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| 绝经后骨质疏松静滴唑来膦酸急性期发热相关因素分析 |
| Potential factors associated with acute febrile reaction in postmenopausal osteoporosis patients receiving intravenous zoledronic acid |
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| DOI：10.3969/j.issn.1006-7108.2018.10.003 |
| 中文关键词: 骨质疏松，绝经后 唑来膦酸 超氧化物歧化酶 发热 |
| 英文关键词:osteoporosis, postmenopausal zoledronic acid superoxide dismutase fever |
| 基金项目:国家自然科学基金(81500650)；上海市科研计划项目（13ZR1432100） |
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| 中文摘要: |
| 目的 研究绝经后骨质疏松症患者静滴唑来膦酸发生急性期发热的情况和潜在的影响因素。方法 收集2015年8月-2017年5月上海市第十人民医院内分泌代谢科唑来膦酸治疗绝经后骨质疏松症患者102例。根据用药后3 d内是否发生发热（耳温＞38℃）分为发热（+）组和发热（-）组；比较两组间的年龄、体质量指数(body mass index，BMI)、骨密度、血常规、肝肾功能和骨代谢指标的组间差异，对存在组间差异的指标进行二元Logistic回归分析，寻找发热的潜在影响因素。结果 102例绝经后骨质疏松患者中有28例（27.45％）发生发热。唑来膦酸治疗前，发热（+）组的中性粒细胞/淋巴细胞比值和骨钙素均高于发热（-）组，组间差异具有统计学意义（P＜0.05）；而发热（+）组超氧化物歧化酶(superoxide dismutase，SOD)低于发热（-）组，组间差异具有统计学意义（P＜0.05）。治疗前双膦酸盐的使用可以降低发热的发生，差异具有统计学意义（P＜0.05）。二元Logistic回归分析显示超氧化物歧化酶的OR值为0.985，95％CI为（0.972，0.999），高水平超氧化物歧化酶是发热发生的抑制因素（P＜0.05）。受试者工作特征曲线分析显示，超氧化物歧化酶-发热曲线下面积为0.64，既往双膦酸盐使用-发热曲线下面积为0.702，超氧化物歧化酶水平及双膦酸盐使用对预测绝经后骨质疏松静滴唑来膦酸急性期发热反应有一定价值。结论 27.45％绝经后骨质疏松症患者在静滴唑来膦酸后发生急性期发热反应（耳温＞38℃），高水平超氧化物歧化酶和既往双膦酸盐使用可减少急性期不良反应发热发生的风险。 |
| 英文摘要: |
| Objective To explore the situation and potential influencing factors of the acute adverse reaction of zoledronic acid in patients with postmenopausal osteoporosis. Methods 102 postmenopausal osteoporosis patients who received zoledronic acid in the Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital from August 2015 to May 2017 were enrolled based on inclusion and exclusion criteria. The patients were divided into fever (-) group and fever (+) group based on ear temperature (>38℃). We compared the differences between the two groups for age, BMI, bone density, blood routine, liver function, renal function and bone metabolism indicators. The binary logistic regression analysis was used to identify the potential influencing factors for fever. Results 28 cases (27.45%) of the 102 postmenopausal osteoporosis patients had transient fever (ear temperature>38℃). The neutrophil/lymphocyte ratio and osteocalcin level were higher in the fever (+) group than in the fever (-) group (P<0.05), and the fever (+) group had significantly lower superoxide dismutase (SOD) levels than those without fever (P<0.05). Patients with a history of bisphosphonates use had lower rate of fever (P<0.05). Binary logistic regression analysis showed that the OR of SOD was 0.985(95% CI: 0.972-0.999), implying higher levels of SOD was an inhibiting factor of fever (P<0.05). The receiver-operating characteristic curve (ROC curve) showed that SOD-fever area under the curve was 0.64, and bisphosphonates-fever area under the curve was 0.702. The results suggest that SOD and the history of using bisphosphonate have certain influence on the acute febrile reaction. Conclusion 27.45% patients had a transient fever reaction in the acute phase after zoledronic acid treatment (ear temperature>38℃). Higher levels of superoxide dismutase and the history of bisphosphonates use can reduce the risk of acute adverse reaction of fever. |
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