摘要
目的探讨西格列汀联合二甲双胍对2型糖尿病伴骨质疏松患者骨转换标志物和骨密度的影响。方法选取2015年1月至2016年1月在本院明确诊断的2型糖尿病合并骨质疏松患者95例,随机分为3组,二甲双胍(metformin,M)+阿卡波糖组(acarbose,A)(M+A组)32例、西格列汀(sitagliptin,S)+阿卡波糖组(S+A组)31例、西格列汀+二甲双胍+阿卡波糖组(S+M+A组)32例,治疗随访48周。治疗前及治疗48周后测定体质量指数(body mass index,BMI)、血清空腹血糖(fasting plasma glucose,FPG)、餐后2小时血糖(2-hour postprandial plasma glucose,2h PG)、糖化血红蛋白(glycated hemoglobin A1c,Hb A1c)、25-羟基维生素D[25-hydroxyvitamin D,25(OH)D]、骨钙素(osteocalcin,OC)、I型胶原羧基端肽β特殊系列(β-cterminal cross-linked telpeptide,β-CTX)、骨特异碱性磷酸酶(bone specific alkaline phosphatase,b-ALP)。采用双能X线吸收测定法(dual energy X-ray absorptiometry,DXA)测定患者腰椎2~4及股骨颈的骨密度(bone mineral density,BMD)。比较各组治疗前后BMI、生化指标、骨转换指标和BMD的变化。结果 5例患者因药物不耐受而脱落,90例患者完成治疗随访,3组各30例。M+A组、S+A组、S+M+A组患者治疗前BMI[(25.1±1.5、25.2±1.6、25.1±1.7)kg/m2]、FPG[(8.45±0.81、8.43±0.83、8.46±0.91)mmol/L]、2h PG[(11.54±1.58、11.68±1.61、11.72±1.70)mmol/L]、Hb A1c[(7.92±0.71、7.95±0.73、7.94±0.75)%]比较差异无统计学意义(均P>0.05);治疗后BMI[(24.2±1.6、24.1±1.5、23.5±1.4)kg/m2]、FPG[(6.51±0.69、6.49±0.67、6.15±0.71)mmol/L]、2h PG[(9.10±0.72、9.18±0.89、8.11±0.51)mmol/L]、Hb A1c[(6.71±0.51、6.74±0.53、6.18±0.58)%]均较治疗前显著下降,差异有统计学意义(均P<0.05);治疗后S+M+A组与M+A组和S+A组BMI、FPG、2h PG、Hb A1c比较下降更显著,差异有统计学意义(均P<0.05);M+A组与S+A组BMI、FPG、2h PG、Hb A1c比较差异无统计学意义(均P>0.05)。M+A组、S+A组、S+M+A组患者治疗前b-ALP[(12.5±1.9、12.6±2.1、12.4±2.4)U/L]、OC[(14.2±1.8、14.3±1.7、14.1±1.9)μg/L]、β-CTX[(413.5±65.3、420.4±70.5、428.1±69.6)ng/L]和腰椎2~4的BMD[(0.417±0.091、0.415±0.086、0.419±0.095)g/cm2]及股骨颈的BMD[(0.483±0.086、0.492±0.092、0.487±0.094)g/cm2]比较差异无统计学意义(均P>0.05);治疗后b-ALP[(15.8±2.4、16.1±2.5、20.4±2.9)U/L]、OC[(16.9±2.2、17.2±2.4、20.5±2.6)μg/L]明显升高,β-CTX[(351.7±45.8、352.9±47.9、319.5±50.9)ng/L]明显下降,腰椎2~4的BMD[(0.552±0.087、0.572±0.079、0.632±0.084)g/cm2]及股骨颈BMD[(0.617±0.073、0.621±0.073、0.715±0.083)g/cm2]增加,与治疗前比较差异有统计学意义(均P<0.05);治疗后S+M+A组与M+A组和S+A比较,b-ALP、OC、BMD升高更显著,β-CTX下降更显著,差异有统计学意义(均P<0.05);M+A组与S+A组b-ALP、OC、β-CTX、BMD比较差异无统计学意义(均P>0.05)。3组患者治疗前、后25(OH)D变化无统计学意义(均P>0.05)。结论西格列汀和二甲双胍除了具有降低血糖的作用外,还能够促进骨形成、抑制骨吸收,增加糖尿病合并骨质疏松患者骨密度,且两药联合应用有叠加增强作用。
Objective To evaluate the effects of sitagliptin and metformin on biomarkers of bone turnover and bone mineral density（BMD） in patients with type 2 diabetes（T2 DM） and osteoporosis（OP）. Methods Ninety-five patients diagnosed with T2 DM and OP at our hospital from January 2015 to January 2016 were randomly assigned into three groups,and were treated with metformin ＋ acarbose（M ＋ A group,n = 32）,sitagliptin ＋ acarbose（S ＋ A group,n = 31）,or metformin ＋ sitagliptin ＋acarbose（M ＋ S ＋ A group,n = 32） for 48 weeks. Body mass index（BMI）,serum fasting plasma glucose（FPG）,2-hour postprandial plasma glucose（2 h PG）,glycated hemoglobin A1 c（HbA1 c）,25-hydroxyvitamin D [25（OH） D],bone-specific alkaline phosphatase（b-ALP）,osteocalcin（OC） and β-c-terminal cross-linked telpeptide（β-CTX） were measured at baseline and at the end of the study. Bone mineral density（BMD） of lumbar spine（L2-4） and femoral neck were measured by dual energy Xray absorptiometry（DXA） at baseline and at the end of the study. Results Ninety patients completed the treatment,with 30 patients in each group. The mean values of BMI,FPG,2 hPG and HbA1 c were not significantly different among the three groups at baseline（all P〈0. 05）. The mean values of BMI,FPG,2 hPG and HbA1 c were significantly lower at the end of the study compared with the baseline values in the three groups（all P〈0. 05）. The mean values of BMI,FPG,2 hPG and HbA1 c were significantly lower in M ＋ S ＋ A group at the end of the study compared with M ＋ A group and S ＋ A group（all P〈0. 05）. The mean values of BMI,FPG,2 hPG and HbA1 c were not significantly different between M ＋ A group and S ＋ A group at the end of the study（all P〉0. 05）. The mean values of b-ALP,OC,β-CTX and BMD were not significantly different among the three groups at baseline（all P〉0. 05）. The mean values of b-ALP,OC and BMD were significantly higher and β-CTX were significantly lower at the end of the study compared with the baseline values in the three groups（all P〈0. 05）. The mean values of b-ALP,OC and BMD were significantly higher and β-CTX were significantly lower in M ＋ S ＋ A group at the end of study compared with M ＋ A group and S ＋ A group（all P〈0. 05）. The mean values of b-ALP,OC,β-CTX and BMD were not significant different between M ＋ A group and S ＋ A group at the end of the study（all P〉0. 05）. The mean values of 25（OH） D at the end of study were not significantly different from that at baseline in the three groups（all P〉0. 05）. Conclusion Sitagliptin and metformin could promote bone formation and inhibit bone absorption,and thus increase BMD in patients with T2 DM and OP.Combination of sitagliptin and metformin has the additive effect on bone metabolism in patients with T2 DM and OP.
作者
余洋
王路
杨丽君
李博
高丽杰
马丽敏
YU Yang;WANG Lu;YANG Lijun;LI Bo;GAO Lijie;MA Limin(Zhantansi Outpatient Department,Chinese People＇ s Liberation Army 309 Hospital,Beijing 100034;Xiaoxitian Outpatient Department,Chinese People＇ s Liberation Army 309 Hospital,Beijing 100082;Department of Surgical Clinic,Chinese People＇ s Liberation Army 301 Hospital,Beijing 100853;Department of Medicine Affairs,Chinese People＇ s Liberation Army 306 Hospital,Beijing 100101,China)
出处
《中国骨质疏松杂志》
CAS
CSCD
北大核心
2018年第8期1064-1069,共6页
Chinese Journal of Osteoporosis
作者简介
通信作者：杨丽君，Email：1987220225@qq．com
