健康管理在老年人2型糖尿病并存骨质疏松治疗中的作用

Roles of health management in the treatment of type 2 diabetes combined with osteoporosis in elderly patients

目的探讨健康管理在老年2型糖尿病并存骨质疏松患者治疗中的作用。方法前瞻性研究，连续选取100例诊断明确的2型糖尿病并存骨质疏松的老年患者，分为治疗组和观察组（治疗并健康管理），进行12个月的对照研究，分别于入组与治疗12个月结束时，计算体质指数，测定骨钙素、I型胶原羧基端肽、总I型前胶原氨基端肽、1，25二羟维生素I）3[1，25-（0H）zI）3]、空腹血糖、血钙等指标；采用双能X线骨密度仪测定第1～4腰椎（L1-L4）、左侧股骨颈和髋部骨密度；并比较两组患者新发骨折发生率。结果治疗12个月后，两组血糖指标、I型胶原羧基端肽下降，骨密度、骨钙素、总I型前胶原氨基端肽提高，差异有统计学意义（P〈O．05），治疗后两组间差异并无统计学意义（P〉O．05）。观察组空腹血糖和糖化血红蛋白降低的幅度分别为（1．98±0．59）mmol／L和（1．75±0．47）％，高于治疗组（1．09±0．76）mmol／L和（1．06±0．52）％，差异有统计学意义（t值分别为6．54、6．96，均P〈0．05）。观察组L1-L4、左侧股骨颈和髋部骨密度升高的幅度分别为（O．28±0．09）、（0．274-0．06）和（0．30士0．08）g／cm^2，高于治疗组（O．23±0．07）、（O．22±0．09）和（0．22±0。07）g／cm2，差异有统计学意义（t值分别为3．10、3．27、5．32，均P〈0．05）。观察组骨钙素、总I型前胶原氨基端肽升高的幅度分别为（3．84±1．96）μg／L和（10．66±4．06）μg／L，高于治疗组（2．18±2．03）μg／L和（8．54±3．01）μg／L，差异有统计学意义（t=4．16，P〈O．05；t=2．97，P〈0．05）。观察组I型胶原羧基端肽下降的幅度为（0．31±0．11）μg／L，高于治疗组（O．24±0．09）μg／L，差异有统计学意义（t=3．48，P％0．05）。观察组骨折发生率低于治疗组，但无统计学意义（X^2=1．52，P〉O．05）。结论在老年2型糖尿病合并骨质疏松的治疗过程中，健康管理增强了患者的依从性，可提高药物的治疗效果，保障了治疗的有效性与持续性。

Objective To discuss the roles of health management in the treatment of type 2 diabetes combined with osteoporosis in elderly patients. Methods 100 elderly patients diagnosed with type 2 diabetes combined with osteoporosis were selected, and randomIy divided into treatment group（without health management）and observation group（treatment plus health management）to proceed a randomized controlled study for 12 months. At the beginning and end of the study,calculated were the parameters as follows = the body mass index, osteocalcin（BGP）, N-terminal collagen of type I procollagen peptide （PINP）, type I collagen decomposition of C-terminal peptide （CTX）, 1,25-dihydroxyvitamin D3E1,25-（OH） 2D3 ], fasting blood-glucose, hemoglobin AIc （ HbAle）, blood calcium levels, the positions of the lumbar spine （L1-L4）which was measured by dual energy X-ray absorptiometry,and bone mineral density（BMD）of left femoral neck and hip. Then,the incidence rates of fracture of the two groups were calculated. Results After 12 months of treatments,fasting blood- glucose,HbAlc and CTX in both groups were decreased, while BMD, osteocalcin and PINP were increased. Their differences between pre-and port-treatments showed statistical significance（each P〈0.05）. However,there was no statistical significance between treatment group and observation group （P〉0.05）. Their decrements of fasting blood-glucose [（1.98±0.59） mmol/L and（1.75±0.47）%） than in and HbAlc were higher in observation group treatment group （（1.09±0.76） mmol/L and （1.06±0.52）%,t=6.54,P〈0.05,t=6.96,P〈0. 051. The increments of BMD of L1-L4,femur neck and hip were higher in observation group[（0. 28±0. 09）, （0.27±0.06） and（0. 30±0.08） g/cm^2 ） than in treatment group（0.23±0.07,0. 22±0.09 and 0. 22±0. 07） g/cm2 , respectively） （ t = 3.10, P〈 0. 05 ; t = 3.27 ,P〈0. 05 ;t= 5. 322, P〈0.05）. The increments of BGP and PINP were higher in observation group （（ 3.84±1.96 ） and （ 10. 66±4. 06 ）μg/L] than in treatment group [ （ 2.18±.03 ） and （8. 54±3.01 ）μg/L）, respectively （t=4.16 ,P〈0. 05 ;t=2.97 ,P〈0. 05）. The decrement of CTX was higher in observation group （0. 31±0. 11）μg/L than in treatment group（0.24±0. 09）μg/L（t = 3.48, P〈0.05）. Fracture rate was slightly lower in observation group than in treatment grouP（X^2 = 1.52, P〉0. 05）. Conclusions In the process of treatment for type 2 diabetes combined with osteoporosis in elderly patients,health management enhances the compliance of the patients, and significantly improves the therapeutic effect of drugs. At the same time,it is a powerful guarantee of effectiveness and persistence of the treatment.