骨化三醇联合钙剂治疗糖尿病伴骨质疏松症患者的效果观察

Effect of calcitriol combined with calcium on the treatment of diabetics with osteoporosis

目的探讨骨化三醇联合钙剂治疗糖尿病伴骨质疏松症患者的效果。方法选取2018年10月至2019年10月四川大学华西医院收治的糖尿病伴骨质疏松症患者92例,按照随机数字表法分为对照组与观察组,各46例。对照组在常规干预基础上口服碳酸钙D_(3)片治疗;观察组在对照组基础上口服骨化三醇治疗,2组均治疗8周。比较2组治疗前及治疗4、8周后关节疼痛程度及疼痛指数,治疗前及疗程结束后的骨密度、骨代谢标志物[骨钙素、骨源性碱性磷脂酶(BAP)、抗酒石酸酸性磷酸酶5b(TRACP-5b)、Ⅰ型胶原C末端肽(CTX)]水平,以及治疗期间不良反应发生情况。结果治疗4、8周后2组关节疼痛视觉模拟量表评分、疼痛指数均较治疗前显著下降,且观察组低于对照组[疼痛视觉模拟量表评分:(4.1±0.7)分比(5.0±0.8)分、(1.9±0.4)分比(2.7±0.7)分;疼痛指数:(1.15±0.16)分比(1.56±0.14)分、(0.64±0.11)分比(0.98±0.15)分],差异均有统计学意义(均P<0.05)。疗程结束后2组Ward’s三角及L1~4骨密度、骨钙素、BAP均较治疗前显著升高,且观察组显著高于对照组;TRACP-5b、CTX较治疗前显著降低,且观察组显著低于对照组;差异均有统计学意义(均P<0.05)。2组不良反应发生率差异无统计学意义(P>0.05)。结论骨化三醇联合钙剂治疗糖尿病伴骨质疏松症,可有效缓解患者关节疼痛程度,降低疼痛指数,增加骨密度,调节血清骨代谢标志物含量,且不增加不良反应发生风险,安全性良好。

Objective To explore the effect of calcitriol combined with calcium on the treatment of diabetics with osteoporosis.Methods From October 2018 to October 2019,92 patients with diabetes mellitus and osteoporosis in West China Hospital,Sichuan University were selected.They were randomly divided into the control group and the observation group,with 46 cases in each group.The control group was treated with calcium carbonate D_(3) tablets on the basis of routine intervention;the observation group was treated with calcitriol on the basis of the control group,and both groups were treated for 8 weeks.The joints degree of pain and pain index before treatment and after 4 and 8 weeks of treatment,bone mineral density(BMD),bone metabolic markers[osteocalcin,bone-derived alkaline phosphatase(BAP),tartrate-resistant acid phosphatase 5 b(TRACP-5 b),typeⅠcollagen C-terminal peptide(CTX)]levels and adverse reactions were measured before and after treatment and the adverse reactions during treatment were compared between the two groups.Results After 4 and 8 weeks of treatment,the joints visual analogue scale scores and the pain index of the two groups were lower than those before treatment,and those in observation group were lower than those in control group[visual analogue scale scores:(4.1±0.7)vs(5.0±0.8),(1.9±0.4)vs(2.7±0.7);pain index:(1.15±0.16)vs(1.56±0.14),(0.64±0.11)vs(0.98±0.15)](all P<0.05).After treatment,the Ward’s triangle and L1-4 BMD,osteocalcin,BAP of the two groups were significantly higher than those before treatment,and those of the observation group were significantly higher than those of the control group;TRACP-5b and CTX were significantly lower than those before treatment,and those of the observation group were significantly lower than those of the control group;the differences were statistically significant(all P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions Calcitriol combined with calcium in the treatment of diabetes with osteoporosis can effectively relieve joints pain,reduce pain index,increase BMD,adjust serum bone metabolism markers.It has good safety and does not increase the risk of adverse reactions.