降钙的药物治疗PPT课件

1,.,报告组成,2,.,3,.,参考文献,秦华东,石臣磊,石铁锋,等.急性高血钙危象6例临床分析J.医学临床研究,2008,25(10):1861-1863.,KennethG.Saag,JoseR.Zanchetta,Jean-PierreDevogelaer,etal.EffectsofTeriparatideVersusAlendronateforTreatingGlucocorticoid-InducedOsteoporosis:Thirty-SixMonthResultsofaRandomized,Double-Blind,Contro-lledTrialJ.ARTHRITIS而噻嗪类利尿剂应避免使用,因其可减少肾脏钙的排泄。,秦华东,石臣磊,石铁锋,等.急性高血钙危象6例临床分析J.医学临床研究,2008,25(10):1861-1863.,6,.,降钙的药物治疗,2.应用骨溶解抑制剂：降钙素抑制破骨细胞对骨的吸收和肾小管对钙的重吸收,有利于钠和钙的排泄,作用迅速。降钙素100400U,每6h静脉或皮下注射1次,常用23次,但常于几小时或几天内出现“脱逸”现象而失效。经降钙素治疗的患者,约80%血钙可降低,但难以恢复正常水平。二膦酸盐类药物的作用可能是对破骨细胞的直接毒性作用,尤其适用于高血钙伴低血磷的患者,低磷可使骨吸收和肾脏合成活性维生素D3增强,骨形成减少,高钙血症加重。,秦华东,石臣磊,石铁锋,等.急性高血钙危象6例临床分析J.医学临床研究,2008,25(10):1861-1863.,7,.,降钙的药物治疗,二膦酸盐类药物依据时间先后和结构特点分为3代,包括:第1代的依替膦酸盐和氯甲双膦酸盐第2代的帕米膦酸盐、阿仑膦酸盐和利塞膦酸盐)以及第3代的伊苯膦酸盐、替鲁膦酸盐和唑来膦酸盐。第2代和第3代属于含氮原子的二膦酸盐类药物,其抗骨重吸收能力是第1代的10010000倍。3.其他：如光辉霉素和甲状旁腺激素衍生物特立帕肽等。4.糖皮质激素：病情允许时可口服,紧急情况下可用氢化可的松或地塞米松静滴、静注。其虽有一定的降钙疗效,但起效慢,维持时间短。,秦华东,石臣磊,石铁锋,等.急性高血钙危象6例临床分析J.医学临床研究,2008,25(10):1861-1863.,8,.,9,.,文献二,Studydesignandparticipants.Subjectswererandomlyassignedtoreceiveinjectableteriparatide(20g/day)plusoralplaceboororalalendronate(10mg/day)plusinjectableplacebo.Supplementsofcalcium(1,000mg/day)andvitaminD(800IU/day)wereprovided.Serumcalciummeasurements.Thenumberofsubjectswithelevatedtotalserumcalciumconcentrations(10.5mg/dl2.62mmoles/literwasdeterminedfromserumcollected16hoursafteradministrationofstudydrugs.,KennethG.Saag,JoseR.Zanchetta,Jean-PierreDevogelaer,etal.EffectsofTeriparatideVersusAlendronateforTreatingGlucocorticoid-InducedOsteoporosis:Thirty-SixMonthResultsofaRandomized,Double-Blind,ControlledTrialJ.ARTHRITISP0.001)andwasstillsignificantlylessthantheplacebogroupat18months(2.890.074vs.3.90.65mmol/liter;P0.001).,N.L.Gilchrist,C.M.Frampton,R.H.Acland,etal.AlendronatePreventsBoneLossinPatientswithAcuteSpinalCordInjury:ARandomized,Double-Blind,Placebo-ControlledStudyJ.TheJournalofClinicalEndocrinology&Metabolism,2007,92(4):13851390.,14,.,文献四SubjectsandMethods(1),C.M.Weaver,B.R.Martin,G.S.Jackson.J,etal.AntiresorptiveEffectsofPhytoestrogenSupplementsComparedwithEstradiolorRisedronateinPostmenopausalWomenUsing41CaMethodologyJ.ClinEndocrinol.Metab,2009,94(10):3798-3805.,15,.,文献四SubjectsandMethods(2),Theisoflavoneprofileofeachsupplementvariedwiththebotanicalsourceandthedose.Subjectswereaskedtotakeeachinterventionindivideddosesthroughoutthedaywithmealsbuttoconsumeallcapsules/tabletsbymidnight.Theywereadvisednottotakeextrapillsonanydaytocompen-sateforpreviouslymissedpills.Either1mgoralestradiol(Estrace)combinedwith2.5mgmedroxyprogesteronedailyor5mg/dofrisedronatewasusedasthepositivecontrolforcomparison.Participantswereinstructedtotakerisedronateonrisingatleast30minbeforeconsumingfoodorbeve-ragesandtotakeestrogenbeforebreakfast.,C.M.Weaver,B.R.Martin,G.S.Jackson.J,etal.AntiresorptiveEffectsofPhytoestrogenSupplementsComparedwithEstradiolorRisedronateinPostmenopausalWomenUsing41CaMethodologyJ.ClinEndocrinol.Metab,2009,94(10):3798-3805.,16,.,文献四SubjectsandMethods(3),Althoughsubjectswerenottoldwhichinterventiontheywereon,theinterventionregimenvariedandtabletsandcapsulesvariedinnumberperdayandappearance.Subjectswereprovided500mg/dcalciumand500IU/dvitaminD3throughoutthestudybeginningatbaselinetominimizefluctuationsincalciumintakeandvitaminDstatus.Thesubjectscompleteda3-dfoodrecordbeforeandduringeachinterventionperiodtoassesstheirusualdietarypattern.,C.M.Weaver,B.R.Martin,G.S.Jackson.J,etal.AntiresorptiveEffectsofPhytoestrogenSupplementsComparedwithEstradiolorRisedronateinPostmenopausalWomenUsing41CaMethodologyJ.ClinEndocrinol.Metab,2009,94(10):3798-3805.,17,.,文献四SubjectsandMethods(4),CalciumabsorptionAttheendofbaselineandeachinterventionperiod,acalciumabsorptiontestwith15.2mg44CaasCaCO3andtheassignedsupplementaspartofatestmealcontaining250mgCawasperformedaspreviouslydescribed.44Caenrichmentwasdeterminedinthe5-hbloodsamplebyInductivelyCoupledPlasmaandMassSpectrometryaspreviouslydescribed.Fractionalcalciumabsorptionwasdeterminedas:(5-hSSA0.92373)0.3537(heightmeters0.52847)(weightkilograms0.37213)whereSSA=serum-specificactivity(fractiondosepergramCa).,C.M.Weaver,B.R.Martin,G.S.Jackson.J,etal.AntiresorptiveEffectsofPhytoestrogenSupplementsComparedwithEstradiolorRisedronateinPostmenopausalWomenUsing41CaMethodologyJ.ClinEndocrinol.Metab,2009,94(10):3798-3805.,18,.,文献四,FIG.2.Suppressionofboneresorption(RR)bycommercialisoflavonesupplementsandtraditionalpharmaceu-ticaltherapies,estra-diolorrisedronate.ThelineatRR=1.0isthepreinterventioncompar-ison.Theerrorbarsindicate95%confidenceintervalaboutthemean.,C.M.Weaver,B.R.Martin,G.S.Jackson.J,etal.AntiresorptiveEffectsofPhytoestrogenSupplementsComparedwithEstradiolorRisedronateinPostmenopausalWomenUsing41CaMethodologyJ.ClinEndocrinol.Metab,2009,94(10):3798-3805.,19,.,文献四,TABLE1.Biomarkersofboneturnoverandcalciumregulatinghormonesatbaselineandattheendofeachintervention,n.s.:notsignificant.,C.M.Weaver,B.R.Martin,G.S.Jackson.J,etal.AntiresorptiveEffectsofPhytoestrogenSupplementsComparedwithEstradiolorRisedronateinPostmenopausalWomenUsing41CaMethodologyJ.ClinEndocrinol.Metab,2009,94(10):3798-3805.,20,.,文献四,TABLE2.EstimatedRRduetointerventionsa,an=11exceptsubjectseitheroptedforestrogen(n=4)orrisedronate(n=6)asapositivecontrol.,C.M.Weaver,B.R.Martin,G.S.Jackson.J,etal.AntiresorptiveEffectsofPhytoestrogenSupplementsComparedwithEstradiolorRisedronateinPostmenopausalWomenUsing41CaMethodologyJ.ClinEndocrinol.Metab,2009,94(10):3798-3805.,21,.,文献五MATERIALSANDMETHODS(1),Sixteenpatientsparticipatedinthisprospectiverandomizedcontrolledstudy.Forinclusiontointhisstudy,thepatientsneithersufferedfromanydiseasesaffectingbonemetabolismnorusedanybone-inducingmedicationpreviously.Moreover,thepatientsunderstoodnottouseotherbonegrowth-inducingmedicationduringthestudy.Thepatientsalsohadtobeabletocomplywithastandardpostoperativemobilizationschedule.,T.S.Tapaninen1,P.K.Venesmaa1,J.S.Jurvelin,AlendronatereducesperiprostheticbonelossafteruncementedprimarytotalhiparthroplastyA5-yearfollow-upof16patientsJ,ScandinavianJournalofSurgery,2010,99:3237.,22,.,文献五MATERIALSANDMETHODS(2),Thepatientswererandomizedintotwostudygroupsfora5-yearfollow-upperiod.Nine(fivemenandfourwomen)receivedonly500mgcalciumcarbonatedaily.Seven(twomenandfivewomen)received10mgalendronatesodium(Fosamax)supplementedby500mgcalciumcarbonatedaily.Alendronatetabletswereadministratedorally30minu