达格列净与阿卡波糖对2型糖尿病伴骨量减少患者骨代谢和骨密度的影响比较  

Comparison of influence of dapagliflozin and acarbose on bone metabolism and bone mineral density in type 2 diabetes mellitus patients complicated with osteopenia

作　　者：方靖雯 张雅萍[1] 牟伦盼[1] 黄晓燕 苏劲波[1] 康伦雅 林振忠[2] 蒋建家[1] FANG Jingwen;ZHANG Yaping;MOU Lunpan;HUANG Xiaoyan;SU Jinbo;KANG Lunya;LIN Zhenzhong;JIANG Jianjia(Department of Endocrinology,Quanzhou First Hospital Affiliated to Fujian Medical University,Fujian Province,Quanzhou 360200,China)

机构地区：[1]福建医科大学附属泉州第一医院内分泌科,福建省泉州市360200 [2]福建医科大学附属泉州第一医院检验科,福建省泉州市360200

出　　处：《临床合理用药杂志》2024年第9期28-31,36,共5页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的比较达格列净与阿卡波糖对2型糖尿病伴骨量减少患者骨代谢和骨密度的影响。方法选取2017年2月—2021年6月就诊于福建医科大学附属泉州第一医院内分泌科的2型糖尿病伴骨量减少患者150例,根据随机数字表法分为阿卡波糖组和达格列净组,各75例。其中阿卡波糖组脱落或失访7例,达格列净组9例,最终阿卡波糖组纳入68例,达格列净组纳入66例。阿卡波糖组给予阿卡波糖片,达格列净组给予达格列净片,2组均治疗并随访1年。比较2组治疗前及治疗1年后体质量、BMI、腰围、臀围、收缩压、舒张压、血糖、血钙、血磷、估算肾小球滤过率(eGFR)、骨代谢指标、骨密度、不良反应。结果治疗1年后,达格列净组腰围低于治疗前,且达格列净组腰围、舒张压低于阿卡波糖组(P<0.05或P<0.01);2组空腹血糖、餐后2 h血糖、糖化血红蛋白低于治疗前(P<0.01);达格列净组eGFR、血清骨碱性磷酸酶水平高于治疗前及阿卡波糖组(P<0.05或P<0.01);2组腰椎、股骨颈、髋关节骨密度比较,差异无统计学意义(P>0.05)。达格列净组不良反应总发生率高于阿卡波糖组(12.12%vs.1.47%,χ^(2)=4.483,P=0.034)。结论达格列净与阿卡波糖治疗2型糖尿病伴骨量减少均可有效降低血糖,但达格列净可改善患者骨代谢,对骨密度的影响较小,但不良反应较多。Objective To compare the impact of dapagliflozin and acarbose on bone metabolism and bone mineral density of type 2 diabetic patients complicated with osteopenia.Methods A total of 150 type 2 diabetes mellitus patients complicated with osteopenia admitted the Department of Endocrinology,Quanzhou First Hospital Affiliated to Fujian Medical University from February 2017 to June 2021 were selected,and they were divided into the acarbose group and the dapagliflozin group by random number table method,75 cases in each group.Seven cases were dislodged or lost of the acarbose group,and 9 cases were dislodged or lost of the dapagliflozin group.Finally,68 cases were included in the acarbose group and 66 cases in the dapagliflozin group.Patients in the acarbose group were given acarbose tablets,and patients in the dapagliflozin group were given dapagliflozin tablets,both groups were treated and followed-up for 1 year.The weight,BMI,waist circumference,hip circumference,systolic blood pressure,diastolic blood pressure,blood glucose,blood calcium,blood phosphorus,eGFR,bone metabolism indexes,bone mineral density and incidence of adverse reactions were compared between the two groups.Results After 1 year of treatment,waist circumference of the dapagliflozin group was lower than that before treatment,and the waist circumference and diastolic blood pressure of the dapagliflozin group were lower than those of the acarbose group(P<0.05 or P<0.01);FBG,2 hPG and HbA 1c of the two groups were lower than those before treatment(P<0.01);eGFR and serum BALP level of the dapagliflozin group were higher than those before treatment and the acarbose group(P<0.05 or P<0.01).There was no significant difference of bone mineral density of lumbar spine,femoral neck or hip joint between the two groups(P>0.05).The total incidence of adverse reactions in the dapagliflozin group was higher than that in the acarbose group(12.12%vs.1.47%,χ2=4.483,P=0.034).Conclusion Dapagliflozin and acarbose all can effectively reduce blood glucose levels of type 2

关 键 词：2型糖尿病 骨量减少 达格列净 阿卡波糖 骨密度 骨代谢 

分 类 号：R587.1[医药卫生—内分泌]