二甲双胍联合钙剂对老年2型糖尿病患者骨代谢的影响

Effect of metformin combined with calcium on the metabolism of bone in elderly type 2 diabetes patients

目的探讨二甲双胍单独治疗或与钙剂联合治疗对老年2型糖尿病患者骨代谢的影响。方法将90例老年初发2型糖尿病患者随机分为2组:二甲双胍组、联合组。二甲双胍的起始用量为500 mg/d,观察期间根据患者空腹血糖水平可增加至2 000 mg/d;钙剂补充:患者每日口服钙片(含钙1 000 mg/d)。观察患者治疗24周前后骨密度和骨代谢的变化。结果两组骨密度在治疗前后比较差异无统计学意义(P>0.05)。治疗24周后,联合组骨钙素和血钙水平明显升高,血清Ⅰ型胶原C端肽酶水平明显降低(P<0.05);联合组的血清骨钙素和血钙水平明显高于二甲双胍组(P<0.05),血清硬化蛋白和血清Ⅰ型胶原C端肽酶水平明显低于二甲双胍组(P<0.05);2型糖尿病患者的血钙水平和骨钙素具有明显相关性(P<0.05)。结论二甲双胍和钙剂联合治疗可能通过增加骨形成和抑制骨吸收来降低2型糖尿病致骨质疏松的发生率。

Objective To investigate the effect of metformin alone combined with calcium on the metabolism of bone in elderly type 2 diabetes patients.Methods 90 elderly patients diagnosed as type 2 diabetes primarily were randomly divided into metformin group and combination group.All the patients received metformin （initial dose was 500 mg/d,and it could be adjusted up to 2 000 mg/d according to fasting blood glucose level）,patients in combination group was added 1 000 mg/d of calcium.Bone density and bone metabolic parameters were observed.Results There was no significant difference in bone density of patients before and after treatment.After 24 weeks treat-ment,the osteo calcin and blood calcium levels of combination group increased significantly （P ＜ 0.05）,and the carboxy-terminal crosslinking telopeptide of type Ⅰ collagen decreased（P ＜ 0.05） ;the osteocalcin and blood calcium levels in combination group were higher than those of metformin group（P ＜ 0.05）,and the sclerostin and carboxy-terminal cross-linking telopeptide of type Ⅰ collagen were lower（P ＜ 0.05）.Conclusion Metformin combined with calcium could alleviate the osteoporosis induced by type 2 diabetes by enhancing the bone formation and reducing the bone resorption.