CAJ | 학술논문

目的：研究抗骨质疏松药物对糖皮质激素诱导的骨质疏松症患者血糖稳态的影响。方法选取2009年8月至2012年8月于本院诊断为骨质疏松症且符合入组标准的122例患者为研究对象。随机将患者分为阿伦膦酸盐组，特立帕肽组，钙制剂和维生素D组。比较并分析三组患者应用抗骨质疏松药物前后血糖水平（空腹血糖、糖化血红蛋白）和骨代谢水平（β-胶原特殊序列、骨钙素）变化情况。结果32名（26.2％）患者的骨钙素（ OC）初始值水平低于正常标准。56名（45.9％）患者，根据其血糖初始值水平，诊断为糖耐量异常或糖尿病。 B组患者应用特立帕肽一年后的空腹血糖（FBG）（5.2±0.8 mmol／L）显著低于初始值（5.6±1.0 mmol／L）（P＝0.049）；一年后的糖化血糖蛋白（HbAlc）水平（5.3±1.0％）显著低于初始值（5.9±1.3％）P＝0.021）。且B组患者一年后糖耐量异常患者比例（7.3％）较初始比例（24.3％）显著下降（P＝0.033）；糖尿病（4.8％）比例较初始比例（21.9％）亦显著下降（P＝0.023）。 A、B、C三组患者应用抗骨质疏松药物6个月及1年后，β-胶原特殊序列（β-CTx）水平均显著低于初始值（P值均＜0.05）；而OC水平均显著高于初始值（P值均＜0.05）。 B组应用抗骨质疏松药物1年后，其OC水平（16.4±0.9μg／l）显著高于同期A组（15.9±1.1μg／l）、C组（15.7±0.9μg／l）的OC水平（ P值分别为0.027，0.001）。结论初步认为骨形成促进剂类抗骨质疏松药物（特立帕肽）可以对糖皮质激素诱导的骨质疏松患者的糖代谢平衡产生一定影响，但仍然需要更完善的实验去提供更多的循证依据。
목적：연구항골질소송약물대당피질격소유도적골질소송증환자혈당은태적영향。방법선취2009년8월지2012년8월우본원진단위골질소송증차부합입조표준적122례환자위연구대상。수궤장환자분위아륜련산염조，특립파태조，개제제화유생소D조。비교병분석삼조환자응용항골질소송약물전후혈당수평（공복혈당、당화혈홍단백）화골대사수평（β-효원특수서렬、골개소）변화정황。결과32명（26.2％）환자적골개소（ OC）초시치수평저우정상표준。56명（45.9％）환자，근거기혈당초시치수평，진단위당내량이상혹당뇨병。 B조환자응용특립파태일년후적공복혈당（FBG）（5.2±0.8 mmol／L）현저저우초시치（5.6±1.0 mmol／L）（P＝0.049）；일년후적당화혈당단백（HbAlc）수평（5.3±1.0％）현저저우초시치（5.9±1.3％）P＝0.021）。차B조환자일년후당내량이상환자비례（7.3％）교초시비례（24.3％）현저하강（P＝0.033）；당뇨병（4.8％）비례교초시비례（21.9％）역현저하강（P＝0.023）。 A、B、C삼조환자응용항골질소송약물6개월급1년후，β-효원특수서렬（β-CTx）수평균현저저우초시치（P치균＜0.05）；이OC수평균현저고우초시치（P치균＜0.05）。 B조응용항골질소송약물1년후，기OC수평（16.4±0.9μg／l）현저고우동기A조（15.9±1.1μg／l）、C조（15.7±0.9μg／l）적OC수평（ P치분별위0.027，0.001）。결론초보인위골형성촉진제류항골질소송약물（특립파태）가이대당피질격소유도적골질소송환자적당대사평형산생일정영향，단잉연수요경완선적실험거제공경다적순증의거。
Objective To investigate the effects of anti-osteoporotic on glucose homeostasis in patients with glucocorticoid-induced osteoporosis.Methods Patients with osteoporosis who met the inclusion criteria ( n=122) in our hospital between August 2009 and August 2012 were recruited.They were divided into alendronate group (A), teriparatide group (B), and calcium and vitamin D group ( C) randomly.Blood glucose levels ( FBG and HbAlc) and bone turnover levels (β-CTX and OC) were compared and analyzed before and after the treatment.Results OC value was below the reference range in 32 patients (26.2%) at the initial time of the study.Fifty-six patients ( 45.9%) were diagnosed as glucose tolerance disorder or diabetes mellitus according to their initial blood glucose level.The level of FBG ( 5.2 ±0.8 mmol/L ) in B group after 1-year treatment was significant lower than that before the treatment (5.6 ±1.0 mmol/L, P=0.049).In B group, the level of HbAlc (5.3 ±1.0%) after 1-year treatment was significant lower than that before the treatment experiment ( 5.9 ±1.3%, P =0.021 ) .The ratio of impaired glucose tolerance in patients and diabetes mellitus decreased significantly (24.3%to 7.3%, P=0.033;21.9%to 4.8%, P=0.023, respectively) .β-CTX level after 6 months and 1 year treatment was significantly lower than that before the treatment in A, B, and C group (p<0.05), but OC level was higher (p<0.05).OC level in B group (16.4 ±0.9μg/l) was higher than that in group A (15.9 ±1.1 μg/l) and C (15.7 ±0.9 μg/l) after 1-year treatment (P =0.027 and P =0.001, respectively). Conclusion The anti-osteoporotic bone-anabolic drug teriparatide may affect glucose metabolism in patients with glucocorticoid-induced osteoporosis.But more studies are needed to provide more evidence.