二甲双胍和胰高糖素样多肽-1对2型糖尿病患者并发骨折恢复的影响

Effects of metformin and glucagon like polypeptide-1 on fracture recovery in patients with type 2 diabetes mellitus

目的探讨二甲双胍和胰高糖素样多肽-1对2型糖尿病患者并发骨折恢复的影响。方法选取2016年5月—2017年4月我院骨科收治的2型糖尿病并发骨折患者120例,按随机原则分为5组,每组24例,单药低剂量二甲双胍组(A1)、单药高剂量二甲双胍组(A2)、单药GLP-1组(B)、低剂量二甲双胍联合GLP-1组(C1)和高剂量二甲双胍联合GLP-1组(C2)。二甲双胍低剂量用药量为0.5 g/次,每日2次口服,高剂量用药量为0.5 g/次,每日4次口服。皮下注射利拉鲁肽每日1次,起始量为每日0.6 mg,1周增加为每日1.2 mg,再1周后增加为每日1.8 mg。血糖控制在理想水平后按照标准的手术方法和规程行相应的手术治疗。同时给予饮食控制及其它对症治疗。分别在1、3、6个月时检测其股骨颈骨密度值(BMD)和Harris系统评分。结果随着治疗时间延长,A1组、C1组、C2组BMD值和Harris系统评分均增高,在术后3月和6月时,C1组骨密度值和Harris评分高于A1组(P<0.05),C1组骨密度值和Harris评分高于C2组(P<0.05)。结论胰高糖素样多肽-1可促进2型糖尿病患者骨折愈合、功能恢复,且与低剂量二甲双胍联用促进骨折愈合效果优于与高剂量二甲双胍联用。

Objective To investigate the effects of metformin and glucagon like polypeptide-1 on fracture recovery in patients with type 2 diabetes mellitus（ DM）. Methods We selected 120 patients with type 2 diabetes mellitus from May2016 to April 2017 in department of orthopedicsin in our hospital and randomly divided them into 5 groups,24 cases in each group,including the low dose of metformin monotherapy group（ A1）,the high dose of metformin monotherapy group（ A2）,single drug GLP-1 group（ B）,and GLP-1 group low dose of metformin combination（ C1） and high dose of metformin combination with GLP-1 group（ C2）. The low dose of metformin was 0. 5 g/time,2 times a day for oral administration. The high dose was 0. 5 g/time,4 times a day. Subcutaneous injection of liraglutide was once daily,starting at a daily dose of 0. 6 mg,1. 2 mg daily after 1 week and 1. 8 mg daily after another week. After an ideal level of blood glucose control,corresponding surgical procedures should be performed according to standard surgical methods and procedures. Diet control and other symptomatic treatments were also given. The femoral neck bone mineral density（ BMD） and the Harris system score were examined at the first,third,and sixth month respectively. Results With the prolongation of treatment time,the BMD value and Harris system score in the A1 group,C1 group,C2 group were increased. After surgery in March and June,the BMD and Harris score of C1 group were higher than that of A1 group（ P〈0. 05）. The bone mineral density and Harris score of C1 group was significantly higher than that of group C2（ P〈0. 05）. Conclusion Glucagon like peptide-1 may promote the fracture recovery and functional recovery in patients with type 2 diabetes mellitus,and with combination of low dose metformin is more effective than that with high dose metformin.