目的 探討壯骨止痛膠囊聯(lián)合特立帕肽治療絕經(jīng)后骨質(zhì)疏松癥的臨床療效。方法 選取2020年1月—2021年10月平煤神馬醫(yī)療集團總醫(yī)院收治的126例絕經(jīng)后骨質(zhì)疏松癥患者，采用隨機數(shù)字表法將所有患者分為對照組和治療組，每組各63例。對照組皮下注射特立帕肽注射液，20 μg/次，1次/d，注射部位選擇下腹部或大腿。治療組在對照組基礎(chǔ)上口服壯骨止痛膠囊，4粒/次，3次/d。兩組療程均為6個月。觀察兩組臨床療效；并比較治療前后兩組主要部位骨密度（BMD）值，相關(guān)癥狀評分，原發(fā)性骨質(zhì)疏松癥患者生活質(zhì)量量表（OQOLS）總分及血清骨轉(zhuǎn)換標志物[Ⅰ型前膠原N-端前肽（PINP）、Ⅰ型膠原交聯(lián)C-末端肽β-降解產(chǎn)物（β-CTX）]和白細胞介素（IL）-33、IL-17、胰島素樣生長因子-1（IGF-1）水平。結(jié)果 治療后，治療組總有效率為92.1%，顯著高于對照組的79.4%（P<0.05）。治療后，兩組腰椎L_1～4、髖部股骨頸、全髖BMD值均顯著增加（P<0.05），且治療后治療組主要部位BMD值增加更顯著（P<0.05）。治療后，兩組腰背疼痛、下肢抽筋、腰膝酸軟、步履艱難、持重困難評分均顯著降低，OQOLS總分則均顯著升高（P<0.05）；且均以治療組改善更顯著（P<0.05）。治療后，兩組血清PINP、β-CTX水平比治療前均顯著上升（P<0.05）；且治療后，治療組對血清PINP、β-CTX水平的升高作用較對照組更顯著（P<0.05）。治療后，兩組血清IL-33和IGF-1水平均顯著上升，血清IL-17水均顯著下降（P<0.05）；且治療組改善更顯著（P<0.05）。結(jié)論 絕經(jīng)后骨質(zhì)疏松癥應(yīng)用壯骨止痛膠囊聯(lián)合特立帕肽治療的總體療效確切，能安全有效地增加患者骨強度，減輕腰背疼痛等癥狀，提高生活質(zhì)量，改善體內(nèi)骨代謝活動，并可進一步上調(diào)血中IL-33、IGF-1及下調(diào)血中IL-17水平。

Objective To investigate the clinical efficacy of Zhuanggu Zhitong Capsules combined with teriparatide in treatment of postmenopausal osteoporosis. Methods A total of 126 patients with postmenopausal osteoporosis admitted to General Hospital of Pingmei Shenma Group from January 2020 to October 2021 were selected. All patients were divided into control group and treatment group by random number table method, with 63 cases in each group. Patients in the control group were sc administered with Teriparatide Injection, 20 μg/time, once daily, the injection site was chosen as the lower abdomen or thigh. Patients in the treatment group were po administered with Zhuanggu Zhitong Capsules on the basis of the control group, 4 grains/time, three times daily. Patients in two groups were treated for 6 months. After treatment, the clinical efficacy was evaluated. The bone mineral density (BMD) values of the main parts, the related symptom scores, the total score of the quality of life scale (OQOLS), and the serum bone turnover markers[Type I procollagen N-terminal propeptide (PINP), type I collagen cross-linked C-terminal peptide β-degradation product (β-CTX)] and interleukin (IL)-33, IL-17, insulin-like growth factor-1 (IGF-1) level in two groups were compared. Results After treatment, the total effective rate of the treatment group was 92.1%, which was significantly higher than that of the control group (79.4%, P < 0.05). After treatment, BMD values of lumbar L_1-4, hip femoral neck and whole hip were significantly increased in the two groups (P < 0.05), and the BMD values of main parts in the treatment group were increased more significantly after treatment (P < 0.05).After treatment, the scores of low back pain, lower extremity cramps, low back and knee tenderness, difficult walking and difficulty in weight holding were significantly decreased, and the total score of OQOLS was significantly increased in the two groups (P < 0.05). The improvement was more significant in the treatment group (P < 0.05). After treatment, the serum PINP and β-CTX levels of the two groups were significantly increased compared with those before treatment (P < 0.05). After treatment, the increase of serum PINP and β-CTX levels in the treatment group was more significant than that in the control group (P < 0.05). After treatment, the serum levels of IL-33 and IGF-1 in the two groups were significantly increased, and the serum IL-17 water was significantly decreased (P < 0.05). The improvement was more significant in the treatment group (P < 0.05). Conclusion Zhuanggu Zhitong Capsules combined with teriparatide has a definite overall curative effect in the treatment of postmenopausal osteoporosis. It can safely and effectively increase the bone strength of patients, relieve symptoms such as low back pain, improve the life quality, and improve the bone metabolic activity in the body. It can further up-regulate the levels of IL-33 and IGF-1 in blood and down-regulate the levels of IL-17 in blood.

R982

河南省高等學(xué)校重點科研項目（21B320035）