肠促胰腺素类降糖药物对2型糖尿病患者骨质代谢的影响
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摘要
目的探讨肠促胰腺素类降糖药物对2型糖尿病患者骨质代谢的影响。方法回顾性分析医院101例2型糖尿病患者的临床资料,根据其治疗方案的不同进行分组,其中行二甲双胍+二肽基肽酶4(DPP-4)抑制剂(西格列汀片)治疗的为A组(34例),进行二甲双胍+胰高血糖素样肽-1(GLP-1)受体激动剂治疗的为B组(31例),进行二甲双胍+甘精胰岛素治疗的为C组(36例)。结果 3组患者治疗前的性别、年龄、糖尿病病程、体质量指数(BMI)、糖化血红蛋白(HbA1C)、空腹血糖(FBG)比较均无显著差异(P>0.05);治疗后,A组体质量明显大于B组与C组(P<0.05),骨密度(BMD)、血清钙离子(Ca~(2+))浓度、磷酸盐和碱性磷酸酶(ALP)水平均明显高于B组与C组(P<0.05);B组BMD、血清Ca~(2+)、磷酸盐和ALP水平与C组比较均无显著性差异(P>0.05)。结论 DPP-4抑制剂与二甲双胍联合治疗2型糖尿病疗效显著,且对BMD和血清骨代谢标志物水平有更好的改善作用。
Objective To investigate the effect of incretin-like hypoglycemic drugs on bone metabolism in patients with type 2 diabetes mellitus( T2DM).Methods The clinical data of 101 patients with T2DM in our hospital were retrospectively analyzed.The patients were divided into 3 groups according to their treatment regimens:Group A( 34 cases) was treated with metformin and DPP-4 inhibitor( Sitagliptin Tablets),group B( 31 cases) was treated with metformin and GLP-1 receptor agonist,group C( 36 cases) was treated with metformin and insulin glargine.Results There was no significant difference in the gender,age,duration of diabetes,BMI,HbA1 Cand FBG among the three groups before treatment( P > 0.05).After treatment,the body weight in group A was significantly higher than those in group B and group C( P < 0.05).After treatment,the levels of bone mineral density( BMD),serum Ca~(2+) concentration,phosphate and alkaline phosphatase in group A were significantly higher than those group B and group C( P < 0.05),but there was no significant difference in the above indexes between group B and group C( P < 0.05).Conclusion DPP-4 inhibitor combined with metformin is effective in the treatment of T2DM,and it has a good improvement effect on the BMD and serum bone metabolism markers.
Objective To investigate the effect of incretin-like hypoglycemic drugs on bone metabolism in patients with type 2 diabetes mellitus( T2DM).Methods The clinical data of 101 patients with T2DM in our hospital were retrospectively analyzed.The patients were divided into 3 groups according to their treatment regimens:Group A( 34 cases) was treated with metformin and DPP-4 inhibitor( Sitagliptin Tablets),group B( 31 cases) was treated with metformin and GLP-1 receptor agonist,group C( 36 cases) was treated with metformin and insulin glargine.Results There was no significant difference in the gender,age,duration of diabetes,BMI,HbA1 Cand FBG among the three groups before treatment( P > 0.05).After treatment,the body weight in group A was significantly higher than those in group B and group C( P < 0.05).After treatment,the levels of bone mineral density( BMD),serum Ca~(2+) concentration,phosphate and alkaline phosphatase in group A were significantly higher than those group B and group C( P < 0.05),but there was no significant difference in the above indexes between group B and group C( P < 0.05).Conclusion DPP-4 inhibitor combined with metformin is effective in the treatment of T2DM,and it has a good improvement effect on the BMD and serum bone metabolism markers.
引文
[1]Xu Y,Wang L,He J,et al.Prevalence and control of diabetes in Chinese adults[J].JAMA,2013,310(9):948-959.
[2]Schwartz AV,Vittinghoff E,Bauer DC,et al.Association of BMD and FRAX score with risk of fracture in older adults with type 2diabetes[J].JAMA,2011,305(21):2184-2192.
[3]Khazai NB,Beck GR Jr,Umpierrez GE.Diabetes and fractures:an overshadowed association[J].Curr Opin Endocrinol Diabetes Obes,2009,16(6):435-445.
[4]蔡倩,刘蕾.新型降糖药物二肽基肽酶-4抑制剂的研究进展[J].中国新药杂志,2014,23(3):302-307.
[5]杨苗苗,李彩娜,白国良,等.长效GLP-1类似物HYHN抗糖尿病药理作用评价[J].中国药理学与毒理学杂志,2016,30(10):1051.
[6]潘盼,赵芳雅,张磊,等.2型糖尿病患者肾功能指标对外周血管病变的评估价值[J].中国糖尿病杂志,2014,6(10):712-716.
[7]Jensen LB,Kollerup G,Quaade F,et al.Bone mineral changes in obese women during a moderate weight loss with and without calcium supplementation[J].J Bone Miner Res,2001,16(1):141-147.
[8]Riedt CS,Cifuentes M,Stahl T,et al.Overweight postmenopausal women lost bone with moderate weight reduction and 1 g/day calcium intake[J].J Bone Miner Res,2005,20(3):455-463.
