丹参川芎联合骨瓜或骨肽对糖尿病骨质疏松患者糖代谢和骨代谢的影响
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摘要
目的:探讨在丹参川芎治疗基础上,结合骨瓜或骨肽应用于糖尿病骨质疏松症对糖代谢、骨代谢作用价值。方法:选取2016年3月至2017年9月湖北省黄石市第二医院受诊的糖尿病骨质疏松症患者253例作为研究对象。将应用丹参川芎结合骨瓜治疗的128例归为骨瓜组,将予以丹参川芎结合骨肽治疗的125例归为骨肽组,分析2组糖化血红蛋白(Hb A1c)、空腹血糖(FBG) N-端中段骨钙素(N-MID-OT)、骨特异性碱性磷酸酶(BAP),骨形态发生蛋白-2(BMP-2),骨钙素(BBGP)。骨密度(BMD),甲状旁腺素(PTH)、碱性磷酸酶(ALP),β-胶原特殊序列(β-CTx),并比较药物安全性。结果:1)骨瓜组糖代谢Hb A1c(7. 41±0. 64)%、钙离子(2. 21±0. 28) mmol/L、FBG(6. 12±0. 59) mmol/L、血磷(1. 42±0. 25)mmol/L在治疗后与骨肽组Hb A1c(7. 79±0. 51)%、钙离子(2. 27±0. 33) mmol/L、FBG(6. 37±0. 83) mmol/L、血磷(1. 35±0. 31) mmol/L差异无统计学意义(P> 0. 05); 2)骨肽组N-MID-OT(16. 37±2. 83) ng/m L和骨瓜组差异无统计学意义(P>0. 05),BAP(142. 26±10. 66)μg/L、BGP(5. 07±1. 32)μg/L显著低于骨瓜组,BMP-2 (86. 35±6. 24) ng/L显著高于骨瓜组,差异有统计学意义(P <0. 05); 3)骨肽组BMD(0. 57±0. 13) g/cm3显著高于骨瓜组,PTH(32. 26±2. 15) pg/m L、ALP(72. 35±5. 19) U/L显著低于骨瓜组,差异有统计学意义(P <0. 05),β-CTx(0. 39±0. 02) ng/m L和骨瓜组(0. 42±0. 04)ng/m L差异无统计学意义著(P> 0. 05); 4)骨瓜组不良反应率(3. 13%)显著低于骨肽组(9. 60%),差异有统计学意义(P <0. 05)。结论:对于糖尿病骨质疏松症的治疗,基于丹参川芎,增加注射用骨肽比较注射用骨瓜提取物,更能促进患者多项骨代谢指标、血清生化指标及BMD的恢复,二者具有相似的调节糖代谢的作用,但骨肽不良反应相对较高,临床上应结合患者实际情况进行药物的选择。
Objective: To explore the effects of Salvia Rhizoma Miltiorrhiza and Rhizoma Chuanxiong combined with bone melon or Ossotide on glucose metabolism and bone metabolism in patients with diabetic osteoporosis. Methods: From March 2016 to September 2017,253 diabetic patients with osteoporosis treated in The Second Hospital of Huangshi were selected as the study object. The bone melon group included 128 cases treated with Rhizoma Salviae Miltiorrhizae and Rhizoma Chuanxiong,combined with bone melon. The ossotide group included 125 cases treated with Rhizoma Salviae Miltiorrhizae and Rhizoma Chuanxiong,combined with ossotide. The fluctuation of bone metabolism,glucose metabolism and other related biochemical indexes were analyzed before and after treatment. The drug safety was also compared. Results: 1) After the treatment,there was no significant difference in glucose metabolism( Hb A1 c( 7. 41 ± 0. 64) %,Ca( 2. 21 ± 0. 28) mmol/L,FBG( 6. 12 ± 0. 59) mmol/L,P( 1. 42 ± 0. 25) mmol/L,Hb A1 c( 7. 79 ± 0. 51) %,Ca( 2. 27 ± 0. 33) mmol/L,FBG( 6. 37 ± 0. 83) mmol/L,P( 1. 35 ± 0. 31) mmol/L) between the bone melon group and the ossotide group( P > 0. 05); 2) There was no significant difference in N-MID-OT( 16. 37 ± 2. 83) ng/m L between the ossotide group and the bone melon group( P > 0. 05),while BAP( 142. 26 ± 10. 66) μg/L,BGP( 5. 07 ± 1. 32) μg/L of the ossotide group were significantly lower than that of the bone melon group,and BMP-2( 86. 35 ± 6. 24) ng/L significantly higher than that of the bone melon group( P < 0. 05); 3) The BMD( 0. 57 ± 0. 13) g/cm~3 of the ossotide group was significantly higher than that of the bone melon group,while PTH( 32. 26 ± 2. 15) pg/m L,ALP( 72. 35 ± 5. 19) U/L were significantly lower than that of the bone melon group( P < 0. 05); there was no significant difference in β-CTx between the ossotide group( 0. 39 ± 0. 02) ng/m L and the bone melon group( 0. 42 ± 0. 04) ng/m L( P > 0. 05). 4) The adverse reaction rate of the bone melon group( 3. 13%) was lower than that of the ossotide group( 9. 60%)( P < 0. 05). Conclusion: For the treatment based on Rhizoma Salviae Miltiorrhizae and Rhizoma Chuanxiong on patients with diabetic osteoporosis,compared to bone melon,the ossotide injection can improve multiple indexes of bone metabolism,serum biochemical indexes and BMD. Both have similar effects in regulating glucose metabolism,but the side effects of ossotide are relatively higher,so it is preferred to select drugs according to individual conditions.
