二甲双胍和吡格列酮对男性2型糖尿病患者骨代谢指标的影响

Effects of metformin and pioglitazone on bone metabolism in male patients with type 2 diabetes

目的了解二甲双胍和吡格列酮对男性2型糖尿病患者骨代谢指标的影响。方法将口服降糖治疗的90例男性2型糖尿病患者随机分为格列吡嗪组、格列吡嗪＋二甲双胍组和格列吡嗪＋吡格列酮组3组，治疗1年。治疗前后检测患者的空腹血糖（FBS）、空腹胰岛素（Ins）、糖化血红蛋白（HbAlc）、骨钙素、尿吡啶酚／尿肌酐（尿PYD／Cr）。采用双能x线骨密度测量仪测量腰椎、髋部骨密度。结果二甲双胍组腰椎骨密度平均增加0．49％，髋部骨密度平均增加1．82％。而吡格列酮组腰椎、髋部骨密度分别下降1．46％和1．97％左右。治疗后二甲双胍组髋部骨密度明显高于吡格列酮组。结论与吡格列酮组比较，二甲双胍能明显增加男性糖尿病患者髋部骨密度。

Objective To compare changes in bone mineral density （BMD）and bone biochemical indicator during 1-year metformin treatment with pioglitazone in type 2 diabetic men. Methods 90 men with type 2 diabetic were divided into three groups （ glipizide group, glipizide ＋ mefformin group, glipizide ＋ pioglitazone group）. The metformin group were treated with glipizide and metformin. Pioglitazone group with pioglitazone and glipizide. BMD at the lumbar spine and hip was measure by dual-energy X-ray absorptiometry at the beginning and end of treatment. Samples were analyzed simultaneously for serum markers of bone formation osteocalcin（BGP） and markers of bone resorption urinary pyridinoline（uPYD） and urinary creatinine （Cr）. Results In diabetic men. 1-year Metformin treatment was associated with increased BMD at all sites studied, including 0.49% at the lumbar spine and 1.82% at the hip. whereas men in the pioglitazone group experienced a decrease in BMD about 1.46% at the iumbar spine and 1. 97% at the hip. BMD in metformin group was higher than that in pioglitazone group at lumbar and hip. Conclusions Metformin increased BMD at hip in men with type 2 diabetes combared with pioglitazone.