阿仑膦酸钠治疗绝经后糖尿病性骨质疏松的疗效及对动脉硬化的影响

Effect and impact of alendronate on arteriosclerosis in postmenopausal patients with diabetic osteoporosis

目的：探讨阿仑膦酸钠治疗绝经后糖尿病性骨质疏松（DOP）患者的疗效及其对动脉硬化（AS）的影响。方法将绝经后DOP患者86例随机分为治疗组和对照组各43例。所有患者均在量化饮食、运动治疗及控制血糖的基础上给予钙尔奇D口服，治疗组加用阿仑膦酸钠70 mg／周，连服6个月。观察2组患者骨密度（ BMD）、骨转换指标及斑块面积和内膜中层厚度（ IMT）的变化。结果治疗后治疗组各部位BMD及骨转换指标均较治疗前显著改善（ P ＜0．05），且L2～4、股骨颈、Wards三角的BMD及甲状旁腺素（PTH）、I型胶原羧基端肽β特殊序列（β-CTX）改善均显著优于对照组（ t ＝3．91、2．62、3．70、2．68、3．17， P ＜0．05）；而对照组各指标均无明显改善（ P ＞0．05）。治疗后，治疗组颈动脉斑块面积明显减小、IMT明显变薄（ t ＝2．64、4．61， P ＜0．05），且治疗组均优于对照组（ t ＝3．01、2．79， P ＜0．05）；而对照组无显著改善（ P ＞0．05）。斑块面积与腰椎L2～4的BMD呈负相关（ r ＝－0．578， P ＜0．05），IMT与Wards三角、Troch的BMD呈负相关（ r ＝－0．591、－0．541， P ＜0．05）。结论绝经后2型糖尿病患者是糖尿病性骨质疏松的高危人群，阿仑膦酸钠治疗绝经后DOP安全有效，可明显增加骨密度，降低骨转化水平，且对AS具有一定防治作用。

Objective To investigate the effect of alendronate sodium in treatment of postmenopausal diabetic osteo-porosis（ DOP） and effect on atherosclerosis（ AS） .Methods 86 cases of postmenopausal DOP patients were randomly divided into treatment group and control group with 43 cases in each group.All patients were given Caltrate D oral based on quantified diet, exercise therapy and blood sugar control, the treatment group was treated with Allen alendronate 70 mg/week for 6 months.Bone mineral density （BMD）, bone turnover markers and area of plaque and intima-media thickness （IMT） changes between the 2 groups were observed.Results After treatment, BMD and bone turnover markers were significantly improved in the treatment group （ P 〈0.05）, L2～4, the femoral neck, Wards’ triangle BMD and parathyroid hormone （PTH）, type I carboxy terminal peptide sequence （ beta special CTX） in the treatment group were significantly higher than that of the control group （ t =3.91,2.62, 3.70, 2.68, 3.17, P 〈0.05）;while all indexes in the control group were not significant improve-ment （ P 〉0.05）.After the treatment, the treatment group’ s carotid plaque area reduced obviously, IMT was obviously thinning （ t =2.64, 4.61, P 〈0.05）;and after treatment, they were superior to the control group （ t =3.01, 2.79, P 〈0.05）;while in the control group, there were no significant improvement （ P 〉0.05）.Plaque area were negative correlated with lumbar L2～4 BMD （ r =-0.578, P 〈0.05）, IMT was negatively correlated with Wards triangle and Troch BMD （r =-0.591, -0.541, P 〈0.05）.Conclusion Postmenopausal patients with type 2 diabetes are at high risk of postmenopausal diabetic osteoprosis, Allen phosphonic acid sodium in treatment of postmenopausal DOP is safe and effective, can significantly increase the bone density, decrease bone conversion level, and has a certain role in the prevention and treatment of atheroscle-rosis.