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目的探讨阿仑膦酸钠联合胰岛素治疗2型糖尿病(diabetic mellitus,DM)骨质疏松(osteoporosis,OP)疗效及其作用机制。方法选择2015年3月—2016年3月间温州市人民医院收治的DM合并OP患者94例,经随机数表法将94例患者分为观察组及对照组各47例,所有患者在入院后均常规治疗,给予对照组患者二甲双胍联合胰岛素治疗,给予观察组患者阿仑膦酸钠联合胰岛素治疗,评价2组患者临床疗效,检测血清中糖化血红蛋白(HbA1c)、空腹血糖(FPG)、血钙(Ca)、抗酒石酸酸性磷酸酶5b(TRAP-5b)、骨钙素(BGP)、骨特异性碱性磷酸酶(BAP)水平。经DPX-LBMD双能x线测量仪测定股骨颈、Wards三角、大转子的骨密度(BMD)。结果观察组总有效率为89.36%,高于对照组的72.34%,差异有统计学意义(P<0.05);治疗后观察组BAP、TRAP-5b、BGP水平优于对照组,差异均有统计学意义(均P<0.05);治疗后观察组股骨颈、Wards三角、大转子的BMD高于对照组,差异均有统计学意义(均P<0.05)。结论采用阿仑膦酸钠联合胰岛素对DM合并OP治疗可有效提高骨密度水平,疗效显著,安全性高,值得推广。
Objective To investigate the curative effect and mechanism of alendronate combined with insulin on diabetic mellitus (DM) osteoporosis (OP). Methods From March 2015 to March 2016, 94 patients with DM combined with OP in Wenzhou People’s Hospital were enrolled, 94 patients were divided into observation group and control group by random number table method, 47 cases in each group. All patients were admitted to hospital All patients in the control group were given metformin combined with insulin therapy. Patients in the observation group were treated with alendronate plus insulin. The clinical efficacy was evaluated in both groups. HbA1c, fasting blood glucose (FPG), serum calcium (Ca), tartrate-resistant acid phosphatase 5b (TRAP-5b), osteocalcin (BGP) and bone-specific alkaline phosphatase (BAP) The bone mineral density (BMD) of femoral neck, Wards triangle and greater trochanter were measured by DPX-LBMD dual-energy x-ray apparatus. Results The total effective rate in observation group was 89.36%, which was higher than that in control group (72.34%), the difference was statistically significant (P <0.05). After treatment, the levels of BAP, TRAP-5b and BGP in observation group were better than those in control group (All P <0.05). The BMD of femoral neck, Wards triangle and greater trochanter in the observation group after treatment were significantly higher than those in the control group (all P <0.05). Conclusion The combination of alendronate and insulin on DM combined with OP can effectively increase the bone mineral density, with significant curative effect and high safety. It is worth popularizing.