目的 探討地仲強(qiáng)骨膠囊聯(lián)合阿法骨化醇治療老年性骨質(zhì)疏松癥的臨床療效。方法 選取2018年1月—2019年5月于河南省洛陽正骨醫(yī)院（河南省骨科醫(yī)院）診治的136例老年骨質(zhì)疏松癥患者，隨機(jī)分為對(duì)照組和治療組，每組各68例。對(duì)照組口服阿法骨化醇軟膠囊，2粒/次，1次/d；治療組患者在對(duì)照組基礎(chǔ)上口服地仲強(qiáng)骨膠囊，3粒/次，3次/d。兩組患者均連續(xù)治療6個(gè)月。觀察兩組的臨床療效，比較兩組治療前后NRS評(píng)分、ODI評(píng)分、骨密度、骨形成和骨吸收標(biāo)志物、細(xì)胞因子水平的變化情況。結(jié)果 治療后，對(duì)照組總有效率75.0%，治療組總有效率88.2%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組NRS和ODI評(píng)分均較治療前顯著下降，且治療后治療組NRS和ODI評(píng)分下降更明顯（P<0.05）。兩組腰椎L₂-L₄、股骨頸骨密度均較治療前顯著提高（P<0.05）；且治療后治療組腰椎L₂-L₄、股骨頸骨密度提高更明顯（P<0.05）。兩組患者骨保護(hù)素（OPG）、Ⅰ型前膠原氨基端前肽（PINP）、骨形態(tài)發(fā)生蛋白-2（BMP-2）水平均顯著提高（P<0.05）；且治療組治療后OPG、PINP、BMP-2水平提高更明顯（P<0.05）。治療后，兩組患者β-膠原降解產(chǎn)物（β-CTX）、I型膠原交聯(lián)N-末端肽（NTX）水平均顯著降低（P<0.05）；且治療后治療組β-CTX、NTX水平降低更明顯（P<0.05）。治療后，兩組患者白細(xì)胞介素6（IL-6）、轉(zhuǎn)化生長因子-α（TNF-α）水平均顯著下降，胰島素樣生長因子（IGF-I）、轉(zhuǎn)化生長因子-β（TGF-β）水平均顯著提高（P<0.05）；且治療后治療組IL-6、TNF-α水平下降更明顯，IGF-I、TGF-β水平提高更明顯（P<0.05）。結(jié)論 地仲強(qiáng)骨膠囊聯(lián)合阿法骨化醇治療老年骨質(zhì)疏松癥具有良好的臨床療效，可有效提高骨密度，緩解患者疼痛癥狀，改善功能障礙，調(diào)節(jié)骨代謝，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To explore the clinical effect of Dizhong Qianggu Capsules combined with alfacalcitol in treatment of senile osteoporosis. Methods 136 Cases with senile osteoporosis treated in Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital) from January 2018 to May 2019 were randomly divided into control group and treatment group with 68 cases in each group. The patients in the control group were po administered with Alfacalcidol Soft Capsules, 2 grains/time, once daily. The treatment group was po administered with Dizhong Qianggu Capsules on the basis of the control group, 3 grain/time, three times daily. All patients were treated for 6 months. The clinical efficacy was observed, and the changes of NRS score, ODI score, bone density, markers of bone formation and bone absorption, and cytokine levels before and after treatment in the two groups were compared. Results After treatment, the total effective rate was 75.0% in the control group and 88.2% in the treatment group, and the difference between the two groups was statistically significant (P<0.05). The NRS and ODI scores in both groups decreased significantly compared with those before treatment (P<0.05), and the NRS and ODI scores in the treatment group decreased more significantly after treatment (P<0.05). The bone density of lumbar L₂-L₄ and femoral neck in both groups was significantly higher than that before treatment (P<0.05). After treatment, lumbar L₂-L₄ and femoral neck bone mineral density increased more significantly in the treatment group (P<0.05). Two groups of patients with bone protection element (OPG), a former Ⅰ type collagen amino terminal propeptide (PINP), BMP-2 (BMP-2) levels were significantly increased (P<0.05); In addition, the OPG, PINP and BMP-2 levels in the treatment group increased more significantly after treatment (P<0.05). After treatment, the levels of collagen degradation products (β-CTX) and type I collagen cross-linked n-terminal peptide (NTX) were significantly reduced in both groups (P<0.05). Moreover, after treatment, the levels of β-CTX and NTX in the treatment group decreased more significantly (P<0.05). After treatment, the levels of interleukin 6 (IL-6) and transforming growth factor α (TNF-α) in both groups decreased significantly, but the levels of IGF-I and TGF-β increased significantly (P<0.05). After treatment, IL-6 and TNF-α levels in the treatment group decreased more significantly, and IGF-I and TGF-β levels increased more significantly (P<0.05). Conclusion Dizhong Qianggu Capsules combined with alfacalcitol has a good clinical effect in treatment of senile osteoporosis, and can effectively improve bone density, relieve pain symptoms, and can improve dysfunction and regulate bone metabolism, which has a certain clinical application value.

R977