胰岛素治疗对2型糖尿病患者骨代谢的影响

Effects of insulin therapy on the bone metabolism in patients with type 2 diabetes mellitus

目的探讨胰岛素治疗对2型糖尿病患者骨代谢的影响及可能机制。方法收集547例2型糖尿病患者(口服降糖药188例:B组,应用胰岛素349例:C组)临床资料,测定骨密度(BMD)、空腹血糖、糖化血红蛋白、血钙、血磷、碱性磷酸酶,并对两组患者上述指标进行比较;另设健康对照组(A组)282例,与2型糖尿病患者骨密度进行比较。结果 (1)与健康对照组相比,2型糖尿病患者骨密度降低(P<0.05);(2)C组与B组相比,两组间骨密度无统计学差异,C组男女间比较,男性骨密度高于女性(P<0.05);(3)B组和C组血钙、血磷、血碱性磷酸酶无统计学差异,C组HbA1c明显低于B组(P<0.05);(4)2型糖尿病患者的骨密度与病程、年龄负相关,与体重正相关。结论女性、高龄、病程长、低体重是糖尿病合并骨质疏松的危险因素,胰岛素治疗对2型糖尿病患者骨代谢无明显影响。

Objective To explore the effect of insulin on the bone metabolism in type 2 diabetic patients and the relative risk factors.Methods 547 type 2 diabetic patients including 188 patients who treated with oral hypoglycemic agents（Group B）and 349 patients with insulin（Group C）were recruited in the study.Another 282 healthy individuals were chosen as normal controls（Group A）.BMD levels,HbA1c,FBG,Ca,P and ALP were measured in all groups and body mass index（BMI）were recorded in all the participators.Results ① The level of the bone density in diabetic patients was lower than that in Group A（P0.05）,however,no significant difference was found between Group B and Group C.②The bone density level of men was higher than that of women in Group C（P0.05）.③ There were no differences in FBG,Ca,P and ALP between Group B and Grope C,but HbA1c was significantly decreased in Group C（P0.05）.④The change in BMD was respectively negative correlated with the change in duration（r=-0.218,r=-0.018,r=-0.135,P0.05）and age（r=-0.197,r=-0.073,r=-0.129,P0.05）,while it had a positive correlation with weight（r=0.230,r=0.352,r=0.223,P0.05）.Conclusion Female,old,long duration and low birth weight were risk factors for osteoporosis with diabetic patients.Insulin therapy have on negative impacts for bone metabolism in patients with type 2 diabetes mellitus.