Objective: To explore the effects of Salvia Rhizoma Miltiorrhiza and Rhizoma Chuanxiong combined with bone melon or Ossotide on glucose metabolism and bone metabolism in patients with diabetic osteoporosis. Methods: From March 2016 to September 2017,253 diabetic patients with osteoporosis treated in The Second Hospital of Huangshi were selected as the study object. The bone melon group included 128 cases treated with Rhizoma Salviae Miltiorrhizae and Rhizoma Chuanxiong,combined with bone melon. The ossotide group included 125 cases treated with Rhizoma Salviae Miltiorrhizae and Rhizoma Chuanxiong,combined with ossotide. The fluctuation of bone metabolism,glucose metabolism and other related biochemical indexes were analyzed before and after treatment. The drug safety was also compared. Results: 1) After the treatment,there was no significant difference in glucose metabolism( Hb A1 c( 7. 41 ± 0. 64) %,Ca( 2. 21 ± 0. 28) mmol/L,FBG( 6. 12 ± 0. 59) mmol/L,P( 1. 42 ± 0. 25) mmol/L,Hb A1 c( 7. 79 ± 0. 51) %,Ca( 2. 27 ± 0. 33) mmol/L,FBG( 6. 37 ± 0. 83) mmol/L,P( 1. 35 ± 0. 31) mmol/L) between the bone melon group and the ossotide group( P > 0. 05); 2) There was no significant difference in N-MID-OT( 16. 37 ± 2. 83) ng/m L between the ossotide group and the bone melon group( P > 0. 05),while BAP( 142. 26 ± 10. 66) μg/L,BGP( 5. 07 ± 1. 32) μg/L of the ossotide group were significantly lower than that of the bone melon group,and BMP-2( 86. 35 ± 6. 24) ng/L significantly higher than that of the bone melon group( P < 0. 05); 3) The BMD( 0. 57 ± 0. 13) g/cm~3 of the ossotide group was significantly higher than that of the bone melon group,while PTH( 32. 26 ± 2. 15) pg/m L,ALP( 72. 35 ± 5. 19) U/L were significantly lower than that of the bone melon group( P < 0. 05); there was no significant difference in β-CTx between the ossotide group( 0. 39 ± 0. 02) ng/m L and the bone melon group( 0. 42 ± 0. 04) ng/m L( P > 0. 05). 4) The adverse reaction rate of the bone melon group( 3. 13%) was lower than that of the ossotide group( 9. 60%)( P < 0. 05). Conclusion: For the treatment based on Rhizoma Salviae Miltiorrhizae and Rhizoma Chuanxiong on patients with diabetic osteoporosis,compared to bone melon,the ossotide injection can improve multiple indexes of bone metabolism,serum biochemical indexes and BMD. Both have similar effects in regulating glucose metabolism,but the side effects of ossotide are relatively higher,so it is preferred to select drugs according to individual conditions.
引文
[1]刘君英,阎德文,邓建新,等.围绝经期2型糖尿病骨质疏松症治疗中胰岛素与阿仑膦酸钠的联合应用效果观察[J].山东医药,2017,57(19):69-71.
