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目的:研究类风湿关节炎患者接受依那西普(etanercept,ETN)治疗52周后血清骨代谢生化指标、骨密度改变。方法:39例患者分为对照组(MTX7.5 mg/周逐渐加量至15 mg/周,3例患者于第8周时最大剂量为20 mg/周);治疗组17例(MTX用法同前,其中2例患者于第8周时最大剂量为20 mg/周,ETN:25 mg,每周2次,皮下注射)。于治疗前、12周、26周、52周分别检测骨保护素(OPG)、血清骨钙素(OC)、降钙素(CT)、甲状腺旁素(iPTH)。并行腰椎及股骨不同部位骨密度(BMD)测定。结果:2组在治疗前血清OPG水平即有显著降低,对照组随着治疗时间的持续而进一步降低。治疗组在治疗26周后出现升高,2组比较有统计学差异(P<0.01);而血清iPTH在治疗前2组均有显著升高,对照组随着治疗时间的持续而进一步升高。治疗组在治疗12周后出现升高,2组比较有统计学差异(P<0.01);2组患者腰椎、股骨颈、股骨沃德三角BMD比较有统计学意义(P<0.01)。结论:应用依那西普治疗类风湿关节炎能减少骨丢失、有效改善患者骨质疏松。
OBJECTIVE: To study the changes of serum biochemical markers of bone metabolism and bone mineral density after receiving etanercept (ETN) for 52 weeks in patients with rheumatoid arthritis. METHODS: Thirty-nine patients were divided into control group (MTX 7.5 mg / week and 15 mg / week, and 3 patients at 20 mg / week at week 8); 17 patients in treatment group Before, two of the patients had a maximum dose of 20 mg / week at Week 8, ETN: 25 mg twice a week, subcutaneously). The levels of osteoprotegerin (OPG), serum osteocalcin (OC), calcitonin (CT) and thyroid parathyroid hormone (iPTH) were measured before treatment, 12 weeks, 26 weeks and 52 weeks respectively. Parallel lumbar and femoral bone mineral density (BMD) measurements. Results: The levels of OPG in the two groups before treatment were significantly lower, while those in the control group decreased further with the duration of treatment. The treatment group increased after 26 weeks of treatment, there was a significant difference between the two groups (P <0.01), while the serum iPTH increased significantly in the two groups before treatment and the control group increased further as the treatment time continued . The treatment group showed an increase after 12 weeks of treatment, and there was a significant difference between the two groups (P <0.01). The BMD of lumbar, femoral neck and femur in the two groups was statistically significant (P <0.01). Conclusion: Etanercept treatment of rheumatoid arthritis can reduce bone loss, effectively improve patients with osteoporosis.