绝经后女性2型糖尿病患者骨代谢研究

目的探讨绝经后女性2型糖尿病患者骨代谢及生化指标的特征。方法对我院内分泌科住院44例中老年女性2型糖尿病患者（均为绝经后）的骨代谢及相关指标进行检测。糖尿病患者根据病程分为糖尿病1组（糖尿病病程10年以下）及糖尿病2组（糖尿病病程10年以上，含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％）。同时选取我院50例体检健康女性作为对照组。结果①糖尿病组25-羟维生素D3、I型前胶原氨基末端（C端）前肽（PICP）及估计肾小球滤过率（eGFR）明显低于正常对照组，而抗酒石酸碱性磷酸酶（TrACP一5b）N显较正常对照组升高，且有统计学差异fP〈O．05）。②糖尿病2组患者血I型前胶原氨基末端（N端）前肽fPINP）、PICP和eGFR水平明显低于糖尿病1组患者（P〈0．051，而TrACP-5b水平高于糖尿病1组，雌二醇（estradiol，E）、25-羟维生素D，则无明显统计学差异。③糖尿病3组血PINP、PICP和eGFR明显高于糖尿病4组，TrACP-5b低于糖尿病4组，差异存在统计学意义（P〈0．05）。（4）HbAlc和eGFR与PINP、PICP和TrACP-5b存在显著相关性（相关系数〉0．3），而雌二醇与PINP、PICP、25-羟维生素D3、TrACP-5b无明显相关性。结论（1）2型糖尿病患者的骨形成降低，而骨吸收增加，肾脏出现较重的损害，这提示糖尿病患者的骨质形成减弱、骨质破坏增加。②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，肾脏损害加重。③血糖控制不佳会对骨的形成及骨质的吸收产生影响，而肾脏损害亦是加重发生骨质疏松的重要因素，因而严格的血糖控制可有效延缓骨质疏松进展。

Bone metabolism in female postmenopausal patients with type 2 diabetes mellitus

Objective To investigate the bone metabolism and blood biochemical parameters in postmenopausal female patients with type 2 diabetes mellitus （T2DM）. Methods 44 elderly female patients with T2DM （all of them were postmenopausal） hospitalized in our hospital were recruited. Bone metabolism and related parameters 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 HbAlc levels, patients were divided into T2DM group 3 （HbAlc〈8%） and group 4 （HbAle≥8%）. 50 healthy female people were chosen as the control group. Results （1）25-OH VitD3, PICP and eGFR in pa- tients were significantly lower than those of control group, while TrACP-5b was significantly higher than that of control grouti （P〈 0.05）. （2）PINP, PICP and eGFR in T2DM group 2 were lower than those of group 1 （P〈0.05）, while TrACP-5b was higher than that of group 1.There was no statistical differences about serum estradiol and 25-OH VitD3. （3）PINP, PICP and eGFR in T2DM group 3 were much higher than those of group 4 and TrACP-5b was lower than that of group 4. All these have statistical differ- ences （P〈0.05）. （4）HbAlc and eGFR were related to PINP, PICP and TrACP-5b （r〉0.3）, however estradiol had no evident rela- tivity with PINP, PICP, 25-OH VitD3 and TrACP-5b. Conclusion （1）Reduced bone formation and increased bone absorption, presenting lessened bone formation and increased bone destruction with T2DM patients, also severe injury appeared in kidney. （2）With the extension about duration of T2DM, the rate of bone formation was much slower, as well as the increased bone absorption and kidney injury. （3）Poor blood glucose control will influence bone formation and bone absorption, while kidney injury is also an factor making osteoporosis more serious, so strict blood glucose control can delay the progress of osteoporosis effectively.