摘要
目的分析达格列净(DAPA)联合西格列汀(SITA)对围绝经期2型糖尿病(T2DM)合并骨质疏松(OP)患者血糖、25-羟维生素D及骨代谢指标水平的影响。方法选取2021年9月—2023年9月杭州市富阳区第一人民医院收治的102例围绝经期T2DM合并OP患者为研究对象,按照随机数字表法分为对照组(51例,采用二甲双胍治疗)和观察组(51例,采用DAPA和SITA治疗),用药3个月后比较两组治疗前后的糖代谢指标[空腹血糖(FPG)、餐后2 h血糖(PBG)、糖化血红蛋白(HbA1c)]、骨代谢指标[N-端骨钙素(N-MID)、总Ⅰ型胶原氨基酸延长肽(t-P1NP)、骨源性碱性磷酸酶测定(BAP)水平、β-胶原特殊序列(β-CTX)、甲状旁腺激素(PTH)]、25-羟维生素D指标(25-羟维生素D2、25-羟维生素D3、总25-羟维生素D)及不良反应发生率。结果治疗后,观察组N-MID[(16.53±3.50)ng/ml vs.(13.28±2.94)ng/ml]、t-P1NP[(85.65±10.14)pg/ml vs.(77.19±11.37)pg/ml]、BAP[(30.52±3.76)U/L vs.(28.23±2.19)U/L]、25-羟维生素D2[(33.86±3.87)ng/ml vs.(25.29±4.15)ng/ml]、25-羟维生素D3[(17.68±2.51)ng/ml vs.(14.35±2.20)ng/ml]及总25-羟维生素D[(24.45±2.11)ng/ml vs.(16.28±4.24)ng/ml]水平均显著高于对照组,差异均有统计学意义(t=-5.078、-3.966、-3.758、10.786、7.125及12.320,均P<0.05);观察组FPG[(6.46±0.99)mmoL/L vs.(7.26±0.91)mmoL/L]、PBG[(9.20±0.72)mmoL/L vs.(11.38±0.87)mmoL/L]、HbA1c[(6.58±0.86)%vs.(7.14±0.77)%]、β-CTX[(0.32±0.16)ng/ml vs.(0.97±0.21)ng/ml]及PTH[(58.51±12.38)pg/ml vs.(64.74±13.16)pg/ml]水平均显著低于对照组,差异均有统计学意义(t=4.249、13.786、3.464、17.583及2.462,均P<0.05)。观察组不良反应总发生率(7.84%vs.41.18%)显著低于对照组,差异有统计学意义(χ^(2)=15.313,P<0.05)。结论DAPA联合SITA能够降低围绝经期T2DM合并OP患者的血糖水平,改善25-羟维生素D和骨代谢指标水平,减少不良反应发生。
Objective Toanalyze the effect of dapagliflozin(DAPA)combined with sitagliptin(SITA)on blood glucose,25-hydroxyvitamin D and bone metabolism indexes in perimenopausal patients with type 2 diabetes mellitus(T2DM)complicated with osteoporosis(OP).Methods A total of 102 patients with perimenopausal T2DM combined with OP admitted tothe Hangzhou Fuyang First People's Hospital from September 2021 to September 2023 were selected as the research objects.According to the random number table method,they were divided into the control group(51 patients,treated with metformin)and the observation group(51patients,treated with DAPA and SITA).After 3 months of treatment,the glucose metabolism indexes[fasting blood glucose(FPG),2 h postpranpranal blood glucose(PBG),glycosylated hemoglobin(HbA1c)],the bone metabolism indexes[N-terminal osteocalcin(N-MID),total type I collagen amino acid prolongating peptide(t-P1NP),bone-derived alkaline phosphatase(BAP),β-collagen specific sequence(β-CTX),and parathyroid hormone(PTH)],25-hydroxyvitamin Dindex(25-hydroxyvitamin D2,25-hydroxyvitamin D3,total 25-hydroxyvitamin D)and the incidence of adverse reactions were compared between the two groups before and after treatment.Results After treatment,observation group N-MID[(16.53±3.50)ng/ml vs.(13.28±2.94)ng/ml],t-P1NP[(85.65±10.14)pg/ml vs.(77.19±11.37)pg/ml],BAP[(30.52±3.76)U/L vs.(28.23±2.19)U/L],25-hydroxyvitamin D2[(33.86±3.87)ng/ml vs.(25.29±4.15)ng/ml],25-hydroxyvitamin D3[(17.68±2.51)ng/ml vs.(14.35±2.20)ng/ml]and total 25-hydroxyvitamin D[(24.45±2.11)ng/ml vs.(16.28±4.24)ng/ml]levels were significantly higher than those in control group,and the difference were statistically significant(t=-5.078,-3.966,-3.758,-10.786,7.125 and-12.320,all P<0.05).Observation group FPG[(6.46±0.99)mmoL/L vs.(7.26±0.91)mmoL/L],PBG[(9.20±0.72)mmoL/L vs.(11.38±0.87)mmoL/L],HbA1c[(6.58±0.86)%vs.(7.14±0.77)%],β-CTX[(0.32±0.16)ng/ml vs.(0.97±0.21)ng/ml]and PTH[(58.51±12.38)pg/ml vs.(64.74±13.16)pg/ml]were significantly lower than those of control group,and the difference were statistically significant(t=4.249,13.786,3.464,17.583 and 2.462,all P<0.05).The total incidence of adverse reactions in the observationgroup(7.84%vs.41.18%)was significantly lower than that in the control group,and the difference was statistically significant(χ^(2)=15.313,P<0.05).Conclusion DAPA combined with SITA can reduce blood glucose,improve 25-hydroxyvitamin D and bone metabolism indexesin perimenopausal T2DM patients with OP,and reduce the occurrence of adverse reactions.
作者
徐赛
周海龙
XU Sai;ZHOU Hai-long(Department of Endocrinology,Fuyang First People′s Hospital Affiliated to Zhejiang Chinese Medical University(Hangzhou Fuyang First People's Hospital),Hangzhou,Zhejiang 311400,China;不详)
出处
《中国妇幼保健》
2025年第13期2329-2333,共5页
Maternal and Child Health Care of China
基金
浙江省中医药科研项目(2023ZL619)。
