伊班膦酸钠联合辛伐他汀治疗2型糖尿病合并骨质疏松的临床研究

摘要

目的：探讨伊班膦酸钠联合辛伐他汀治疗对2型糖尿病（ T2DM）合并骨质疏松症患者骨代谢指标（ TRACP-5b、s-CTX、BAP、OC）及骨密度（ BMD）的影响，为临床治疗T2DM合并骨质疏松症提供参考。方法：选择T2DM合并骨质疏松症患者115例，随机分为观察组（n＝58）和对照组（n＝57）。对照组给予常规治疗加用伊班膦酸钠注射液，观察组在对照组基础上联用辛伐他汀。观察两组治疗前、治疗12个月后血Ca、P、ALP、s-CTX、TRACP-5b、BAP、OC及BMD的变化。结果：观察组治疗12个月后TRACP-5b、s-CTX明显低于对照组（P＜0．05），BAP、OC水平则明显高于对照组（P＜0．05）。观察组治疗12个月后腰椎L2～4、股骨颈的BMD明显高于对照组（ P＜0．05）。结论：伊班膦酸钠联合辛伐他汀治疗T2 DM合并骨质疏松症可有效促进骨形成、抑制骨吸收、增加骨BMD，疗效明显优于单纯伊班膦酸钠。提示在防治T2DM合并骨质疏松症时，除了给予抑制骨吸收、促骨形成的药物治疗外，还应积极治疗T2DM，控制影响骨代谢的危险因素，如降血糖、改善胰岛素缺乏和脂代谢异常等，以进一步提高临床疗效。%Objective: To investigate the bone metabolic markers ( TRACP-5b,s-CTX, BAP, OC) and bone mineral density (BMD) of patient with type 2 diabetes mellitus (T2DM) who was treated by ibandronate combined with simvastatin , in order to provide reference for clinical treatment of T 2 DM complicated with osteoporosis . Methods:One hundred and fifteen cases of patients with T 2 DM complicated with osteoporosis were randomly divided into observation group ( n=58 ) and control group ( n =57 ) .Patients in control group were given with ibandronate injection combined with conventional therapy , patients in observation group were treated with simvastatin on basis of treatment of patients in control group .The blood Ca, P, ALP, s-CTX, TRACP-5b,BAP, OC and BMD of patiets in two groups before treatment or at posttreatment 12 months were observed .Results:The TRACP-5b, s-CTX at posttreatment 12 months in observation group were significantly lower than those in control group (P<0.05), the BAP,OC levels were significantly higher than those in control group (P<0.05).The BMD of lumbar L2-4 , femoral neck in observation group at posttreatment 12 months were higher than that in control group(P<0.05).Conclusion:Treating T2DM complicated with osteoporosis by ibandronate combined with simvastatin can effectively promote bone formation , inhibit bone resorption ,increase BMD , its curative effect is obviously better than sodium ibandronate.Therefore, in prevention and treatment of T2DM complicated with osteoporosis, in addition to using drug about inhibiting bone resorption , promoting bone formation , actively treating T2DM, controlling effect of risk factors of bone metabolism such as lowering blood glucose , improving insulin deficiency and abnormal lipid metabolism should be done , so that clinical efficacy is further improved .