唑来膦酸输注后的急性期反应：25-羟维生素 D 的保护作用和先前的口服双膦酸盐治疗。
ACUTE PHASE REACTIONS AFTER ZOLEDRONIC ACID INFUSION: PROTECTIVE ROLE OF 25-HYDROXYVITAMIN D AND PREVIOUS ORAL BISPHOSPHONATE THERAPY.
出版信息
Endocr Pract. 2018 May;24(5):405-410. doi: 10.4158/EP161638.OR. Epub 2018 Mar 2.
OBJECTIVE
The most common adverse reaction to zoledronic acid (ZOL) infusion is the acute phase reaction (APR), characterized by transient, usually mild, flu-like symptoms. Previous treatment with oral amino-bisphosphonates (BPs) was reported as an independent protective factor for APR, and an association between APR and 25-hydroxyvitamin D (25(OH)D) levels in BP-naïve patients treated with ZOL was identified. The aims of our study were to confirm this association and to see if it was different in patients previously treated with oral BPs compared with BP-naïve patients and to investigate the role of 25(OH)D for the time of APR onset.
METHODS
We included 153 consecutive patients with postmenopausal osteoporosis undergoing their first ZOL infusion. Sixty-eight had been previously treated with oral BPs. Clinical, demographic, and serologic data were recorded.
RESULTS
25(OH)D levels were significantly lower in patients experiencing APR compared to patients without APR (26.3 ± 12.7 vs. 37.0 ± 13.5 ng/mL, respectively; P<.0001). Patients with 25(OH)D <30 ng/mL had a significantly higher risk of APR (odds ratio [OR] 4.2 [95% confidence interval [CI] 2.1-8.2]) occurring in 65%. APR was significantly less frequent in patients previously treated with oral BPs than in BP-naïve subjects (33.8% [23/68] vs 52.9% [45/85], P = .018), but only a weak association remained after correction for 25(OH)D (OR 0.5, 95% CI 0.3-1.1, P = .08).
CONCLUSION
Higher baseline 25(OH)D levels appear to be protective for APR post-ZOL infusion. The role of previous treatment with oral BPs as an independent protective factor for APR should be evaluated in a larger cohort.
ABBREVIATIONS
APR = acute phase reaction; BPs = amino-bisphosphonates; CI = confidence interval; 25(OH)D = 25-hydroxyvitamin D; OP = osteoporosis; OR = odds ratio; PTH = parathyroid hormone; ROC = receiver operating characteristic; ZOL = zoledronic acid.
目的
唑来膦酸（ZOL）输注最常见的不良反应是急性期反应（APR），其特征为短暂的、通常为轻度的流感样症状。先前接受口服氨基双膦酸盐（BPs）治疗被报道为 APR 的独立保护因素，并且在接受 ZOL 治疗的 BP 初治患者中，APR 与 25-羟维生素 D（25（OH）D）水平之间存在关联。本研究的目的是确认这种关联，并观察其在先前接受口服 BPs 治疗的患者与 BP 初治患者中的差异，同时研究 25（OH）D 对 APR 发病时间的作用。
方法
我们纳入了 153 例绝经后骨质疏松症患者，他们正在接受首次 ZOL 输注。其中 68 例患者先前接受过口服 BPs 治疗。记录了临床、人口统计学和血清学数据。
结果
与无 APR 的患者相比，出现 APR 的患者 25（OH）D 水平显著降低（26.3±12.7 与 37.0±13.5ng/mL，分别为；P<.0001）。25（OH）D <30ng/mL 的患者发生 APR 的风险显著更高（优势比[OR]4.2[95%置信区间[CI]2.1-8.2]），发生率为 65%。与 BP 初治患者相比，先前接受过口服 BPs 治疗的患者中 APR 的发生率明显更低（33.8%[23/68]比 52.9%[45/85]，P=.018），但在校正 25（OH）D 后仅存在较弱的关联（OR 0.5，95% CI 0.3-1.1，P=.08）。
结论
较高的基线 25（OH）D 水平似乎对 ZOL 输注后 APR 具有保护作用。以前接受口服 BPs 治疗作为 APR 的独立保护因素的作用，应在更大的队列中进行评估。
缩写词
APR = 急性期反应；BPs = 氨基双膦酸盐；CI = 置信区间；25（OH）D = 25-羟维生素 D；OP = 骨质疏松症；OR = 优势比；PTH = 甲状旁腺激素；ROC = 接受者操作特征；ZOL = 唑来膦酸。
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