二甲双胍联合雷尼酸锶治疗糖尿病性骨质疏松的临床研究
|
摘要
目的观察二甲双胍联合雷尼酸锶治疗糖尿病性骨质疏松(DOP)的临床疗效。方法将120例DOP患者随机分为2组,每组60例。对照组行二甲双胍治疗,研究组在对照组治疗的基础上加服雷尼酸锶治疗,2组均治疗6个月。观察并记录2组患者治疗前后骨密度及骨代谢指标血钙、血磷、骨钙素(BGP)、抗酒石酸酸性磷酸酶-5b(TRACP-5b)、骨源性碱性磷酸酶(BAP)、及疼痛评分的变化情况。结果研究组临床总有效率为85.00%,对照组为70.00%,研究组临床疗效更佳(P<0.05)。治疗后对2组股骨颈、股骨粗隆及ward’s三角区处的骨密度进行检测显示,均较本组治疗前明显增加(P<0.05),且研究组显著高于对照组(P<0.05)。治疗后检测显示,研究组骨代谢相关的血钙、BAP及TRACP-5b水平均较本组治疗前降低(P<0.05),BGP升高(P<0.05),且BGP、BAP及TRACP-5b水平较对照组治疗后差异有统计学意义(P<0.05);对照组治疗后血钙、血磷较本组治疗前无明显变化(P<0.05),BGP、BAP及TRACP-5b较本组治疗前变化差异有统计学意义(P<0.05)。治疗后2组疼痛评分均较本组治疗前下降(P<0.05),且研究组评分低于对照组(P<0.05)。结论二甲双胍联合雷尼酸锶治疗DOP临床疗效确切。
Objective To observe the clinical efficacy of metformin combined with strontium ranelate in treatment of diabetic osteoporosis(DOP).Methods One hundred and twenty patients with DOP were randomly divided into control group(n=60) and research group(n=60).The patients in control group were treated by metformin, however,the patients in research group,on the basis of control group,were treated by strontium ranelate,with a treatment course of 6 months for both groups.The changes of bone mineral density,bone metabolism indexes,serum calcium,serum phosphorus,osteocalcin(BGP),tartrate-resistant acid phosphatase-5 b(TRACP-5 b),bone-derived alkaline phosphatase(BAP),and the changes in pain scores before and after treatment were observed and compared between the two groups.Results The total effective rate was in research group was 85.00%,which was superior to that(70.00%) in control group(P<0.05). After treatment,the bone mineral density at the femoral neck,femoral tuberosity,and ward'd triangles in both groups was significantly higher than that before treatment(P<0.05),which in research group was significantly higher than that in control group(P<0.05).After treatment,the levels of serum calcium, BAP and TRACP-5 b in research group were significantly lower than those before treatment(P<0.05),however,the BGP levels were significantly increased(P<0.05),moreover,there were significant differences in the levels of BGP,BAP,and TRACP-5 b between the two groups(P<0.05).In addition there were no significant differences in the levels of serum calcium and serum phosphorus in control group before and after treatment(P>0.05), however, there were significant differences in the levels of BGP,BAP,and TRACP-5 b in control group before and after treatment(P<0.05).Besides,the pain scores after treatment in both groups were significantly decreased,as compared with those before treatment(P<0.05),moreover,which in research group were significantly lower than those in control group(P<0.05). Conclusion The metformin combined with strontium ranelate has definite therapeutic effects on DOP.
Objective To observe the clinical efficacy of metformin combined with strontium ranelate in treatment of diabetic osteoporosis(DOP).Methods One hundred and twenty patients with DOP were randomly divided into control group(n=60) and research group(n=60).The patients in control group were treated by metformin, however,the patients in research group,on the basis of control group,were treated by strontium ranelate,with a treatment course of 6 months for both groups.The changes of bone mineral density,bone metabolism indexes,serum calcium,serum phosphorus,osteocalcin(BGP),tartrate-resistant acid phosphatase-5 b(TRACP-5 b),bone-derived alkaline phosphatase(BAP),and the changes in pain scores before and after treatment were observed and compared between the two groups.Results The total effective rate was in research group was 85.00%,which was superior to that(70.00%) in control group(P<0.05). After treatment,the bone mineral density at the femoral neck,femoral tuberosity,and ward'd triangles in both groups was significantly higher than that before treatment(P<0.05),which in research group was significantly higher than that in control group(P<0.05).After treatment,the levels of serum calcium, BAP and TRACP-5 b in research group were significantly lower than those before treatment(P<0.05),however,the BGP levels were significantly increased(P<0.05),moreover,there were significant differences in the levels of BGP,BAP,and TRACP-5 b between the two groups(P<0.05).In addition there were no significant differences in the levels of serum calcium and serum phosphorus in control group before and after treatment(P>0.05), however, there were significant differences in the levels of BGP,BAP,and TRACP-5 b in control group before and after treatment(P<0.05).Besides,the pain scores after treatment in both groups were significantly decreased,as compared with those before treatment(P<0.05),moreover,which in research group were significantly lower than those in control group(P<0.05). Conclusion The metformin combined with strontium ranelate has definite therapeutic effects on DOP.
