摘要
目的探讨唑来膦酸联合活性维生素D及骨化三醇对2型糖尿病性骨质疏松症(T2DOP)患者骨密度、血清骨硬化蛋白及骨特异性碱性磷酸酶(BALP)等骨代谢指标的影响。方法选取2018年6月至2019年12月杭州市萧山区中医院收治的T2DOP患者92例作为研究对象,采用随机数字表法分为干预组和对照组,每组46例。两组患者均接受常规降血糖治疗,对照组采取活性维生素D联合骨化三醇方案治疗,干预组在此基础上加用唑来膦酸注射液,静脉滴注,1次/年。治疗1年后,观察并比较两组患者治疗前后血清FPG、餐后2 h血糖(2 h PPG)、糖化血红蛋白(HbA_(1C))等血糖指标,骨保护素(OPG)、骨硬化蛋白、BALP、血钙、血磷、骨钙素(OC)、1型胶原C端β特殊序列(β-CTX)等骨代谢指标,股骨颈、腰椎骨L_(1~4)和Ward三角区骨密度情况,视觉模拟评分(VAS)及不良反应发生情况。结果两组患者治疗前后FPG、2 h PPG、HbA_(1C)水平比较差异均无统计学意义(均P>0.05),但两组治疗后FPG、2 h PPG、HbA_(1C)水平均低于治疗前,差异均有统计学意义(均P<0.05)。干预组患者血清OPG、BALP、骨硬化蛋白、OC水平均高于对照组,β-CTX水平低于对照组,且两组治疗后血清OPG、BALP、骨硬化蛋白、OC水平均高于治疗前,β-CTX水平均低于治疗前,差异均有统计学意义(均P<0.05)。治疗后,干预组患者股骨颈、腰椎骨L_(1~4)和Ward三角区骨密度均高于对照组,且两组患者治疗后股骨颈、腰椎骨L_(1~4)和Ward三角区骨密度均高于治疗前,差异均有统计学意义(均P<0.05)。治疗后,干预组患者VAS评分低于对照组,且两组患者治疗后VAS评分均低于治疗前,差异均有统计学意义(均P<0.05)。两组患者均未发生严重不良反应。结论唑来膦酸联合活性维生素D及骨化三醇能有效改善T2DOP患者血清骨硬化蛋白及骨代谢指标的表达情况,提高患者的骨密度,临床疗效显著且具有一定的安全性
Objective To investigate the effects of zoledronic acid combined with active vitamin D and calcitriol on bone mineral density,serum sclerostin and bone alkaline phosphatase(BALP)in patients with type 2 diabetic osteoporosis(T2DOP).Methods Ninety-two patients with T2DOP admitted to Hangzhou Xiaoshan District Hospital of Traditional Chinese Medicine from June 2018 to December 2019 were enrolled.The patients were randomly divided into study group and control group with 46 cases in each group.Patients in both groups received conventional hypoglycemic therapy,and active vitamin D combined with calcitriol,the study group received additional zoledronic acid injection.After 1 year of treatment,the serum FPG,2 h-postprandial plasma glucose(2 h PPG),HbA_(1C) and other blood glucose indexes,OPG,osteosclerosis protein,BALP,blood calcium,blood phosphorus,OC,β-CTX and other bone metabolic indexes,bone mineral density of the femoral neck,lumbar vertebrae and Ward triangle were measured and compared between the two groups.The visual analogue scale/score(VAS)and adverse reactions were also compared between the two groups.Results There were no significant differences in the levels of FPG,2 h PPG and HbA_(1C) between two groups before and after treatment(all P>0.05),but the levels of FPG,2 h PPG and HbA_(1C) in the two groups after treatment were lower than thsose before treatment(all P<0.05).The levels of serum OPG,BALP,osteosclerin and OC in the study group were higher than those in the control group,while the levels ofβ-CTX were lower than those in the control group.The levels of serum OPG,BALP,osteosclerin and OC in the two groups after treatment were higher than those before treatment,and the levels ofβ-CTX were lower than those before treatment(all P<0.05).After treatment,the bone mineral density of the femoral neck,lumbar vertebra and Ward triangle in the study group was higher than that in the control group,these indicators were higher than those before treatment in both groups(all P<0.05).After treatment,VAS score in th
作者
沈小利
张灿芬
陈璐
SHEN Xiaoli;ZHANG Canfen;CHEN Lu(First-author's address:Department of Orthopedics,Hangzhou Xiaoshan District Hospital of Traditional Chinese Medicine(Jiangnan Hospital Affiliated to Zhejiang Chinese Medical University),Hangzhou 311201,China)
出处
《浙江医学》
CAS
2022年第9期945-949,共5页
Zhejiang Medical Journal
