高血糖状态对骨形成和骨吸收作用及骨密度的影响

Effects of hyperglycaemia state on bone formation and resorption and bone mass density

目的探讨不同血糖水平对骨形成、骨吸收和骨密度的影响。方法对糖尿病组（DM）148例，葡萄糖耐量低减组（IGT）30例，空腹血糖受损组（IFG）30例，健康对照组（Contr01）50例，分别测定血浆葡萄糖（BG）、糖化血红蛋白（HbA1c）、血清骨钙素（BGP）、尿脱氧吡啶啉（DPD）／肌酐（Cr）、腰椎（L2、L3、L4）和髋部（股骨颈、Ward三角、大转子）骨密度（BMD），并对上述指标进行T检验和方差分析。结果四组间方差分析显示BMD在Ward三角、L4差异有统计学意义（P〈0．05）。血清BGP水平在四组呈递增趋势，尿DPD／Cr水平在四组呈递减趋势，方差分析显示尿DPD／Cr水平差异有显著统计学意义（P〈0．001）。尿DPD／Cr水平随HbA1c水平递增逐渐增高。结论糖尿病的前期阶段（IGT），骨吸收已呈现高于同龄正常人水平，糖尿病患者骨形成低于同龄正常人而骨吸收高于同龄正常人，骨平衡呈现负平衡，骨量逐渐丢失；IGT开始骨密度已较正常人低，良好的血糖控制对减少骨吸收和延缓骨量下降具有保护作用。应在糖调节受损的早期阶段对骨质疏松进行干预治疗。

Objective To investigate an effect of the impaired glucose regulating in different stage and blood glucose level on bone formation and bone resorption and bone mass density. Methods The level of plasma glucose （BG） and HbAlc, serum osteocalcin （BGP）, urine deoxypyridinoline （DPD）in 148 cases with type 2 diabetes （T2DM）, 30 cases with impaired glucose tolerance （IGT） ,30 cases with impaired fasting blood glucose （IFG） were assayed. Bone mass density （BMD） at lumbar vertebrae, hip and forearm were determined by dual energy x-ray absorptiometry（DEXA）. These results were compared with 50 healthy cases （Control）at the same time. Results The analysis of variance in four groups revealed significantly difference on Ward triangle and L4 BMD （ P 〈 0. 05 ）. The level of BGP in serum had a decrement tendency in Control and IFG, IGT and DM groups. DM was significantly lower than Control（P 〈0. 05）. The level of DPD/Cr in urine had an increase tendency in Control and IFG,IGT and DM groups. IGT and DM were significantly higher than Control（ P 〈 0. 05 ,P 〈 0. 001 ）. The analysis of variance in four groups revealed significantly difference on the level of DPD/Cr in urine （P 〈0. 001 ）. BGP was fall-off following the level of HbAlc increase. DPD/Cr was increase gradually following the level of HbAlc inerease. Conclusion Bone resorption in IGT is higher than healthy group and had a negative balance in bone metabolism. BMD is lower than healthy because bone mass loss increase. Bone formation and BMD in diabetes are lower than healthy and bone resorption is higher in diabetes. The level of blood glucose is favourable control to make for decreasing bone resorption and bone mass lossing. The pretreatment for osteoporosis ought to begin on more early stage in impaired glucose regulation.