双膦酸盐联合钙尔奇D治疗老年2型糖尿病骨质疏松女性疗效的影响因素分析

摘要

目的 研究阿伦膦酸盐联合钙尔奇D治疗老年女性T2DM患者骨质疏松疗效的影响因素. 方法 老年女性T2DM骨质疏松患者67例,随机接受钙尔奇D或阿伦膦酸盐联合钙尔奇D治疗6个月,检测治疗前后骨密度(BMD)及生化、骨盐代谢指标. 结果 阿伦膦酸盐联合钙尔奇D疗效优于钙尔奇D.与联合治疗6个月腰椎、髋骨BMD改善正相关的指标:FPG(r=0.287和0.160)、HbA1c(r =0.283和0.110)、糖尿病病程(r=0.137和0.072)、治疗中增加胰岛素的剂量(r=0.201和0.082)、HbA1c降低幅度(r=0.302和0.139)、尿钙/Cr(r=0.115和0.096)、尿羟脯氨酸/Cr(r=0.132和0.123)、血清抗酒石酸酸性磷酸酶(r=0.204和0.296)、血碱性磷酸酶(r=0.184和0.073)、骨钙素(r=0.149和0.065)、骨碱性磷酸酶(r=0.263和0.486)(P均＜0.05).而与FC-P水平(r=-0.136和-0.212)、24 h UA1b(r=-0.220和-0.077)和基线时的骨密度(股骨颈)(r=-0.316和-0.245)负相关(P均＜0.05). 结论 阿伦膦酸盐联合钙尔奇D治疗老年女性T2DM患者骨质疏松,病情越重者获益越多,但大量UAlb影响疗效.%Objective To investigate the affecting factors of therapeutic effect of combined alendronate and caltrate D on osteoporosis in elderly type 2 diabetic women. Methods Sixty-seven elderly type 2 diabetic women were randomized into caltrate D group and comined alendronate and caltrate D group. After treatment for 6 months, the changes in bone mineral density (BMD) and biochemical and bone metabolism indices were determined for comparisoa Results The effect of combined alendronate and caltrate D was better than that of caltrate D. Those parameters positively related with the improvement of BMD of lumbar vertebrae and hip bone were fasting blood glucose (r=0. 287 and 0. 160), HbA1c 0=0. 283 and 0.110), duration of diabetes 0=0.137 and 0. 072), increased dosage of insulin (r = 0: 201 and 0. 082) , decreased amplitude of HbA1c (r=0. 302 and 0. 139) , urinary Ca/Cr (r=0. 115 and 0. 096) , urinary hydroxyproline/Cr (r=0. 132 and 0. 123) , tartrate-resistant acid phosphatase -5b 0=0. 204 and 0. 296), alkaline phosphatase (r = 0. 184 and 0. 073), osteocalcin 0=0. 149 and 0. 065), and bone-specific alkaline phosphatase (r=0. 263 and 0. 486) (all P<0. 05). But it was negatively related with the fasting C-peptide (r= — 0. 136 and —0. 212), 24 h urinary albumin excretion (r=— 0. 220 and —0. 077), and baseline BMD (femur neck) (r= — 0. 316 and -0. 245) (all P<0. 05). Conclusion Treatment with alendronate plus caltrate D is effective for elderly type 2 diabetic women with osteoporosis. The more the serious the condition, the more the benefit High urinary albumin excretion affects the results.