of group A1 was better than group A2 significantly (P < 0. 05)，and there was no significant difference of side effects between two groups (P > 0. 05). Before the treatment，the levels of E2 and BMP-2 in group A were lower than those in group B. After the treatment，the levels of E2 and BMP-2 in group A1 were higher than those in group A2 (P < 0. 05). The levels of iPTH and Ca were not different before and after the treatment (P > 0. 05). Multiple linear regression analysis revealed that iPTH was negatively correlated with BMD in group A before the treatment and group A2 after the treatment (P < 0. 05). E2，BMP-2，and blood calcium had positive correlation with BMD (P < 0. 05). E2 an BMP-2 had greatest influence in BMD. Indices in group B and group A1 had no linear regression correlation with BMD. ROC curves revealed that E2 and BMP-2 had close correlation with BMD in all patients selected. Conclusion Tamoxifen may treat osteoporosis safely and effectively by increasing the E2 and BMP-2 levels in female MHD patients. E2 and BMP-2 are important factors affecting hemodialysis female patients with osteoporosis. |
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