CAJ | 학술논문

目的：通过观察胰岛素、阿仑膦酸钠干预，观察在糖尿病骨质疏松症治疗12个月后股骨颈（ Femur Neck ）骨密度（BMD）及骨特异性碱性磷酸酶（BAP）、骨钙素（BGP）、抗酒石酸酸性磷酸酶-5b（TRAP-5b）等血清骨转换指标的变化。方法选取在我院治疗的糖尿病骨质疏松症患者128例，随机分成4组，即对照组（ METF）、胰岛素组（ INSU）、二甲双胍＋阿仑膦酸钠组（ METF＋ALEN）、胰岛素＋阿仑膦酸钠组（ INSU＋ALEN），每组同时服用钙尔奇D片作为基础用药，分别于服药前及服药12月后，测定4组患者股骨颈BMD及血BAP、BGP、TRAP-5b，分析治疗前后以及治疗组与对照组间的差异。结果 INSU＋ALEN组治疗12月可见患者骨密度较前增加，治疗前后有统计学意义（ P＜0.05）， METF、INSU组较前无明显改变，治疗前后无统计学意义（P＞0.05），METF＋ALEN组治疗12月可见患者BMD较前略有增加，治疗前后无统计学意义（P＞0.05），INSU＋ALEN组治疗后BMD的增加明显高于其它组（P均＜0.05）。 INSU＋ALEN治疗组患者治疗12月后血清BAP、BGP显著升高（P＜0.05），TRAP-5b显著降低（P＜0.05）；将上述指标与对照组、其它治疗组比较， BAP、BGP、TRAP-5b差异显著（P均＜0.01）；METF、INSU、METF＋ALEN组治疗12月可见患者血清BAP、BGP较前略有增加，TRAP-5b略有降低，治疗前后无统计学意义（P＞0.05）。结论胰岛素是糖尿病骨质疏松症首选治疗，可增加骨量，预防骨丢失。阿仑膦酸钠能抑制骨吸收，促进骨形成，减缓骨量丢失，提高骨密度，二者联用可有效防治糖尿病骨质疏松症。
목적：통과관찰이도소、아륜련산납간예，관찰재당뇨병골질소송증치료12개월후고골경（ Femur Neck ）골밀도（BMD）급골특이성감성린산매（BAP）、골개소（BGP）、항주석산산성린산매-5b（TRAP-5b）등혈청골전환지표적변화。방법선취재아원치료적당뇨병골질소송증환자128례，수궤분성4조，즉대조조（ METF）、이도소조（ INSU）、이갑쌍고＋아륜련산납조（ METF＋ALEN）、이도소＋아륜련산납조（ INSU＋ALEN），매조동시복용개이기D편작위기출용약，분별우복약전급복약12월후，측정4조환자고골경BMD급혈BAP、BGP、TRAP-5b，분석치료전후이급치료조여대조조간적차이。결과 INSU＋ALEN조치료12월가견환자골밀도교전증가，치료전후유통계학의의（ P＜0.05）， METF、INSU조교전무명현개변，치료전후무통계학의의（P＞0.05），METF＋ALEN조치료12월가견환자BMD교전략유증가，치료전후무통계학의의（P＞0.05），INSU＋ALEN조치료후BMD적증가명현고우기타조（P균＜0.05）。 INSU＋ALEN치료조환자치료12월후혈청BAP、BGP현저승고（P＜0.05），TRAP-5b현저강저（P＜0.05）；장상술지표여대조조、기타치료조비교， BAP、BGP、TRAP-5b차이현저（P균＜0.01）；METF、INSU、METF＋ALEN조치료12월가견환자혈청BAP、BGP교전략유증가，TRAP-5b략유강저，치료전후무통계학의의（P＞0.05）。결론이도소시당뇨병골질소송증수선치료，가증가골량，예방골주실。아륜련산납능억제골흡수，촉진골형성，감완골량주실，제고골밀도，이자련용가유효방치당뇨병골질소송증。
Objective To observe the intervention of insulin and alendronate sodium, and to investigate the changes of bone specificity alkaline phospha-tase (BAP), tartrate-resistant acid phosphatase-5b (TRAP-5b), osteocalcin (BGP), and the bone mineral density ( BMD) of the femur neck in diabetes patients with osteoporosis after 12-month treatment.Methods One hundred and twenty-eight senile patients with osteoporosis, who were treated in our hospital, were selected and randomly divided into 4 groups:control group ( METF) , insulin group ( INSU) , metformin +alendronate sodium group ( METF +ALEN) , and insulin+alendronate sodium group ( INSU +ALEN) .At the same time, Caltrate D was given as a basic treatment.BMD of the femoral neck and the serum levels of BAP, BGP, and TRAP-5b were detected before the treatment and 12 months after the treatment.And the results were analyzed.Results After 12-month treatment, BMD in INSU +ALEN group increased compared with that before the treatment (P<0.05), while no significant change in METF group and INSU group was observed (P>0.05). BMD of the femoral neck in METF +ALEN group increased slighthly without significant difference (P>0.05).BMD in INSU +ALEN group increased more significantly compared with that in other groups (P<0.05).After 12-month treatment, the levels of BAP and BGP in INSU +ALEN group increased obviously, while the level of TRAP-5b decreased significantly (P <0.05). Compared with that in control group and other treatment groups, the difference was significant (P<0.01).In METF group, INSU group, and METF +ALEN group, the serum levels of BAP and BGP increased slightly after 12-month treatment, while serum TRAP-5b level decreased slightly (P>0.05).Conclusion Insulin is the first choice in the treatment of diabetes mellitus-induced osteoporosis, which can increase bone mass and prevent bone from loss.Alendronate sodium can inhibit bone resorption, promote bone formation, retard the bone mass loss, and raise BMD.The combination of both drugs can prevent and treat diabetes mellitus-induced osteoporosis effectively.