| 摘要: |
| 目的探讨二甲双胍和西格列汀对绝经后2型糖尿病合并骨量减少或骨质疏松患者骨代谢及骨密度的影响。方法选择接受治疗的绝经后2型糖尿病合并骨量减少或骨质疏松患者129例，采用随机数字表法分为磺脲类促泌剂治疗组（格列吡嗪组，G组）、二肽基肽酶-4抑制剂联合磺脲类促泌剂治疗组（西格列汀+格列吡嗪组，S+G组）、双胍类联合磺脲类促泌剂治疗组（二甲双胍+格列吡嗪组，M+G组）3组，随访48周，治疗前后测定患者空腹血糖（FBG）、糖化血红蛋白（HbA1C）、LDL-C、碱性磷酸酶（ALP）、骨钙素（OC）、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)，采用双能X线骨密度仪测定所有患者股骨颈和髋关节骨密度，对比治疗前后一般生化指标、骨转换指标及骨密度变化。结果129例中有122例完成48周随访，其中G组40例，S+G组41例，M+G组41例。3组患者治疗后BMI、OC、β-CTX、股骨颈和髋关节骨密度比较差异均有统计学意义（均P＜0.05）。3组患者治疗后FBG、HbA1C均较治疗前显著下降（均P＜0.01）。M+G组治疗后BMI较治疗前显著下降（P＜0.01），G组和S+G组治疗后OC均较治疗前显著下降（均P＜0.01），S+G组治疗后β-CTX较治疗前显著下降（P＜0.01），G组治疗后股骨颈和髋关节骨密度均较治疗前显著下降（均P＜0.01）。结论西格列汀主要通过抑制骨吸收，并可能有部分促进成骨发挥其减少骨丢失的作用，二甲双胍可能通过促进成骨发挥其减少骨丢失的作用，两者均可作为绝经后女性2型糖尿病合并骨量减少或骨质疏松患者降糖的一线用药选择。 |
| 关键词: 骨质疏松 骨转换 糖尿病 二甲双胍 西格列汀 |
| DOI：10.12056/j.issn.1006-2785.2017.39.16.2017-323 |
| 分类号: |
| 基金项目:浙江省医药卫生科技计划项目（2014KYA023） |
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| Effects of metformin and sitagliptin on bone metabolism in postmenopausal patients with type 2 diabetes |
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YANG Di, SHEN Jie, LI Xiaolin, ZHAO YU, ZHU Danjie, ZOU Cheng, FENG Fafu
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Zhejiang provincial People's Hospital
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| Abstract: |
| Objective To evaluate the effect of metformin and sitagliptin on bone mineral density (BMD) and bone turnover biomarkers in type 2 diabetic postmenopausal patients with osteoporosis or osteopenia. Methods One hundred and twenty nine type 2 diabetic postmenopausal patients with osteoporosis or osteopenia were randomly assigned to three groups: treated with glipizide (G group, n=43), sitagliptin+glipizide (S+G group, n=43) or metformin+glipizide (M+G group, n=43) for 48 weeks, respectively. Fasting blood samples were collected for measurement of fasting blood glucose (FBG), glycosylated hemoglobin (HbA1C), low-density lipoprotein cholesterol (LDL-C), serum phosphatase (ALP), osteocalcin (OC), and β-C-terminal cross-linked telpeptide (β-CTX) which were measured at baseline and at the end of the study. BMD of femoral neck and hip were measured by dual energy X-ray absorptiometry at baseline and the end of study. Results One hundred and twenty two of 129 patients completed the 48-week intervention, including 40 in G group, 41 in S+G group and 41 in M+G group, respectively. The mean values of three groups at the end of the study for BMI, OC, β-CTX,BMD of femoral neck and hip were sighificantly different (all P＜0.05). The mean values of FBG and HbA1C were significantly decreased at the end of study in three groups compared to baseline values (both P＜0.01). The mean BMI after treatment was significantly decreased in M+G group compared
to baseline (P＜0.01). The mean serum OC was significantly decreased in G and S+G groups after treatment(both P＜0.01). The mean serum β-CTX was significantly decreased in S+G group (P ＜0.01). The mean BMD of femoral neck and hip were significantly decreased in G group (both P＜0.01). Conclusion Sitagliptin has anti-osteoporotic and partially osteogenic effect, while metformin has osteogenic effect, and both can be used as the first line drugs for diabetic postmenopausal women with os- teoporosis or osteopenia. |
| Key words: Osteoporosis Bone turnover Diabetes Metformin Sitagliptin |
