二甲双胍在降低代谢综合征患者骨质疏松发生率中的应用

Effects of metformin on the incidence of osteoporosis in patients with metabolic syndrome

目的探讨二甲双胍降低代谢综合征(Metabolic syndrome,MS)患者骨质疏松发生率的作用。方法选择2013年9月至2017年2月在我院诊治的178例MS患者,根据治疗方法的不同分为2组,对照组(88例)给予格列吡嗪治疗,观察组(90例)给予二甲双胍治疗,治疗8周。结果治疗后,两组患者空腹血糖(Fasting blood glucose,FBG)、糖化血红蛋白(HbA1c)降低(P<0.05),且观察组低于对照组(P<0.05);治疗前后,两组患者低密度脂蛋白胆固醇(Low density lipoprotein cholesterol,LDL-C)、体重指数(Body mass index,BMI)的组内、组间比较差异均无统计学意义(P>0.05)。治疗后,观察组骨钙素(Osteocalcin,OC)水平升高(P<0.05),Ⅰ型胶原羟基端肽β降解产物(β-CTX)值降低(P<0.05),两组比较差异有统计学意义(P<0.05)。治疗前后,两组患者碱性磷酸酶(Alkaline phosphatase,ALP)值比较差异无统计学意义(P>0.05)。治疗后,观察组患者股骨颈、髋关节骨密度与治疗前比较差异无统计学意义(P>0.05);对照组相关指标呈下降趋势(P<0.05),且低于观察组(P<0.05)。治疗期间,观察组与对照组的腹泻、恶心呕吐、低血糖等不良反应发生率分别为5.6%、6.8%,两组比较差异无统计学意义(P>0.05)。结论二甲双胍能改善MS患者的骨代谢指标,对骨密度无显著影响,能促进血糖降低,安全性良好,从而发挥降低骨质疏松发生率的作用。

Objective To investigate the effects of metformin on the incidence of osteoporosis in patients with metabolic syndrome（MS）. Methods Totally 178 cases with MS in our hospital were selected from September 2013 to February 2017,were divided into 2 groups according to the different treatment methods. Patients in control group（n = 88） and observation group（n = 90） received glipizide and metformin for 8 weeks respectively. Results After treatment,the levels of FBG and HbA1c of the two patients decreased significantly（P 〈0. 05）,and the observation group was lower than the control group,there were significant differences between the two groups（P〈 0. 05）. There was no significant differences in the levels of LDL-C and BMI of patients between the two groups before and after treatment（P 〉0. 05）. After treatment,the level of OC in observation group was increased（P 〈0. 05）,while the level of β-CTX was decreased（P 〈0. 05）; there were significant difference in the levels of OC and β-CTX between the two groups（P〈 0. 05）. There was no significant difference in the ALP between the two groups before and after treatment（P 〉0. 05）. There was no significant difference in the bone mineral density of femoral neck and hip joint in observation group before and after treatment（P 〉0. 05）,while the related indexes was decreased significantly in control group（P 〈0. 05）,which was also lower than that of observation group（P〈 0. 05）. The incidence rates of diarrhea,nausea and vomiting and hypoglycemia in observation group and control group were 5. 6% and 6. 8%,respectively,there was no significant difference between the two groups（P 〉0. 05）. Conclusion Metformin can improve the bone metabolism index of patients with MS without influencing the bone density,and promote the reduction of blood glucose safely,which can play a role in reducing the incidence of osteoporosis.