2型糖尿病对骨代谢及相关激素的影响

The effect of type 2 diabetes mellitus on bone metabolism and the related hormones

目的 探讨２型糖尿病对骨代谢紊乱及相关激素的影响。方法 测定２０例健康对照者和６０例２型糖尿病患者血甲状旁腺激素（ＰＴＨ）、降钙素（ＣＴ）、２５羟维生素Ｄ３ 〔２５（ＯＨ）Ｄ３〕、环磷酸腺苷（ｃＡＭＰ）和血、尿钙（Ｃａ）、磷（Ｐ）、镁（Ｍｇ）、糖基化血红蛋白（ＨｂＡ１ｃ）、２４小时尿糖、Ｃ肽曲线下面积等指标。结果 ①２型糖尿病患者血ＰＴＨ 水平显著高于对照组（Ｐ＜ ０．００１和Ｐ＜ ０．０１），ＣＴ水平显著低于对照组（Ｐ＜ ０．０１），尿Ｃａ、尿Ｍｇ 排泄量显著高于对照组（Ｐ＜ ０．０１和Ｐ＜ ０．０５）；②ＰＴＨ水平与ＨｂＡ１ｃ和尿Ｃａ 呈显著正相关（ｒ＝ ０．４０，Ｐ＜ ０．０５和ｒ＝ ０．８３，Ｐ＜ ０．００１），与ＣＴ呈显著负相关（ｒ＝ － ０．７４， Ｐ＜ ０．０１）；③ＰＴＨ水平与Ｃ肽曲线下面积呈负相关（ｒ＝ － ０．３１， Ｐ＜ ０．２）。结论 ２型糖尿病患者存在明显Ｃａ、Ｍｇ 代谢异常和继发性ＰＴＨ、ＣＴ改变是造成骨质疏松的主要原因，这种变化在糖尿病早期更明显。

Objective To explore the effect of type 2 diabetes mellitus on bone metabolism disorder and the related hormones. Methods Serum parathyroid hormone(PTH)、 calcitonin (CT)、25 hydroxycholecalciferol〔25(OH)D 3〕、cyclic adenosine monophosphate(cAMP) and serum calcium (Ca)、phosphorus(P)、magnesium (Mg) and urinary Ca、P、Mg and glycosylated hemoglobin (HbA1c), and 24 hour urinary glucose excretion were mearsured in 20 healthy subjects and 60 type 2 diabetic patients.Results ①PTH level was obviously increased (P<0 001)and CT level was markedly decreased in diabetic groups (P<0 01), and urinary Ca、Mg excretion was apparently increased (P<0 01 and P<0 05);②The level of PTH was remarkably positively correlated with the HbA1c and urinary Ca(r=0 40,P<0 05 and r=0 83,P<0 001),and was remarkably negatively correlated with CT(r=-0 74,P<0 01);③The area under the C peptide curved line was negatively correlated with PTH (r=-0 31,P<0 2).Conclusion These results suggested that type 2 diabetic patients had Ca、Mg metabolism disorder and secondary PTH、CT changes, which were the main cause of the osteoporosis and more remarkable in early duration. Poor glucose control accelerated the development and progression of bone metablism disorder.