引文
1 Schwartz AV.Efficacy of osteoporosis therapies in diabetic patients.Calcif Tissue Int,2017,100:165-173.
2 Reginster JY,Deroisy R,Dougados M,et al.Prevention of early postmenopausal bone loss by strontium ranelate:the randomized,two-year,double-masked,dose-ranging,placebo-controlled PREVOS trial.Osteoporos Int,2002,13:925-931.
3 Meunier PJ,Slosman DO,Delmas PD,et al.Strontium ranelate:dose-dependent effects in established postmenopausal vertebral osteoporosis--a 2-year randomized placebo controlled trial.Journal of Clinical Endocrinology & Metabolism,2002,87:2060-2066.
4 Vestergaard P,Rejnmark L,Mosekilde L.Relative fracture risk in patients with diabetes mellitus,and the impact of insulin and oral antidiabetic medication on relative fracture risk.Diabetologia,2005,48:1292-1299.
5 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版).中华内分泌代谢杂志,2014,30:893-942.
6 中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊治指南(2011年).中华骨质疏松和骨矿盐疾病杂志,2011,4:2-17.
7 李晓宇,冯正平.糖尿病性骨质疏松发病机制的研究进展.中国骨质疏松杂志,2014,18:580-583.
8 粟麟,陈文辉,李双蕾,等.2型糖尿病性骨质疏松发病机制研究进展.实用中医药杂志,2013,29:499-501.
9 张在慧.糖尿病骨质疏松发病机制的研究进展.医学综述,2012,18:3644-3646.
10 Kanazawa I,Yamaguchi T,Yano S,et al.Metformin enhances the differentiation and mineralization of osteoblastic MC3T3-E1 cells via AMP kinase activation as well as eNOS and BMP-2 expression.Biochem Biophys Res Commun,2008,375:414-419.
11 Molinuevo MS,Schurman L,Mccarthy AD,et al.Effect of metformin on bone marrow progenitor cell differentiation:in vivo and in vitro studies.Journal of Bone & Mineral Research,2010,25:211-221.
12 薛云,胡继红,成金罗,等.不同治疗方法对2型糖尿病患者骨密度的影响.南京医科大学学报(自然科学版),2013:1594-1596.
13 王密.二甲双胍骨保护效应中晚期糖基化终产物的作用机制.山西医科大学,2017.
14 甄东户,汤旭磊,成建国,等.二甲双胍减轻糖基化终末产物对成骨细胞功能损害的观察.中国糖尿病杂志,2012,20:549-552.
15 甄东户,刘丽娟,成建国,等.二甲双胍对糖基化终末产物诱导的成骨细胞氧化应激和凋亡的影响.中国临床药理学与治疗学,2013,18:743-0.
16 吕娇,刘洪臣,王东胜,等.二甲双胍对成骨细胞葡萄糖摄取及葡萄糖转运蛋白-1表达的影响.口腔颌面修复学杂志,2008,9:121-123.
17 Zhen D,Chen Y,Tang X.Metformin reverses the deleterious effects of high glucose on osteoblast function.J Diabetes Complications,2010,24:334-344.
18 魏开惠,王振华.二甲双胍对2型糖尿病患者骨代谢的影响.实用临床医药杂志,2015,19:117-118.
19 王运林,罗卓章.二甲双胍和吡格列酮对男性2型糖尿病患者骨代谢指标的影响.临床内科杂志,2011,28:524-526.
20 张丽丽,闫宇梅.不同降糖药物对绝经后2型糖尿病患者骨密度及相关指标的影响.中国临床实用医学,2016,7:10-13.
21 Canalis E,Hott M,Deloffre P,et al.The divalent strontium salt S12911 enhances bone cell replication and bone formation in vitro.Bone,1996,18:517-523.
22 彭亦良,吴雪辉,张彦,等.雷奈酸锶治疗原发性骨质疏松症慢性腰背痛的前瞻性随机双盲对照研究.中国骨质疏松杂志,2013:1269-1272.
23 聂玮,李晓林,蒋梁华,等.雷奈酸锶对骨质疏松性骨痛及骨密度疗效评价.中国骨质疏松杂志,2011,17:419-423.
24 蔡绍东,廖利江,陈秀芳.雷奈酸锶对糖皮质激素骨质疏松模型大鼠的的影响.临床和实验医学杂志,2012,11:1687-1688.
25 石勇,宋玮.雷奈酸锶对糖尿病大鼠种植体骨结合的影响.临床口腔医学杂志,2015,31:579-581.
26 高慧祯,张会娟,任欣会.血清骨钙素与2型糖尿病胰岛素抵抗和胰岛功能的相关性研究.实用医学杂志,2013,29:754-756.