[2]Feng W,Mao G,Li Q,et al. Effects of chromium malate on glycometabolism,glycometabolism-related enzyme levels and lipid metabolism in type 2 diabetic rats:A dose-response and curative effects study[J]. J Diabetes Investig,2015,6(4):396-407.
[3]潘颖,郄素会,刘国强,等.金天格胶囊联合唑来膦酸注射液治疗绝经后糖尿病骨质疏松患者的临床观察[J].中国药房,2016,27(35):4953-4955,4956.
[4]张翠英,章洪,董宇,等.基于药效成分丹酚酸B和阿魏酸在大鼠血浆的药代动力学研究丹参与川芎配伍[J].中国中药杂志,2015,40(8):1589-1593.
[5]王芳,任汉强,沈晓波.胰岛素联合阿仑膦酸钠对老年糖尿病骨质疏松症患者骨密度及血清BAP、TRAP-5b、BGP水平影响[J].海南医学院学报,2016,22(13):1387-1389,1393.
[6]Li XJ,Zhu Z,Han SL,et al. Bergapten exerts inhibitory effects on diabetes-related osteoporosis via the regulation of the PI3K/AKT,JNK/MAPK and NF-κB signaling pathways in osteoprotegerin knockout mice[J]. Int J Mol Med,2016,38(6):1661-1672.
[7]赵春芝,娄方勇.胰岛素、阿仑膦酸钠治疗新诊断老年糖尿病骨质疏松症患者骨密度及骨转换指标的研究[J].中国骨质疏松杂志,2014,20(4):392-395,438.
[8]Chen Z,Zhao GH,Zhang YK,et al. Research on the correlation of diabetes mellitus complicated with osteoporosis with lipid metabolism,adipokines and inflammatory factors and its regression analysis[J].Eur Rev Med Pharmacol Sci,2017,21(17):3900-3905.
[9]温滨红,张艳阳,赵璐,等.利拉鲁肽对糖尿病骨质疏松大鼠骨代谢、炎性反应和氧化应激的影响[J].中华骨质疏松和骨矿盐疾病杂志,2017,10(6):550-556.
[10]Hyassat D,Alyan T,Jaddou H,et al. Prevalence and Risk Factors of Osteoporosis Among Jordanian Postmenopausal Women Attending the National Center for Diabetes,Endocrinology and Genetics in Jordan[J]. Biores Open Access,2017,6(1):85-93.
[11]丛宝华,赵方,宋飞,等.胰岛素联合阿仑膦酸钠对2型糖尿病骨质疏松症患者骨代谢的影响[J].现代生物医学进展,2017,17(3):516-519.
[12]赵伟平.唑来膦酸联合胰岛素治疗老年糖尿病骨质疏松症患者的临床疗效及其对骨相关代谢指标的影响[J].中国慢性病预防与控制,2017,25(6):457-459.
[13]Kumar BS,Ravisankar A,Mohan A,et al. Effect of oral hypoglycaemic agents on bone metabolism in patients with type 2 diabetes mellitus&occurrence of osteoporosis[J]. Indian J Med Res,2015,141(4):431-437.
[14]周琳,李嘉俊,任继刚,等.丹参川芎嗪联合替罗非班对急性ST段抬高型心肌梗死患者冠脉介入术后视黄醇结合蛋白4的影响[J].中国临床保健杂志,2018,21(1):51-54.
[15]Ha M,Hu J,Petrini MA,et al. The effects of an educational self-efficacy intervention on osteoporosis prevention and diabetes self-management among adults with type 2 diabetes mellitus[J]. Biol Res Nurs,2014,16(4):357-367.
[16]刘成龙.联合应用骨瓜提取物注射液对骨质疏松性椎体压缩骨折患者骨密度的影响[J].临床骨科杂志,2017,20(4):413-415.
[17]Inoue D,Muraoka R,Okazaki R,et al. Efficacy and Safety of Risedronate in Osteoporosis Subjects with Comorbid Diabetes,Hypertension,and/or Dyslipidemia:A Post Hoc Analysis of Phase III Trials Conducted in Japan[J]. Calcif Tissue Int,2016,98(2):114-122.
[18]张宁,张佩娟,于仁波,等.锝[99Tc]亚甲基二膦酸盐注射液联合骨瓜提取物注射液治疗骨质疏松性椎体压缩骨折效果分析[J].中国医药,2015,10(11):1648-1650.
