利拉鲁肽联合唑来磷酸治疗初诊T2DM合并OP的疗效及对患者骨代谢、骨密度指标的影响

Efficacy of liraglutide combined with zoledronic acid in the treatment of newly diagnosed type 2 diabetes mellitus complicated with osteoporosis and its effect on bone metabolism and bone mineral density in the patients.

目的探讨利拉鲁肽联合唑来磷酸治疗初诊2型糖尿病(T2DM)合并骨质疏松(OP)的疗效及对患者骨代谢、骨密度(BMD)指标的影响。方法选择2018年8月至2021年3月中国人民解放军空军军医大学第二附属医院收治的158例初诊T2DM合并OP患者,依照随机数表法分为观察组和对照组,每组79例,对照组患者在常规治疗基础上给予唑来膦酸治疗,观察组患者在对照组治疗基础上联合利拉鲁肽治疗,两组患者均持续治疗6个月。比较两组患者治疗后的预后情况,以及治疗前后的空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、碱性磷酸酶(ALP)、Ⅰ型胶原羟基端肽β降解产物(β-CTX)、I型胶原N端前肽(PINP)、L_(2-4)、股骨颈BMD的变化和治疗期间的不良反应发生情况。结果治疗后,观察组患者的预后良好率为91.14%,明显高于对照组的77.22%,差异具有统计学意义(P<0.05);治疗后,观察组患者的FBG、2 hPG、HbA1c分别为(6.39±1.40)mmol/L、(8.27±1.65)mmol/L、(6.53±0.67)%,明显低于对照组的(6.87±1.21)mmol/L、(9.02±1.71)mmol/L、(6.88±0.72)%,差异均有统计学意义(P<0.05);治疗后,观察组患者的ALP、PINP分别为(123.04±15.32)U/L、(1700.83±167.41)μg/mL,明显高于对照组的(101.61±13.76)U/L、(1481.52±182.07)μg/mL,β-CTX为(327.61±48.93)μg/mL,明显低于对照组的(411.83±72.81)μg/mL,差异均有统计学意义(P<0.05);治疗后,观察组患者的L_(2-4)、股骨颈BMD分别为(0.88±0.07)g/cm 2、(0.68±0.09)g/cm 2,明显高于对照组的(0.82±0.06)g/cm 2、(0.63±0.06)g/cm 2,差异均有统计学意义(P<0.05);观察组患者治疗期间的不良反应总发生率为10.00%,略高于对照组的7.50%,但差异无统计学意义(P>0.05)。结论利拉鲁肽联合唑来磷酸治疗初诊T2DM合并OP能有效改善患者的骨代谢和BMD指标,临床治疗效果显著,且安全性较好。

Objective To study the efficacy of liraglutide combined with zoledronic acid in the treatment of newly diagnosed type 2 diabetes mellitus(T2DM)complicated with osteoporosis(OP)and its effect on bone metabolism and bone mineral density(BMD)in the patients.Methods A total of 158 newly diagnosed T2DM patients complicated with OP admitted to the Second Affiliated Hospital of Air Force Military Medical University of Chinese People's Liberation Army from August 2018 to March 2021 were selected.According to random number table method,the patients were divided into an observation group and a control group,with 79 patients in each group.The patients in the control group were given zoledronic acid on the basis of conventional treatment,and the patients in the observation group were given liraglutide on the basis of control group,for 6 months.The prognosis after treatment,the changes of fasting blood glucose(FBG),2 h postprandial blood glucose(2 hPG),glycosylated hemoglobin(HbA1c),alkaline phosphatase(ALP),degradation products of hydroxy terminal peptideβof typeⅠcollagen(β-CTX),type I collagen N terminal propeptide(PINP),L_(2-4),femoral neck BMD,and the incidence of adverse reactions during treatment were compared between the two groups.Results After treatment,the good prognosis rate in the observation group was 91.14%,which was significantly higher than 77.22%in the control group(P<0.05).After treatment,the FBG,2 hPG,and HbA1c in the observation group were(6.39±1.40)mmol/L,(8.27±1.65)mmol/L,(6.53±0.67)%,which were significantly lower than(6.87±1.21)mmol/L,(9.02±1.71)mmol/L,(6.88±0.72)%in the control group(P<0.05).After treatment,the ALP and PINP in the observation group were(123.04±15.32)U/L and(1700.83±167.41)μg/mL,which were significantly higher than(101.61±13.76)U/L and(1481.52±182.07)μg/mL in the control group,while theβ-CTX was(327.61±48.93)μg/mL,significantly lower than(411.83±72.81)μg/mL in the control group(P<0.05).After treatment,the L_(2-4) and femoral neck BMD in the observation group were(0.88±0.07)g/cm 2 and(0.68±0.09)g/cm 2,which were significantly higher than(0.82±0.06)g/cm 2 and(0.63±0.06)g/cm 2 in the control group(P<0.05).The total incidence of adverse reactions in the observation group was 10.00%,which was slightly higher than 7.50%in the control group,with no statistically significant difference(P>0.05).Conclusion Liraglutide combined with zoledronic acid in the treatment of newly diagnosed T2DM complicated with OP can effectively improve the bone metabolism and BMD indexes of patients,which have significant clinical effect and good safety.