度拉糖肽联合阿法骨化醇对2型糖尿病合并骨质疏松患者的疗效研究

Dulaglutide combined with alfacalcitol for patients with type 2 diabetes mellitus complicated with osteoporosis

目的探究度拉糖肽联合阿法骨化醇对2型糖尿病合并骨质疏松患者的疗效。方法本研究为随机对照试验,选取2022年1月至2023年6月单县中心医院收治的107例2型糖尿病合并骨质疏松患者作为研究对象,采用随机数字表法分为观察组(54例)和对照组(53例)。观察组男25例、女29例,年龄(65.23±8.81)岁,病程(8.53±1.21)年,体质量指数(22.52±1.68)kg/m^(2);对照组男26例,女27例,年龄(66.57±8.91)岁,病程(8.87±1.56)年,体质量指数(22.34±1.59)kg/m^(2)。两组患者均予以二甲双胍常规降糖,对照组在此基础上口服阿法骨化醇,观察组在对照组基础上进行度拉糖肽治疗,两组均持续治疗30 d。对比两组患者临床疗效、血糖水平变化[空腹血糖(FPG)、餐后2 h血糖(2 h PBG)及糖化血红蛋白(HbA1c)]、骨代谢指标变化[血清钙(Ca)、碱性磷酸酶(ALP)及骨特异性碱性磷酸酶(BALP)]及不良反应发生情况。统计学方法采用t检验、χ^(2)检验。结果观察组治疗总有效率为96.30%(52/54),高于对照组的84.91%(45/53),差异有统计学意义(χ^(2)=4.096,P=0.043)。治疗后,观察组FPG、2 h PBG、HbA1c水平均低于对照组[(6.41±1.36)mmol/L比(7.27±1.18)mmol/L、(9.63±2.21)mmol/L比(11.57±2.43)mmol/L、(5.58±1.29)%比(7.21±1.67)%],差异均有统计学意义(t=-3.491、-4.322、-5.656,均P<0.05)。治疗后,观察组Ca、BALP水平均高于对照组[(2.67±0.45)mmol/L比(2.43±0.48)mmol/L、(19.38±3.31)U/L比(17.27±3.19)U/L],ALP水平低于对照组[(32.75±9.34)U/L比(36.82±9.49)U/L],差异均有统计学意义(t=2.669、3.357、-2.225,均P<0.05)。观察组不良反应发生率为5.56%(3/54),与对照组[9.43%(5/53)]比较,差异无统计学意义(χ^(2)=0.582,P=0.446)。结论度拉糖肽联合阿法骨化醇治疗2型糖尿病合并骨质疏松患者,可以有效提高临床疗效,控制血糖,改善骨质疏松情况,且具有安全性。

Objective To explore the curative effect of dulaglutide combined with alfacalcitol for patients with type 2 diabetes mellitus complicated with osteoporosis.Methods A total of 107 patients with type 2 diabetes mellitus complicated with osteoporosis admitted to Department of Endocrinology,Shanxian Central Hospital from January 2022 to June 2023 were selected for the randomized controlled trial,and were divided into an observation group(54 cases)and a control group(53 cases)by the random number table method.In the control group,there were 26 males and 27 females;they were(66.57±8.91)years old;the diabetes course was(8.87±1.56)years;their body mass index was(22.34±1.59)kg/m^(2).In the observation group,there 25 males and 29 females;they were(65.23±8.81)years old;the diabetes course was(8.53±1.21)years;their body index was(22.52±1.68)kg/m^(2).Both groups were given metformin for routine hypoglycemia;in addition,the control group orally took alfacalcitol,and the observation group took dulaglutide and alfacalcitol.The clinical efficacies,changes of blood glucose[fasting plasma glucose(FPG),2 hours plasma glucose(2hPG),and glycosylated hemoglobin(HbA1c)]and bone metabolism indicators,and incidences of adverse reactions in both groups were observed.t andχ^(2) tests were observed.Results The total effective rate of the observation group was higher than that of the control group[96.30%(52/54)vs.84.91%(45/53)],with a statistical difference(χ^(2)=4.096,P=0.043).After the treatment,the levels of FPG,2 h PBG,and HbA1c in the observation group were lower than those in the control group[(6.41±1.36)mmol/L vs.(7.27±1.18)mmol/L,(9.63±2.21)mmol/L vs.(11.57±2.43)mmol/L,and(5.58±1.29)%vs.(7.21±1.67)%],with statistical differences(t=-3.491,-4.322,and-5.656;all P<0.05).After the treatment,the serum calcium(Ca)concentration and bone specific alkaline phosphatase(BALP)level in the observation group were higher than those in the control group[(2.67±0.45)mmol/L vs.(2.43±0.48)mmol/L and(19.38±3.31)U/L vs.(17.27±3.19)U/L];the alkaline phosphatase(ALP)level in the observation group was lower than that in the control group[(32.75±9.34)U/L vs.(36.82±9.49)U/L];there were statistical differences(t=2.669,3.357,and-2.225;all P<0.05).There was no statistical differences in the incidence of adverse reactions between the observation group and the control group[5.56%(3/54)vs.9.43%(5/53);χ^(2)=0.582;P=0.446].Conclusion Duloglucoptide combined with alfacalcitol is effective in the treatment of patients with type 2 diabetes mellitus complicated with osteoporosis,and can effectively control their blood glucose and improve their osteoporosis,and is safe.