二甲双胍联合维生素D对糖尿病合并骨质疏松症患者血清胰岛素样生长因子1及骨代谢标志物水平的影响

Effects of metformin combined with vitamin D on levels of serum insulin-like growth factor-1 and bone metabolic markers in patients with diabetes mellitus and osteoporosis

目的 探讨二甲双胍联合维生素D对糖尿病合并骨质疏松症患者血清胰岛素样生长因子1(IGF-1)及骨代谢标志物水平的影响。方法 选取北京医院2020年3月至2023年3月收治的160例2型糖尿病(T_(2)DM)合并骨质疏松症患者作为研究对象,按照随机数字表法分为对照组和观察组,各80例。对照组给予维生素D联合运动干预和控制饮食等常规血糖控制方法治疗,观察组在上述治疗的基础上外加二甲双胍治疗,2组均治疗6个月。比较2组患者治疗前后空腹血糖、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、血钙、血磷、骨钙素、总Ⅰ型胶原氨基端延长肽(T-PⅠNP)、IGF-1、高敏C反应蛋白(hs-CRP)、维生素D_(3)水平以及总有效率。结果 治疗后,2组空腹血糖、2 hPG、HbA1c、血磷、hs-CRP水平均低于治疗前,且观察组均低于对照组(均P<0.05);2组血钙、骨钙素、T-PⅠNP、骨密度、IGF-1、维生素D_(3)水平均高于治疗前、且观察组均高于对照组[(2.82±0.20)mmol/L比(2.40±0.15)mmol/L、(19.9±2.4)ng/L比(13.6±2.1)ng/L、(48±4)μg/L比(37±4)μg/L、(0.98±0.16)g/cm^(2)比(0.78±0.15)g/cm^(2)、(206±35)μg/L比(137±25)μg/L、(37±3)μg/L比(29±3)μg/L](均P<0.05)。观察组总有效率高于对照组(P<0.001)。结论 二甲双胍联合维生素D治疗T_(2)DM合并骨质疏松症效果较好,可更好地控制血糖水平,上调血清IGF-1水平,改善机体骨代谢。

Objective To investigate the effect of metformin combined with vitamin D on levels of serum insulin-like growth factor-1(IGF-1) and bone metabolic markers in patients with diabetes mellitus and osteoporosis.Methods Totally 160 patients with type 2 diabetes mellitus(T_(2)DM) and osteoporosis admitted to Beijing Hospital from March 2020 to March 2023 were enrolled.Patients were randomly divided into control group and observation group,with 80 cases in each group.The control group was treated with vitamin D combined with routine blood glucose control methods such as exercise intervention and diet control,and the observation group was treated with metformin on the basis of the control group.The levels of fasting plasma glucose(FPG),postprandial 2 h plasma glucose(2 hPG),glycated hemoglobin(HbA1c),serum calcium,serum phosphorus,osteocalcin,total n-terminal propeptide of type Ⅰprecollagen(T-PⅠNP),IGF-1,high-sensitivity C-reactive protein(hs-CRP) and vitamin D_(3) before and after treatment as well as total effective rate were compared between the two groups.Results After treatment,levels of FPG,2 hPG,HbA1c,serum phosphorus and hs-CRP in both groups were lower than those before treatment,and the levels in the observation group were lower than those in the control group(all P<0.05);serum levels of calcium,osteocalcin,T-PⅠNP,bone mineral density,IGF-1 and vitamin D_(3) in both groups were higher than those before treatment,and the levels in the observation group were higher than those in the control group[(2.82±0.20)mmol/L vs(2.40±0.15)mmol/L,(19.9±2.4)ng/L vs(13.6±2.1)ng/L,(48±4)μg/L vs(37±4)μg/L,(0.98±0.16)g/cm^(2) vs(0.78±0.15)g/cm^(2),(206±35)μg/L vs(137±25)μg/L,(37±3)μg/L vs(29±3)μg/L](all P<0.05).The total effective in the observation group was higher than that in the control group(P<0.001).Conclusions Metformin combined with vitamin D is effective in the treatment of T_(2)DM with osteoporosis,which can control plasma glucose level better,raise serum IGF-1 level,and improve bone metabolism.