绝经后T2DM合并OP患者饮食及运动管理与糖、骨代谢及骨密度相关性的临床研究  

The association among the management of diet and sport,glucose metabolism,bone metabolism,and bone mineral density in postmenopausal women with type II diabetes and osteoporosis: a clinical study

作　　者：宋立源[1] 轩应利[1] 杨军[1] 宣淼[1] 王永兰[1] 宋利格[1] 王文杏 张秀珍[1] 

机构地区：[1]上海市同济医院内分泌科,上海200065

出　　处：《中国骨质疏松杂志》2014年第2期156-160,共5页Chinese Journal of Osteoporosis

摘　　要：目的探讨绝经后2型糖尿病(type 2 diabetes mellitus,T2DM)合并骨质疏松(osteoporosis,OP)患者的糖代谢、骨代谢、骨密度(bone mineral density,BMD)与饮食及运动管理的相关性。方法选择562例绝经后妇女T2DM合并OP患者,分为严格管理组(管理组)278例;一般指导组(对照组)284例。分别给予严格管理和一般管理,所有患者均为口服降糖药物,同时每天口服钙尔奇D600mg和骨化三醇0.25μg,在0、24、48 w测定糖代谢指标HbA1C、FPG,和骨代谢指标血清25羟基维生素D3(VitD3)、骨碱性磷酸酶(bone alkaline phosphate,BALP)、抗酒石酸酸性磷酸酶(tartrate-resistant acid phosphatase,TrAP-5b)、血清骨钙素(osteocalcin,OT),用双能X线仪测定不同部位BMD等指标,探讨经过严格管理后各指标的变化情况。结果在24w时,管理组与基线、对照组相比血糖均明显下降,48 w时更加显著,血清HbA1C管理组的不同时间分别为:8.16±1.50%、7.10±1.60%、6.01±1.59%,对照组分别为:8.46±1.65%、8.16±1.03%、8.21±1.02%,观察到无论是管理组还是对照组,糖化血红蛋白都有所下降,但管理组更加明显,组间相比差异均显著(P<0.01)。同时TrAP-5b均较对照组明显下降(P<0.01),VitD3、BALP、OT升高显著(P<0.01),管理组腰椎、股骨颈BMD自24 w始,逐渐上升,对照组呈下降状态,48 w时,两组BMD差异显著(P值均<0.01)。结论根据T2DM合并OP患者的具体情况,进行严格的饮食控制、适当的运动等个体化管理后,在原药物治疗的基础上,不但可以有效地控制血糖,同时具有减少骨量丢失,增加骨密度的作用。Objective To explore the association among the management of diet and sport, glucose metabolism, bone metabolism, and bone mineral density （BMD） in postmenopausal women with type 2 diabetes mellitus （T2DM） and osteoporosis （OP）. Methods A total of 562 postmenopausal women with T2DM and OP were selected and divided into two groups： the manage group （ n = 278）, and the control group （ n = 284）. Subjects in the 2 groups were given strict management and general management, respectively. All the patients took oral medication of glucose-lowering drugs with 600mg/d Caltrate D and 0, 25 ug/d calcitriol, simultaneously. At the beginning, the 24^th week, and the 48^th week of the treatment, the glucose metabolism indexes such as glycosylated hemoglobin Alc（HbAlc） and fasting plasma glucose （FPG）, and the bone metabolism indexes such as vitamin D3 （VitD3）, bone alkaline phosphatase （BALP） , tartrate-resistant acid phosphatase-5b （TRAP-Sb）, and serum osteocalcin （OC） were detected. BMD of different parts were measured using dual-energy X-ray absorptiometry, in order to explore the changes of each index after strict management. Results At the 24^th week, HbA1C in the manage group decreased significantly compared to that in the control group, while at the 48^th week, the result was even more significant. HbA1C in the manage group was 8. 16 ± 1.50% , 7. 10 ±1.60% , and 6.01 ± 1.59% at the 0, the 24th, and the 48th week, respectively; and HbA1C in the control group was 8.46 ± 1.65%, 8. 16 ± 1.03% , and 8, 21 ± 1, 02% , respectively. The decrease of HbA1C was observed in both manage groupand control group, and was much more obvious in the manage group, and the difference between groups was significant （P 〈 0. 01 ）. Meanwhile TRAP-5b in the manage group decreased obviously compared to that in the control group, while BALP, VitD3, and OC increased significantly （P 〈0.01 ）. After 24th week treatment, BMD of the lumbar vertebrae and the femoral neck in the manage group i

关 键 词：2型糖尿病 骨质疏松症 糖代谢 骨密度 饮食与运动 

分 类 号：R589[医药卫生—内分泌]