二甲双胍和阿格列汀对2型糖尿病患者骨代谢、骨密度及血清Apelin-13水平的影响  

Effects of alogliptin and metformin on bone metabolism,bone mineral density,and serum Apelin-13 level in patients with type 2 diabetes mellitus

作　　者：宋彦伟 王君[2] 马朝朋 郭淑芹[2] 王晓妍[2] 尹超[2] 马竞轩 SONG Yan-wei;WANG Jun;MA Zhao-peng;GUO Shu-qin;WANG Xiao-yan;YIN Chao;MA Jing-xuan(Graduate School of Chengde Medical College,Chengde 067000,Hebei,CHINA;Department of Endocrinology,Baoding First Central Hospital,Baoding 071000,Hebei,CHINA)

机构地区：[1]承德医学院研究生学院,河北承德067000 [2]保定市第一中心医院内分泌科,河北保定071000

出　　处：《海南医学》2022年第10期1229-1233,共5页Hainan Medical Journal

基　　金：2019年河北省保定市科学技术研究与发展指导计划(编号:1951ZF051)。

摘　　要：目的探究二甲双胍和阿格列汀对2型糖尿病(T2DM)患者骨代谢、骨密度及血清脂肪细胞因子-13(Apelin-13)水平的影响,为T2DM患者的临床诊疗提供依据。方法选取2019年8月至2020年8月就诊于保定市第一中心医院内分泌科的T2DM患者108例,按照随机数表法分为A组(采用二甲双胍联合阿卡波糖治疗)和B组(采用阿格列汀联合阿卡波糖治疗),每组54例,治疗48周。检测并比较两组患者治疗前及治疗48周后的血糖、骨代谢指标、Apelin-13水平和左侧股骨颈和L_(1~4)的骨密度(BMD)(采用双能X线骨密度仪测定)。结果治疗48周后,两组患者的骨钙素(BGP)、总Ⅰ型胶原氨基端延长肽(TPINP)、Apelin-13水平及股骨颈和L_(1~4)的BMD均较治疗前升高,差异均有统计学意义(P<0.05),其中B组患者的TPINP、Apelin-13、股骨颈和L_(1~4)的BMD水平分别为(48.69±9.00)ng/mL、(2210.53±376.20)pg/mL、(0.893±0.125)g/cm^(2)、(1.042±0.092)g/cm^(2),明显高于A组的(43.52±8.17)ng/mL、(2000.96±338.04)pg/mL、(0.841±0.110)g/cm^(2)、(0.989±0.084)g/cm^(2),差异均有统计学意义(P<0.05),但治疗后A组和B组患者的BGP水平分别为(17.34±4.38)ng/mL、(17.73±4.96)ng/mL,差异无统计学意义(P>0.05);治疗后,两组患者的Ⅰ型胶原羧基末端肽β特殊序列(β-CTX)水平较治疗前下降,差异均有统计学意义(P<0.05),其中B组患者的β-CTX水平为(329.73±96.07)pg/mL,明显低于A组的(366.21±89.28)pg/mL,差异有统计学意义(P<0.05)。结论阿格列汀联合阿卡波糖在改善T2DM患者骨密度及调节骨代谢方面效果更好,并可有效升高Apelin-13水平。Objective To investigate the effect of alogliptin and metformin on bone metabolism index,bone mineral density,and serum adipocytokine Apelin-13 level in patients with type 2 diabetes mellitus(T2DM),so as to provide evidence for clinical diagnosis and treatment of T2DM.Methods A total of 108 patients with T2DM who were admitted to the Department of Endocrinology,Baoding First Central Hospital from August 2019 to August 2020 were randomly divided into group A(treated with metformin combined with acarbose)and group B(treated with alogliptin combined with acarbose),with 54 patients in each group,for 48 weeks.The blood glucose,bone metabolism indexes,Apelin-13 levels,and bone mineral density(BMD)of left femoral neck and lumbar spine _(1~4) were measured and compared between the two groups before and 48 weeks after treatment(measured by dual energy X-ray absorptiometry).Results After 48 weeks of treatment,the levels of osteocalcin(BGP),total type I collagen N-terminal elongation peptide(TPINP),Apelin-13,and BMD of left femoral neck and lumbar spine 1-4 in the two groups were significantly higher than those before treatment(P<0.05),and the levels of TPINP,Apelin-13,and BMD in group B were(48.69±9.00)ng/mL,(2210.53±376.20)pg/mL,(0.895±0.130)g/cm^(2),(1.042±0.092)g/cm^(2),significantly higher than(43.52±8.17)ng/mL,(2000.96±338.04)pg/mL,(0.841±0.110)g/cm^(2),(0.989±0.084)g/cm^(2) in group A(P<0.05);but the BGP levels in group A and B were(17.34±4.38)ng/mL and(17.73±4.96)ng/mL,respectively,and there was no significant difference(P>0.05).After treatment,the levels ofβ-C-terminal cross-linked telpeptide(β-CTX)in the two groups decreased compared with those before treatment(P<0.05),and the level ofβ-CTX in group B was(329.73±96.07)pg/mL,which was significantly lower than(366.21±89.28)pg/mL in group A(P<0.05).Conclusion Alogliptin combined with acarbose has a better effect on improving bone mineral density and regulating bone metabolism in patients with type 2 diabetes mellitus,which can effectively increase Apel

关 键 词：2型糖尿病 阿格列汀 二甲双胍 骨代谢 脂肪细胞因子-13 

分 类 号：R587.1[医药卫生—内分泌]