不同中医证型2型糖尿病患者骨密度及骨代谢改变

背景2型糖尿病患者骨密度易出现异常改变,但规律尚未明确.目的从中医证型角度探讨2型糖尿病患者骨密度和骨代谢改变的病理生理特征. 设计病例-对照,对比观察.单位解放军广州军区广州总医院内分泌科.对象选择2003-04/2004-04解放军广州军区广州总医院内分泌科住院2型糖尿病患者103例,男55例,女48例.按中医证型将患者分为3组阴虚热盛证组32例、气阴两虚证组36例、阴阳两虚证组35例.选择同期本院健康体者30人为对照组,男16人,女14人.纳入对象均对实验目的知情同意.方法①采用双能X线吸收骨矿含量测定仪测定各组对象第1～4腰椎正位和总体髋部及左侧髋部股骨颈的骨密度.②采用放射免疫法测定血清骨钙素.③采用比色法测定血清抗酒石酸酸性磷酸酶水平.④计量和计数资料差异比较分别采用q检验和x2检验.主要观察指标①各组对象第1～4腰椎和总体髋部及左侧髋部股骨颈骨密度.②各组对象骨质疏松患病率比较.③各组对象血清骨钙素和抗酒石酸酸性磷酸酶水平比较.结果2型糖尿病患者103例和健康体检者30人均进入结果分析.①第1～4腰椎和总体髋部及髋部股骨颈骨密度阴虚热盛证组、气阴两虚证组、对照组均明显高于阴阳两虚证组(P＜0.05～0.01).②骨质疏松发生率阴虚热盛证组、气阴两虚证组、对照组明显低于阴阳两虚证组34%(11/32),42%(15/36),33%(10/30),71%(25/35),P＜0.01].③血清骨钙素水平阴虚热盛证组和气阴两虚证组明显高于阴阳两虚证组(P＜0.01),低于对照组(P＜0.05).④血清抗酒石酸酸性磷酸酶水平各组差异不明显(P＞0.05).结论①阴阳两虚证2型糖尿病患者骨量和骨形成明显低于健康人和阴虚热盛证和气阴两虚证患者,骨质疏松发生率明显高于健康人和其他2个证型患者.②阴虚热盛证、气阴两虚证2型糖尿病患者骨量、骨形成接近健康人.

Changes of bone mineral density and metabolism in patients with type 2 diabetes mellitus of different traditional Chinese medicine syndrome types

BACKGROUND: Abnormal changes of bone mineral density (BMD) easily occur in patients with non-insulin-dependent diabetes mellitus (NIDDM),however the mechanisms are still unclear.OBJECTIVE: To investigate the pathophysiological features of changes of BMD and metabolism in patients with NIDDM from the angle of traditional Chinese medicine (TCM) syndrome types.DESIGN: A case controlled and comparative observation.SETTING: Department of Endocrinology of Guangzhou General Hospital of Guangzhou Military Area Command of Chinese PLA PARTICIPANTS: Totally 103 cases (55 males and 48 females) of patients with NIDDM admitted in Department of Endocrine of Guangzhou General Hospital of Guangzhou Military Area Command of PLA from April 2003 to April 2004 were enrolled. They were, according to TCM syndrome types, divided into 3 groups: yin deficiency with heat excess (32 cases),deficiency of both qi and yin (36 cases), and deficiency of both yin and yang (35 cases) groups. The healthy persons of 30 staff, 16 males and 14 females, in the hospital were concurrently recruited as control group. Informed consent was obtained from all the subjects.METHODS: ①A dual-energy X-ray absorption meter was used to determine the bone mineral densities of orthophoric 1-4 lumber vertebrae, total hipbone and head of femur in left hip in each group. ② Radioimmunoassay was taken to measure the content of serum osteocacin (OC). ③Colorimetry was used to measure the level of serum tartrate resistant acid phosphatase (TRACP). ④ q-test and x2-test were respectively used for comparison of measurement and enumeration data.MAIN OUTCOME MEASURES: ①The BMD of the 1-4 lumber vertebrae, total hipbone and head of femur in left hip in each group. ②The morbidities of osteoporosis of subjects in each group. ③ The levels of OC and TRACP in each group.RESULTS:All 103 NIDDM patients and 30 healthy subjects entered the final result analysis. ① The BMD of the 1-4 lumber vertebrae, total hipbone and head of femur in left hip of subjects: The BMD in yin deftciency with heat excess, deficiency of both qi and yin and control groups were obviously higher than that in deficiency of both yin and yang group (P ＜ 0.05-0.01 ) ② The morbidity of osteoporosis: The morbidities of osteoporosis in yin deficiency with heat excess, deficiency of both qi and yin and control groups were obviously lower than that in deficiency of both yin and yang group34%(ll/32),42% (15/36), 33% (10/30), 71% (25/35),P ＜ 0.01]. ③ The level of OC: The levels in yin deficiency with heat excess and deficiency of both qi and yin groups were obviously higher than that in deficiency of both yin and yang group (P ＜ 0.01 ), but lower than that in deficiency of both yin and yang group (P ＜ 0.05). ④ The level of TRACP: There was no significant difference among groups(P ＞ 0.05).CONCLUSION: ① The volume and formation of bone in NIDDM patients of deficiency of both yin and yang syndrome type were obviously lower than those in healthy persons and NIDDM patients of yin deficiency with heat excess and deficiency of both qi and yin syndrome types, and the osteoporosis morbidity in them was obviously higher than those in healthy persons and the other two syndrome-type patients. ② The quantity and formation of bone in NIDDM patients of deficiency of both yin and yang syndrome type were near to those in healthy persons.