双膦酸盐联合钙尔奇D治疗老年2型糖尿病骨质疏松女性疗效的影响因素分析

Study on the therapeutic effect of combined alendronate and caltrate D on osteoporosis in elderly type 2 diabetic women and on its influencing factors

目的研究阿伦膦酸盐联合钙尔奇D治疗老年女性T2DM患者骨质疏松疗效的影响因素。方法老年女性T2DM骨质疏松患者67例,随机接受钙尔奇D或阿伦膦酸盐联合钙尔奇D治疗6个月,检测治疗前后骨密度(BMD)及生化、骨盐代谢指标。结果阿伦膦酸盐联合钙尔奇D疗效优于钙尔奇D。与联合治疗6个月腰椎、髋骨BMD改善正相关的指标:FPG(r=0.287和0.160)、HbA1c(r=0.283和0.110)、糖尿病病程(r=0.137和0.072)、治疗中增加胰岛素的剂量(r=0.201和0.082)、HbA1c降低幅度(r=0.302和0.139)、尿钙/Cr(r=0.115和0.096)、尿羟脯氨酸/Cr(r=0.132和0.123)、血清抗酒石酸酸性磷酸酶(r=0.204和0.296)、血碱性磷酸酶(r=0.184和0.073)、骨钙素(r=0.149和0.065)、骨碱性磷酸酶(r=0.263和0.486)(P均<0.05)。而与FC-P水平(r=-0.136和-0.212)、24hUAlb(r=-0.220和-0.077)和基线时的骨密度(股骨颈)(r=-0.316和-0.245)负相关(P均<0.05)。结论阿伦膦酸盐联合钙尔奇D治疗老年女性T2DM患者骨质疏松,病情越重者获益越多,但大量UAlb影响疗效。

Objective To investigate the affecting factors of therapeutic effect of combined alendronate and caltrate D on osteoporosis in elderly type 2 diabetic women.Methods Sixty-seven elderly type 2 diabetic women were randomized into caltrate D group and comined alendronate and caltrate D group.After treatment for 6 months,the changes in bone mineral density（BMD） and biochemical and bone metabolism indices were determined for comparison.Results The effect of combined alendronate and caltrate D was better than that of caltrate D.Those parameters positively related with the improvement of BMD of lumbar vertebrae and hip bone were fasting blood glucose（r=0.287 and 0.160）,HbA1c（r=0.283 and 0.110）,duration of diabetes（r=0.137 and 0.072）,increased dosage of insulin（r=0.201 and 0.082）,decreased amplitude of HbA1c（r=0.302 and 0.139）,urinary Ca/Cr（r=0.115 and 0.096）,urinary hydroxyproline/Cr（r=0.132 and 0.123）,tartrate-resistant acid phosphatase-5b（r=0.204 and 0.296）,alkaline phosphatase（r=0.184 and 0.073）,osteocalcin（r=0.149 and 0.065）,and bone-specific alkaline phosphatase（r=0.263 and 0.486）（all P〈0.05）.But it was negatively related with the fasting C-peptide（r=-0.136 and-0.212）,24 h urinary albumin excretion（r=-0.220 and-0.077）,and baseline BMD（femur neck）（r=-0.316 and-0.245）（all P〈0.05）.Conclusion Treatment with alendronate plus caltrate D is effective for elderly type 2 diabetic women with osteoporosis.The more the serious the condition,the more the benefit.High urinary albumin excretion affects the results.