唑来膦酸治疗活动性骨Paget病患者的疗效：一项回顾性研究。
Response to Zoledronic Acid in Patients with Active Paget's Disease of Bone: A Retrospective Study.
作者信息
Durgia Harsh, Sahoo Jayaprakash, Kamalanathan Sadishkumar, Palui Rajan, Kumar Ritesh, Halanaik Dhanapathi, Ananthakrishnan Ramesh, Sankar Gowri, Sridharan Kalyani, Raj Henith
机构信息
Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Gorimedu, Puducherry, India.
Department of Nuclear Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Gorimedu, Puducherry, India.
出版信息
Indian J Endocrinol Metab. 2019 Jan-Feb;23(1):117-121. doi: 10.4103/ijem.IJEM_327_18.
BACKGROUND
Traditionally, bisphosphonates are used to treat active Paget's disease of bone (PDB). Intravenous zoledronic acid (ZA) is the most effective treatment option leading to sustained remission.
OBJECTIVE
The primary objective of this study was to analyze the effect of intravenous ZA in patients with active PDB in a tertiary care center of India.
MATERIALS AND METHODS
Retrospective data of 13 patients with active PDB who received a single dose of 4 mg intravenous ZA at our institute from January 2011 to June 2017 were reviewed. Response to therapy was monitored clinically, biochemically by serum alkaline phosphatase (ALP), and scintigraphically by 99m-Technetium methylene diphosphonate bone scan.
RESULTS
All of our patients reported relief of bone pain. The mean duration of follow-up in our study was 35.2 ± 16.8 months. Serum ALP levels reduced significantly from 1190.9 ± 666.1 IU/L ( = 13) at baseline to 200.5 ± 68.4 IU/L ( = 13) at 6 months ( < 0.001). ALP level at 1 year was 174 ± 33.6 IU/L ( = 12), which remained stable till 36 months at 176.5 ± 50 IU/L ( = 8). This indicates that remission achieved by 6 months post ZA is sustained for at least 3 years. Scintigraphic ratio reduced from 9.6 [interquartile range (IQR) 5.25-18.2] at baseline to 2.7 (IQR 1.20-4.05) at follow-up ( < 0.001). Similarly, scintigraphic index of involvement reduced from 9.9 (IQR 5.6-28.5) at baseline to 3 (IQR 2-4) at follow-up ( = 0.018).
CONCLUSION
A 4 mg single dose of intravenous ZA results in clinical, biochemical, and scintigraphic response that is sustained for at least 3 years.
背景
传统上，双膦酸盐用于治疗活动性骨Paget病（PDB）。静脉注射唑来膦酸（ZA）是导致持续缓解的最有效治疗选择。
目的
本研究的主要目的是分析在印度一家三级医疗中心静脉注射ZA对活动性PDB患者的疗效。
材料与方法
回顾性分析了2011年1月至2017年6月在我院接受单剂量4mg静脉注射ZA的13例活动性PDB患者的数据。通过临床、血清碱性磷酸酶（ALP）生化检测以及99m-锝亚甲基二膦酸盐骨扫描进行闪烁显像监测治疗反应。
结果
所有患者均报告骨痛缓解。本研究的平均随访时间为35.2±16.8个月。血清ALP水平从基线时的1190.9±666.1IU/L（n = 13）显著降至6个月时的200.5±68.4IU/L（n = 13）（P < 0.001）。1年时ALP水平为174±33.6IU/L（n = 12），直至36个月时保持稳定，为176.5±50IU/L（n = 8）。这表明ZA治疗6个月后实现的缓解至少持续3年。闪烁显像比率从基线时的9.6[四分位数间距（IQR）5.25 - 18.2]降至随访时的2.7（IQR 1.20 - 4.05）（P < 0.001）。同样，受累闪烁显像指数从基线时的9.9（IQR 5.6 - 28.5）降至随访时的3（IQR 2 - 4）（P = 0.018）。
结论
单剂量4mg静脉注射ZA可产生临床、生化和闪烁显像反应，且至少持续3年。
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