CAJ | 학술논문

目的：探讨绝经后2型糖尿病（type 2 diabetes mellitus，T2DM）合并骨质疏松（osteoporosis，OP）患者的糖代谢、骨代谢、骨密度（bone mineral density，BMD）与饮食及运动管理的相关性。方法选择562例绝经后妇女T2DM合并OP患者，分为严格管理组（管理组）278例；一般指导组（对照组）284例。分别给予严格管理和一般管理，所有患者均为口服降糖药物，同时每天口服钙尔奇D600mg和骨化三醇0.25μg，在0、24、48 w测定糖代谢指标HbA1C、FPG，和骨代谢指标血清25羟基维生素D3（VitD3）、骨碱性磷酸酶（bone alkaline phosphate，BALP）、抗酒石酸酸性磷酸酶（tartrate-resistant acid phosphatase，TrAP-5b）、血清骨钙素（osteocalcin，OT），用双能X线仪测定不同部位BMD等指标，探讨经过严格管理后各指标的变化情况。结果在24 w时，管理组与基线、对照组相比血糖均明显下降，48 w时更加显著，血清HbA1C管理组的不同时间分别为：8.16±1.50％、7.10±1.60％、6.01±1.59％，对照组分别为：8.46±1.65％、8.16±1.03％、8.21±1.02％，观察到无论是管理组还是对照组，糖化血红蛋白都有所下降，但管理组更加明显，组间相比差异均显著（P＜0.01）。同时TrAP-5b均较对照组明显下降（P＜0.01），VitD3、BALP、OT升高显著（P＜0.01），管理组腰椎、股骨颈BMD自24 w始，逐渐上升，对照组呈下降状态，48 w时，两组BMD差异显著（P值均＜0.01）。结论根据T2DM合并OP患者的具体情况，进行严格的饮食控制、适当的运动等个体化管理后，在原药物治疗的基础上，不但可以有效地控制血糖，同时具有减少骨量丢失，增加骨密度的作用。
목적：탐토절경후2형당뇨병（type 2 diabetes mellitus，T2DM）합병골질소송（osteoporosis，OP）환자적당대사、골대사、골밀도（bone mineral density，BMD）여음식급운동관리적상관성。방법선택562례절경후부녀T2DM합병OP환자，분위엄격관리조（관리조）278례；일반지도조（대조조）284례。분별급여엄격관리화일반관리，소유환자균위구복강당약물，동시매천구복개이기D600mg화골화삼순0.25μg，재0、24、48 w측정당대사지표HbA1C、FPG，화골대사지표혈청25간기유생소D3（VitD3）、골감성린산매（bone alkaline phosphate，BALP）、항주석산산성린산매（tartrate-resistant acid phosphatase，TrAP-5b）、혈청골개소（osteocalcin，OT），용쌍능X선의측정불동부위BMD등지표，탐토경과엄격관리후각지표적변화정황。결과재24 w시，관리조여기선、대조조상비혈당균명현하강，48 w시경가현저，혈청HbA1C관리조적불동시간분별위：8.16±1.50％、7.10±1.60％、6.01±1.59％，대조조분별위：8.46±1.65％、8.16±1.03％、8.21±1.02％，관찰도무론시관리조환시대조조，당화혈홍단백도유소하강，단관리조경가명현，조간상비차이균현저（P＜0.01）。동시TrAP-5b균교대조조명현하강（P＜0.01），VitD3、BALP、OT승고현저（P＜0.01），관리조요추、고골경BMD자24 w시，축점상승，대조조정하강상태，48 w시，량조BMD차이현저（P치균＜0.01）。결론근거T2DM합병OP환자적구체정황，진행엄격적음식공제、괄당적운동등개체화관리후，재원약물치료적기출상，불단가이유효지공제혈당，동시구유감소골량주실，증가골밀도적작용。
Objective To explore the association among the management of diet and sport, glucose metabolism, bone metabolism, and bone mineral density (BMD) in postmenopausal women with type 2 diabetes mellitus (T2DM) and osteoporosis (OP).Methods A total of 562 postmenopausal women with T2DM and OP were selected and divided into two groups: the manage group (n=278), and the control group (n=284).Subjects in the 2 groups were given strict management and general management, respectively.All the patients took oral medication of glucose-lowering drugs with 600mg/d Caltrate D and 0.25 ug/d calcitriol, simultaneously.At the beginning, the 24th week, and the 48th week of the treatment, the glucose metabolism indexes such as glycosylated hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG), and the bone metabolism indexes such as vitamin D3 (VitD3 ), bone alkaline phosphatase (BALP), tartrate-resistant acid phosphatase-5b (TRAP-5b), and serum osteocalcin ( OC) were detected.BMD of different parts were measured using dual-energy X-ray absorptiometry, in order to explore the changes of each index after strict management.Results At the 24th week, HbA1C in the manage group decreased significantly compared to that in the control group, while at the 48th week, the result was even more significant.HbA1C in the manage group was 8.16 ± 1.50%, 7.10 ±1.60%, and 6.01 ±1.59%at the 0, the 24th , and the 48th week, respectively; and HbA1C in the control group was 8.46 ±1.65%, 8.16 ±1.03%, and 8.21 ±1.02%, respectively.The decrease of HbA1C was observed in both manage group and control group, and was much more obvious in the manage group, and the difference between groups was significant (P <0.01).Meanwhile TRAP-5b in the manage group decreased obviously compared to that in the control group, while BALP, VitD3, and OC increased significantly (P<0.01).After 24th week treatment, BMD of the lumbar vertebrae and the femoral neck in the manage group increased gradually, while in the control group BMD showed a decreasing tendency.At the 48th week, BMD in 2 groups showed significant difference (P<0.01).Conclusion According to the specific condition in T2DM patients with OP, on the basis of original drug treatment, the management of strict diet control and appropriate individual exercise can effectively control the blood sugar, reduce bone loss, and increase BMD.