吡格列酮对2型糖尿病患者骨钙素、降钙素和骨密度的影响

Effects of pioglitazone on the serum BGP、CT and bone mineral density in patients with type 2 diabetes mellitus

目的探讨噻唑烷二酮类药物吡格列酮对2型糖尿病(T2DM)患者骨钙素、降钙素和骨密度的影响。方法 89例T2DM患者,随机分为T2DM对照组56例和T2DM实验组33例,在口服降糖药治疗的基础上,实验组加服吡格列酮(30mg/日),疗程3个月;正常对照30例。以双能X线吸收测量法(DXA)测量T2DM实验组、T2DM对照组治疗前后及正常对照组骨密度(BMD),放射免疫分析法(RIA)测定T2DM实验组、T2DM对照组治疗前后及正常对照血清骨钙素(BGP)和降钙素(CT)水平,并进行比较。结果①T2DM组血清BGP和CT水平均低于正常对照组(P<0.01);②T2DM实验组经吡格列酮治疗后BGP和CT水平均降低,与治疗前比较差异有显著性意义(P<0.01);③T2DM组骨密度(BMD)低于正常对照组(P<0.05);④T2DM实验组经吡格列酮治疗后髋部及腰椎BMD均有所下降;⑤BGP与糖尿病患者年龄及空腹血糖负相关,与髋部及腰椎BMD正相关;CT与糖尿病患者年龄负相关。结论吡格列酮可致2型糖尿病患者血清BGP和CT水平明显降低,骨密度下降,其中对女性的影响尤为显著,提示该药可致骨量丢失加速,对骨代谢有不利影响。

Objective To investigate the effects of pioglitazone on the osteocalcin （BGP）, calcitonin （CT） and bone mineral density in patients with type 2 diabetes mellitus. Methods Eighty-nine patients were randomly divided into T2DM control group （56 cases） and T2DM experimental group （33 cases）, with thirty cases as normal control group. On the basement therapy of blood sugar control, the experimental group served plus pioglitazone （30mg/day） for three months. BGP, CT levels and BMD were measured and compared before and after treatment. Results ①BGP and CT levels of T2DM were decreased than that of the normal control group （P 〈0. 01 ） ;②BGP and CT levels of T2DM experimental group after pioglitazone treatment were decreased. There were significant difference between pre-treatment and after treatment （P 〈 0. 01 ） ; ③Hip and lumbar spine BMD of T2DM were decrease than that of the normal control group （P 〈 0. 05）; ④Hip and lumbar spine BMD of T2DM experimental group were decreased after pioglitazone treatment; ⑤Osteocalcin level was positively correlated with age and fasting blood glucose; BGP level was correlated with hip and lumbar spine BMD; CT level was positively correlated with age. Conclusion Pioglitazone can lead to decrease BGP and CT level, decline bone mineral density. This study suggest that pioglitazone has adverse effects on bone metabolism.