老年女性2型糖尿病患者骨代谢标志物变化研究

目的 探讨老年女性2型糖尿病患者骨代谢标志物的特征. 方法 对我院内分泌科住院44例老年女性2型糖尿病患者(均为绝经后)的骨代谢标志物进行检测.糖尿病患者根据病程分为耱尿病1组(糖尿病病程＜10年)及糖尿病2组(糖尿病病程≥10年)；根据糖化血红蛋白水平(HbA1c)分为糖尿病3组(HbA1c＜8％)及糖尿病4组( HbA1c≥8％),目前临床上建议老年患者HbA1c水平控制在＜8％为宜.同时选取我院50例体检健康女性作为对照组.结果 (1)耱尿病组25-羟维生素D3、Ⅰ型前胶原氨基末端(C端)前肽(PICP)明显低于正常对照组,而抗酒石酸碱性磷酸酶(TrACP-5b)较对照组明显升高,且有统计学差异(P＜0.05).(2)糖尿病2组患者血Ⅰ型前胶原氨基末端(N端)前肽(PINP)和PICP水平明显低于糖尿病1组患者(P＜0.05),而TrACP-5b水平高于1组,雌二醇、25-羟维生素D3则无明显统计学差异.(3)糖尿病3组血PINP、PICP明显高于糖尿病4组,TrACP-5b低于4组,差异存在统计学意义(P＜0.05).(4) HbA1c与HNP、PICP和TrACP-5b存在显著相关性,而雌二醇与PINP、PICP、25-羟维生素D3、TrACP-5b无明显相关性. 结论 2型糖尿病患者的骨形成降低,而骨吸收增加.这提示糖尿病患者的骨质形成减弱、骨质破坏增加.随着糖尿病病程的延长,患者的骨质形成速率减慢,骨吸收增加.血糖控制不佳会对骨的形成及骨质的吸收产生影响,因而严格的血糖控制可有效延缓骨质疏松进展.

Bone metabolism markers in elderly female patients with type 2 diabetes mellitus

Objective To investigate the bone metabolism markers in elderly female patients with type 2 diabetes mellitus(T2DM).Methods Forty-four elderly female patients with T2DM(all of them were postmenopausal)hospitalized in this hospital were recruited.Bone metabolism markers were detected.Patients were divided into T2DM group 1(duration below 10 years) and group 2(duration more than 10 years,including 10 years) according to their duration of diabetes;and according to HbA1c levels,patients were divided into T2DM group 3(HbA1c<8%) and group 4(HbA1c≥8%).Fifty healthy females were chosen as the control group.Results(1)The levels of 25-OH VitD3 and PICP in patients were significantly lower than those of control group,while the level of TrACP-5b was significantly higher than that of control group(P<0.05).(2)The levels of PINP and PICP in T2DM group 2 were lower than those of group 1(P<0.05),while the level of TrACP-5b was higher than that of group 1.There was no statistical differences in serum estradiol and 25-OH VitD3.(3)The levels of PINP,PICP in T2DM group 3 were much higher than those of group 4 and TrACP-5b was lower than that of group 4(P<0.05).(4)HbA1c was related to PINP,PICP and TrACP-5b,however estradiol had no evident relativity with PINP,PICP,25-OH VitD3 and TrACP-5b.Conclusions Reduced bone formation and increased bone absorption appears in patients with T2DM.With the extension about duration of T2DM,the rate of bone formation decreases,while the bone absorption increases.Poor blood glucose control will influence bone formation and bone absorption,so strict blood glucose control can delay the progress of osteoporosis effectively.