[2]Feng W,Mao G,Li Q,et al. Effects of chromium malate on glycometabolism,glycometabolism-related enzyme levels and lipid metabolism in type 2 diabetic rats:A dose-response and curative effects study[J]. J Diabetes Investig,2015,6(4):396-407.
[3]潘颖,郄素会,刘国强,等.金天格胶囊联合唑来膦酸注射液治疗绝经后糖尿病骨质疏松患者的临床观察[J].中国药房,2016,27(35):4953-4955,4956.
[4]张翠英,章洪,董宇,等.基于药效成分丹酚酸B和阿魏酸在大鼠血浆的药代动力学研究丹参与川芎配伍[J].中国中药杂志,2015,40(8):1589-1593.
[5]王芳,任汉强,沈晓波.胰岛素联合阿仑膦酸钠对老年糖尿病骨质疏松症患者骨密度及血清BAP、TRAP-5b、BGP水平影响[J].海南医学院学报,2016,22(13):1387-1389,1393.
[6]Li XJ,Zhu Z,Han SL,et al. Bergapten exerts inhibitory effects on diabetes-related osteoporosis via the regulation of the PI3K/AKT,JNK/MAPK and NF-κB signaling pathways in osteoprotegerin knockout mice[J]. Int J Mol Med,2016,38(6):1661-1672.
[7]赵春芝,娄方勇.胰岛素、阿仑膦酸钠治疗新诊断老年糖尿病骨质疏松症患者骨密度及骨转换指标的研究[J].中国骨质疏松杂志,2014,20(4):392-395,438.
[8]Chen Z,Zhao GH,Zhang YK,et al. Research on the correlation of diabetes mellitus complicated with osteoporosis with lipid metabolism,adipokines and inflammatory factors and its regression analysis[J].Eur Rev Med Pharmacol Sci,2017,21(17):3900-3905.
[9]温滨红,张艳阳,赵璐,等.利拉鲁肽对糖尿病骨质疏松大鼠骨代谢、炎性反应和氧化应激的影响[J].中华骨质疏松和骨矿盐疾病杂志,2017,10(6):550-556.
[10]Hyassat D,Alyan T,Jaddou H,et al. Prevalence and Risk Factors of Osteoporosis Among Jordanian Postmenopausal Women Attending the National Center for Diabetes,Endocrinology and Genetics in Jordan[J]. Biores Open Access,2017,6(1):85-93.
[11]丛宝华,赵方,宋飞,等.胰岛素联合阿仑膦酸钠对2型糖尿病骨质疏松症患者骨代谢的影响[J].现代生物医学进展,2017,17(3):516-519.
[12]赵伟平.唑来膦酸联合胰岛素治疗老年糖尿病骨质疏松症患者的临床疗效及其对骨相关代谢指标的影响[J].中国慢性病预防与控制,2017,25(6):457-459.
[13]Kumar BS,Ravisankar A,Mohan A,et al. Effect of oral hypoglycaemic agents on bone metabolism in patients with type 2 diabetes mellitus&occurrence of osteoporosis[J]. Indian J Med Res,2015,141(4):431-437.
[14]周琳,李嘉俊,任继刚,等.丹参川芎嗪联合替罗非班对急性ST段抬高型心肌梗死患者冠脉介入术后视黄醇结合蛋白4的影响[J].中国临床保健杂志,2018,21(1):51-54.
[15]Ha M,Hu J,Petrini MA,et al. The effects of an educational self-efficacy intervention on osteoporosis prevention and diabetes self-management among adults with type 2 diabetes mellitus[J]. Biol Res Nurs,2014,16(4):357-367.
[16]刘成龙.联合应用骨瓜提取物注射液对骨质疏松性椎体压缩骨折患者骨密度的影响[J].临床骨科杂志,2017,20(4):413-415.
[17]Inoue D,Muraoka R,Okazaki R,et al. Efficacy and Safety of Risedronate in Osteoporosis Subjects with Comorbid Diabetes,Hypertension,and/or Dyslipidemia:A Post Hoc Analysis of Phase III Trials Conducted in Japan[J]. Calcif Tissue Int,2016,98(2):114-122.
[18]张宁,张佩娟,于仁波,等.锝[99Tc]亚甲基二膦酸盐注射液联合骨瓜提取物注射液治疗骨质疏松性椎体压缩骨折效果分析[J].中国医药,2015,10(11):1648-1650.