利拉鲁肽和甘精胰岛素对男性2型糖尿病患者骨代谢的影响  

Effect of liraglutide and insulin glargine on bone metabolism in male patients with type 2 diabetes

作　　者：杨迪[1] 赵瑜[2] 冯法博[1] 沈洁[2] 朱丹杰[1] 李晓林[1] YANG Di;ZHAO Yu;FENG Fabo;SHEN Jie;ZHU Danjie;LI Xiaolin(Department of Orthopedic Surgery,Zhejiang Provincial People's Hospital(People's Hospital of Hangzhou Medical College),Hangzhou 310014,China)

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》2021年第1期26-32,共7页Zhejiang Medical Journal

基　　金：浙江省医药卫生科研面上项目(2018KY018);浙江省医药卫生科研面上项目(2018KY412)。

摘　　要：目的探讨利拉鲁肽(LIR)和甘精胰岛素(GLA)对男性2型糖尿病(T2DM)患者骨代谢的影响。方法选取2018年1至6月浙江省人民医院收治的单用磺脲类促泌剂(SU)和(或)α-糖苷酶抑制剂(AGI)血糖控制不佳的男性T2DM患者99例,采用随机数字表法分为LIR治疗组[LIR联合SU和(或)AGI,LIR组]、GLA治疗组[GLA联合SU和(或)AGI,GLA组]与口服降糖药物治疗组[SU和(或)AGI,OAD组],随访48周,治疗前、治疗24周及48周分别测定患者一般生化指标:FPG、餐后2 h血糖(2h-PBG)、糖化血红蛋白(HbA1C)、BMI、TG、LDL-C;骨转换指标:骨钙素(OC)、Ⅰ型前胶原氨基端原肽(P1NP)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、25-羟维生素D3(25-OH-D3),治疗前、治疗48周采用双能X线骨密度仪测定所有患者股骨颈、髋关节、腰椎(L1~L4)骨密度(BMD),对比治疗前后一般生化指标、骨转换指标、BMD及不良反应发生情况。结果99例中有90例患者完成48周随访,各组均为30例。3组患者治疗24、48周FPG、2h-PBG、HbA1C、TG均较治疗前显著下降(均P<0.01)。3组患者治疗24周2h-PBG、HbA1C、BMI、LDL-C比较差异均有统计学意义(均P<0.05),而FPG、TG比较差异均无统计学意义(均P>0.05)。3组患者治疗48周2h-PBG、BMI、LDL-C比较差异均有统计学意义(均P<0.05),而FPG、HbA1C、TG比较差异均无统计学意义(均P>0.05)。LIR组治疗48周后LDL-C与治疗24周比较差异有统计学意义(P<0.05)。治疗24及48周LIR组BMI、2h-PBG、LDL-C均低于GLA组及OAD组(均P<0.05)。3组患者治疗前、治疗24周OC、P1NP、β-CTX、25-OH-D3比较差异均无统计学意义(均P>0.05)。3组患者治疗48周OC、25-OH-D3比较差异均有统计学意义(均P<0.05)。LIR组治疗48周OC较治疗前升高(P<0.01),治疗24、48周25-OH-D3均较治疗前升高(均P<0.05);治疗48周OAD组OC较治疗前下降(P<0.01)。与治疗24周比较,LIR组治疗48周25-OH-D3明显升高(P<0.05)。治疗48周,与GLA组、OAD组相比,LIR组OC、25-OH-D3均Objective To investigate the effects of Liraglutide(LIR)and Insulin glargine(GLA)on bone metabolism in male patients with type 2 diabetes(T2DM).Methods Ninety nine male T2DM patients with poor glycemic control by sulfonylurea secretagogues(SU)and/orα-glycosidase inhibitors(AGI)in our hospital fromJanuary to June 2018 were enrolled.Patients were randomly divided into 3 groups with 33 cases in each group:patients in the LIR group were treated with Liraglutide with SU and/or AGI;patients in the GLA group were treated with insulin glargine with SU and/or AGI,and patients in the oral antidiabetic drugs(OAD)group were treated with SU and/or AGI alone.Fasting plasma glucose(FPG),2h-postprandial plasma glucose(2h-PBG),glycosylated hemoglobin(HbA1C),body Mass Index(BMI),low-density lipoprotein cholesterol(LDL-C),triglyceride(TC),osteocalcin(OC),Procollagen I N-Terminal Propeptide(P1NP),β-C-terminal cross-linked telopeptide(β-CTX),and 25-OH-D3 were measured and compared among the three groups before treatment,24 and 48 weeks after treatment.Bone mineral density(BMD)of the femoral neck,hip,and lumbar were measured by dual-energy X-ray absorptiometry at baseline and the end of the study.Results Ninety of 99 patients completed the 48-week intervention with 30 patients per group.The level of FPG,2h-PBG,HbA1C,and TG were significantly decreasing at 24 and 48 weeks in three groups compared to baseline values(all P<0.01).There were statistically significant differences in 2h-PBG,HbA1C,BMI,and LDL-C between the three groups of patients treated for 24 weeks(all P<0.05),but there were no statistically significant diference in FPG and TG(all P>0.05).There were statistically significant differences in 2h-PBG,BMI,and LDL-C between the three groups of patients treated for 48 weeks(all P<0.05),but there were no statistically significant diference in FPG,HbA1C,and TG(all P>0.05).There was a statistically significant differences in LDL-C after 24 and 48 weeks of treatment in the LIR group(P<0.05).The BMI,2h-PBG,and LDL-C levels in the L

关 键 词：糖尿病 利拉鲁肽 甘精胰岛素 骨密度 骨转化 

分 类 号：R587.1[医药卫生—内分泌]