27 Halleen JM,Ylipahkala H,Alatalo SL,et al.Serum Tartrate-Resistant Acid Phosphatase 5b,but not 5a,Correlates with Other Markers of Bone Turnover and Bone Mineral Density.Calcified Tissue International,2002,71:20-25.
2 Reginster JY,Deroisy R,Dougados M,et al.Prevention of early postmenopausal bone loss by strontium ranelate:the randomized,two-year,double-masked,dose-ranging,placebo-controlled PREVOS trial.Osteoporos Int,2002,13:925-931.
3 Meunier PJ,Slosman DO,Delmas PD,et al.Strontium ranelate:dose-dependent effects in established postmenopausal vertebral osteoporosis--a 2-year randomized placebo controlled trial.Journal of Clinical Endocrinology & Metabolism,2002,87:2060-2066.
4 Vestergaard P,Rejnmark L,Mosekilde L.Relative fracture risk in patients with diabetes mellitus,and the impact of insulin and oral antidiabetic medication on relative fracture risk.Diabetologia,2005,48:1292-1299.
5 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版).中华内分泌代谢杂志,2014,30:893-942.
6 中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊治指南(2011年).中华骨质疏松和骨矿盐疾病杂志,2011,4:2-17.
7 李晓宇,冯正平.糖尿病性骨质疏松发病机制的研究进展.中国骨质疏松杂志,2014,18:580-583.
8 粟麟,陈文辉,李双蕾,等.2型糖尿病性骨质疏松发病机制研究进展.实用中医药杂志,2013,29:499-501.
9 张在慧.糖尿病骨质疏松发病机制的研究进展.医学综述,2012,18:3644-3646.
10 Kanazawa I,Yamaguchi T,Yano S,et al.Metformin enhances the differentiation and mineralization of osteoblastic MC3T3-E1 cells via AMP kinase activation as well as eNOS and BMP-2 expression.Biochem Biophys Res Commun,2008,375:414-419.
11 Molinuevo MS,Schurman L,Mccarthy AD,et al.Effect of metformin on bone marrow progenitor cell differentiation:in vivo and in vitro studies.Journal of Bone & Mineral Research,2010,25:211-221.
12 薛云,胡继红,成金罗,等.不同治疗方法对2型糖尿病患者骨密度的影响.南京医科大学学报(自然科学版),2013:1594-1596.
13 王密.二甲双胍骨保护效应中晚期糖基化终产物的作用机制.山西医科大学,2017.
14 甄东户,汤旭磊,成建国,等.二甲双胍减轻糖基化终末产物对成骨细胞功能损害的观察.中国糖尿病杂志,2012,20:549-552.
15 甄东户,刘丽娟,成建国,等.二甲双胍对糖基化终末产物诱导的成骨细胞氧化应激和凋亡的影响.中国临床药理学与治疗学,2013,18:743-0.
16 吕娇,刘洪臣,王东胜,等.二甲双胍对成骨细胞葡萄糖摄取及葡萄糖转运蛋白-1表达的影响.口腔颌面修复学杂志,2008,9:121-123.
17 Zhen D,Chen Y,Tang X.Metformin reverses the deleterious effects of high glucose on osteoblast function.J Diabetes Complications,2010,24:334-344.
18 魏开惠,王振华.二甲双胍对2型糖尿病患者骨代谢的影响.实用临床医药杂志,2015,19:117-118.
19 王运林,罗卓章.二甲双胍和吡格列酮对男性2型糖尿病患者骨代谢指标的影响.临床内科杂志,2011,28:524-526.
20 张丽丽,闫宇梅.不同降糖药物对绝经后2型糖尿病患者骨密度及相关指标的影响.中国临床实用医学,2016,7:10-13.
21 Canalis E,Hott M,Deloffre P,et al.The divalent strontium salt S12911 enhances bone cell replication and bone formation in vitro.Bone,1996,18:517-523.
22 彭亦良,吴雪辉,张彦,等.雷奈酸锶治疗原发性骨质疏松症慢性腰背痛的前瞻性随机双盲对照研究.中国骨质疏松杂志,2013:1269-1272.
23 聂玮,李晓林,蒋梁华,等.雷奈酸锶对骨质疏松性骨痛及骨密度疗效评价.中国骨质疏松杂志,2011,17:419-423.
24 蔡绍东,廖利江,陈秀芳.雷奈酸锶对糖皮质激素骨质疏松模型大鼠的的影响.临床和实验医学杂志,2012,11:1687-1688.
25 石勇,宋玮.雷奈酸锶对糖尿病大鼠种植体骨结合的影响.临床口腔医学杂志,2015,31:579-581.
26 高慧祯,张会娟,任欣会.血清骨钙素与2型糖尿病胰岛素抵抗和胰岛功能的相关性研究.实用医学杂志,2013,29:754-756.
27 Halleen JM,Ylipahkala H,Alatalo SL,et al.Serum Tartrate-Resistant Acid Phosphatase 5b,but not 5a,Correlates with Other Markers of Bone Turnover and Bone Mineral Density.Calcified Tissue International,2002,71:20-25.