二甲双胍和西格列汀对绝经后2型糖尿病患者骨代谢的影响  

Effects of metformin and sitagliptin on bone metabolism in postmenopausal patients with type 2 diabetes

作　　者：杨迪[1] 沈洁[2] 李晓林[1] 赵瑜[2] 朱丹杰[1] 邹成[1] 冯法博[1] 

机构地区：[1]浙江省人民医院、杭州医学院附属人民医院骨科,杭州310014 [2]浙江省人民医院、杭州医学院附属人民医院内分泌科,杭州310014

出　　处：《浙江医学》2017年第16期1328-1332,共5页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2014KYA023)

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(Hb A1C)、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、Hb A1C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。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（Hb A1C）, 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 of129 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 Hb A1 Cwere 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 osteoporosis or osteopenia.

关 键 词：骨质疏松 骨转换 糖尿病 二甲双胍 西格列汀 

分 类 号：R587.1[医药卫生—内分泌]