[9]Ma X,Meng J,Jia M,et al.Exendin-4,a glucagon-like peptide-1 receptor agonist,prevents osteopenia by promoting bone formation and suppressing bone resorption in aged ovariectomized rats[J].J Bone Miner Res,2013,28(7):1641-1652.
[10]Kim JY,Lee SK,Jo KJ,et al.Exendin-4 increases bone mineral density in type 2 diabetic OLETF rats potentially through the down regulation of SOST/sclerostin in osteocytes[J].Life Sci,2013,92(10):533-540.
[11]王婷,董进.胰高血糖素样肽-1类似物对人成骨细胞Wnt信号通路相关基因表达的影响[J].中国骨质疏松杂志,2013,19(6):580-583.
[12]Su B,Sheng H,Zhang M,et al.Risk if bone fractures associated with glucagon-like peptide-1 receptor agonists'treatment:a meta-analysis if randomized control trails[J].Endocrine,2015,48(1):107-115.
[13]Bunck MC,Eliasson B,Corner A,et al.Exenatide treatment did not affect bone mineral density despite body weight reduction in patients with type 2 diabetes[J].Diabetes Obes Metab,2011,13(4):374-377.
[14]Mabilleau G,Mieczkowska A,Chappard D.Use of glucagon-like peptide-1 receptor agonists and bone fractures:a meta-analysis of randomized clinical trials[J].J Diabetes,2014,6(3):260-266.
[15]Glorie L,Behets GJ,Baerts L,et al.DPPⅣinhibitor treatment attenuates bone loss and improve mechanical bone strength in male diabetes rats[J].Am J Physiol Endocrinol Metab,2014,307(5):E447-E455.
[16]Monami M,Dicembrini I,Antenore A,et al.Dipeptidy-1 peptidase-4 inhibitors and bone fractures:a meta-analysis of randomized clinical trials[J].Diabetes Care,2011,34(11):2474-2476.
[2]Schwartz AV,Vittinghoff E,Bauer DC,et al.Association of BMD and FRAX score with risk of fracture in older adults with type 2diabetes[J].JAMA,2011,305(21):2184-2192.
[3]Khazai NB,Beck GR Jr,Umpierrez GE.Diabetes and fractures:an overshadowed association[J].Curr Opin Endocrinol Diabetes Obes,2009,16(6):435-445.
[4]蔡倩,刘蕾.新型降糖药物二肽基肽酶-4抑制剂的研究进展[J].中国新药杂志,2014,23(3):302-307.
[5]杨苗苗,李彩娜,白国良,等.长效GLP-1类似物HYHN抗糖尿病药理作用评价[J].中国药理学与毒理学杂志,2016,30(10):1051.
[6]潘盼,赵芳雅,张磊,等.2型糖尿病患者肾功能指标对外周血管病变的评估价值[J].中国糖尿病杂志,2014,6(10):712-716.
[7]Jensen LB,Kollerup G,Quaade F,et al.Bone mineral changes in obese women during a moderate weight loss with and without calcium supplementation[J].J Bone Miner Res,2001,16(1):141-147.
[8]Riedt CS,Cifuentes M,Stahl T,et al.Overweight postmenopausal women lost bone with moderate weight reduction and 1 g/day calcium intake[J].J Bone Miner Res,2005,20(3):455-463.
[9]Ma X,Meng J,Jia M,et al.Exendin-4,a glucagon-like peptide-1 receptor agonist,prevents osteopenia by promoting bone formation and suppressing bone resorption in aged ovariectomized rats[J].J Bone Miner Res,2013,28(7):1641-1652.
[10]Kim JY,Lee SK,Jo KJ,et al.Exendin-4 increases bone mineral density in type 2 diabetic OLETF rats potentially through the down regulation of SOST/sclerostin in osteocytes[J].Life Sci,2013,92(10):533-540.
[11]王婷,董进.胰高血糖素样肽-1类似物对人成骨细胞Wnt信号通路相关基因表达的影响[J].中国骨质疏松杂志,2013,19(6):580-583.
[12]Su B,Sheng H,Zhang M,et al.Risk if bone fractures associated with glucagon-like peptide-1 receptor agonists'treatment:a meta-analysis if randomized control trails[J].Endocrine,2015,48(1):107-115.
[13]Bunck MC,Eliasson B,Corner A,et al.Exenatide treatment did not affect bone mineral density despite body weight reduction in patients with type 2 diabetes[J].Diabetes Obes Metab,2011,13(4):374-377.
[14]Mabilleau G,Mieczkowska A,Chappard D.Use of glucagon-like peptide-1 receptor agonists and bone fractures:a meta-analysis of randomized clinical trials[J].J Diabetes,2014,6(3):260-266.
[15]Glorie L,Behets GJ,Baerts L,et al.DPPⅣinhibitor treatment attenuates bone loss and improve mechanical bone strength in male diabetes rats[J].Am J Physiol Endocrinol Metab,2014,307(5):E447-E455.
[16]Monami M,Dicembrini I,Antenore A,et al.Dipeptidy-1 peptidase-4 inhibitors and bone fractures:a meta-analysis of randomized clinical trials[J].Diabetes Care,2011,34(11):2474-2476.