摘要
目的前瞻性随机对照研究辛伐他汀对更年期糖尿病患者骨密度、骨代谢的影响。方法前瞻性选取2017年5月至2018年12月南京大学医学院附属鼓楼医院收治的116例更年期糖尿病患者,随机数字表法分为两组,各58例。对照组给予饮食与运动指导和(或)胰岛素降糖,观察组在此基础上给予辛伐他汀,两组均治疗1年。比较两组治疗前后血糖[糖化血红蛋白(HbA1c)、空腹血糖(FBG)、餐后2 h血糖(2 hPG)]、胰岛功能[稳态模型胰岛素抵抗指数(HOMA-IR)]、血脂[甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)]、改良Kupperman评分法评分、骨形成指标[骨保护素(OPG)、Ⅰ型胶原氨基端肽原(PⅠNP)、骨源性碱性磷酸酶(BAP)、骨钙素(OC)]水平、骨吸收指标[Ⅰ型胶原C端肽(CTX)、β-异构C-端肽(β-CTX)、抗酒石酸酸性磷酸酶(TRACP-5b)]水平、骨骼强度指标[全髋、腰椎L 2~4、Ward三角区骨密度(BMD)]、血钙、血磷水平。结果治疗后HbA1c、FBG、2 hPG、TG、TC、HDL-C组间比较差异无统计学意义(P>0.05);治疗后HOMA-IR高于对照组,观察组LDL-C、改良Kupperman评分低于对照组(P<0.05);治疗后观察组OPG、BAP、OC高于对照组(P<0.05);治疗后组间PⅠNP比较,差异无统计学意义(P>0.05);治疗后观察组CTX、β-CTX、TRACP-5b低于对照组(P<0.05);观察组治疗后全髋、腰椎L 2~4、Ward三角区BMD高于对照组(P<0.05);治疗后组间血钙、血磷水平比较,差异无统计学意义(P>0.05)。结论辛伐他汀可能改善更年期糖尿病患者更年期症状与脂质水平,提高骨密度,改善骨代谢,但会影响胰岛β细胞功能,临床应用时可联合保护胰岛β细胞或内分泌胰腺作用的药物,以提高患者受益。
Objective To investigate the effects of simvastatin on bone density and bone metabolism in patients with menopausal diabetes in a prospective randomized controlled study.Methods A total of 116 patients with menopausal diabetes admitted to Nanjing Drum Tower Hospital,Nanjing University from May 2017 to December 2018 were prospectively selected and divided into two groups by random number table method,with 58 patients in each group.The control group was given comprehensive treatment,and the observation group was given simvastatin,on this basis,both groups were treated for one year.The blood glucose[glycated hemoglobin(HbA1c),fasting blood glucose(FBG),2 h postprandial blood glucose(2 hPG)],islet function[steady-state model insulin resistance index(HOMA-IR)],blood lipids[triglycerides(TG),total cholesterol(TC),high-density lipoprotein(HDL-C),and low-density lipoprotein(LDL-C)],the scores of modified Kupperman score,bone formation indexes[osteoprotectin(OPG),typeⅠcollagen aminopeptide(PⅠNP),bone-derived alkaline phosphatase(BAP),and osteocalcin(OC)]level,the levels of bone resorption indicators[type I collagen C-terminal peptide(CTX),β-isomeric C-terminal peptide(β-CTX),and tartrate-resistant acid phosphatase(TRACP-5b)],the bone strength indicators[total hips,lumbar spine L 2~4,bone density in the Ward triangle(BMD)],blood calcium,and blood phosphorus levels were compared between the two groups before and after treatment.Results There was no significant difference in HbA1c,FBG,2 hPG,TG,TC,and HDL-C after treatment(P>0.05);after treatment,HOMA-IR was higher than those in the control group,and the LDL-C and modified Kupperman scores in the observation group were lower than those in the control group(P<0.05);the OPG,BAP,and OC in the observation group were higher than those in the control group after treatment(P<0.05);there was no significant difference in PⅠNP between the groups after treatment(P>0.05);after treatment,the CTX,β-CTX and TRACP-5b in the observation group were lower than those in the control grou
作者
李杰
上官海燕
陈晓倩
王亚梅
仲彬
周琪
LI Jie;SAHNGGUAN Hai-yan;CHEN Xiao-qian(Department of Endocrinology,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing Jiangsu 210008,China;Department of Endocrinology,Nanjing Central Hospital,Nanjing Jiangsu 210018,China)
出处
《临床和实验医学杂志》
2020年第20期2188-2192,共5页
Journal of Clinical and Experimental Medicine
基金
江苏省卫生健康委科研项目(编号:Z2019026)
南京市科技局基金项目(编号:YKK17269)。
关键词
更年期糖尿病
辛伐他汀
骨密度
骨代谢
脂质代谢
胰岛功能
Menopausal diabetes
Simvastatin
Bone density
Bone metabolism
Lipid metabolism
Islet function
