噻唑烷二酮类对2型糖尿病患者骨密度的影响

Effect of Thiazolidinediones on bone mineral density in patients with type 2 diabetes

目的观察噻唑烷二酮药物(Thiazolidinediones,TZDs)对T2DM患者骨密度及骨代谢指标的影响。方法回顾我科2006至2008年,50～80岁T2DM住院患者1 807例,筛选入组186例,根据服用TZDs与否分为4组:女性服用TZDs组(fTZD组,68例)、男性服用TZDs组(mTZD组,31例)、女性未服TZDs组(f组,54例)、男性未服TZDs组(m组,33例),分析间隔20～26个月骨密度及骨代谢指标变化。结果 fTZD组较f组骨密度明显减低:L_(1-4)(0.120±0.143 vs 0.056±0.102)、右髋(0.089±0.159 vs 0.036±0.111)、大粗隆(0.102±0.149 vs0.055±0.111 g/cm^3),P<0.05。男性患者骨密度未见显著差异;各组骨代谢指标均未见显著差异。结论连续服用TZDs20月以上可能对女性T2DM患者的腰椎、髋部及大粗隆有加速骨质疏松作用,对临床药物选择具有一定警示意义。

Objective To study the effect of Thiazolidinediones（TZDs） on bone mineral density （BMD） and bone metabolism in patients with type 2 diabetes.Methods Retrospective study was performed and 168 patients were enrolled in 1 807 hospitalized type 2 diabetes patients.All participants were divided into four groups according to Thiazolidinediones administration or not：female with Thiazolidinediones group（fTZD,68 cases）,male with Thiazolidinediones group（mTZD,31 cases）, female without Thiazolidinediones group（f,54 cases）and male without Thiazolidinediones group（m, 33 cases）.Changes of their BMD and bone metabolism were assayed and analized after 20～26 months.Results Compared with group f,BMD loss of patients in fTZD group was more significant： L_（1-4）（0.120±0.143 vs 0.056±0.102）,right hip（0.089±0.159 vs 0.036±0.111） and trochanter （0.102±0.149 vs 0.055±0.111 g/cm^3）（P0.05）.While no obvious differences of bone metabolism and BMD in male patients were found.Conclusion TZDs administration over 20 months may facilitate BMD loss in female patients with type 2 diabetetes,which provides a possible attention to drug treatment in clinical practice.