阿仑膦酸钠联合胰岛素治疗糖尿病骨质疏松疗效研究

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。 

Alendronate sodium combined with insulin for osteoporosis in patients with type 2 diabetes mellitus

Objective To investigate the efficacy and mechanism of alendronate sodium combined with insulin in the treatment of osteoporosis(OP) in the patients with type 2 diabetes mellitus(DM). Methods Total 94 cases of OP among patients with T2DM in our hospital between March,2015 and March,2016 were enrolled and randomly divided into observation group(47 cases) and control group(47 cases).On the basis of routine treatment,the control group was administrated with metformin and insulin,while the observation group with alendronate sodium and insulin.The levels of serum glycosylated hemoglobin(HbA1c),fasting blood-glucose(FBG),serum calcium(Ca),tartrate-resistant acid phosphatase 5b(TRAP-5b),bone gla protein(BGP),and bone-specific alkaline phosphatase(BAP) were tested.The bone mineral density(BMD) of the femoral neck,Wards triangle and greater trochanter were measured by DPX-LBMD dual energy x-ray measuring instrument. Results The total effective rate was 89.36% in the observation group and significantly higher than that(72.34%) in the control group(P<0.05).The levels of BAP,TRAP-5b and BGP after the treatment in the observation group were improved more significantly as compared with the control group(all P<0.05).The BMD of the femoral neck,wards triangle and the greater trochanter in the observation group were significantly higher than those in the control group(all P<0.05). Conclusion Alendronate sodium combined with insulin in the treatment of osteoporosis among the patients with type 2 diabetes mellitus can effectively improve the level of bone mineral density,with remarkable effect,high safety,and is worthy of promotion.