摘要
目的研究二甲双胍对2型糖尿病(T2DM)伴高血压患者骨密度(BMD)及相关细胞因子的影响,为T2DM伴高血压患者的临床治疗提供依据。方法选取2014年1月至2015年12月于杭州师范大学附属医院就诊的92例T2DM伴高血压患者作为研究对象,随机分为二甲双胍组和对照组,每组46例,两组患者均给予达美康、常规降压药物治疗和糖尿病健康教育,二甲双胍组加用二甲双胍,治疗12周。测定治疗前后体质指数(BMI)、空腹血糖(FPG)、糖化血红蛋白(Hb A1C)、脂联素(APN)、瘦素(LEP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和胰岛素样生长因子-1(IGF-1)水平,用双能X线骨密度仪测定患者第1-4腰椎(L1-4)及左股骨颈BMD。用SPSS 17.0软件进行统计分析,治疗前后同组比较采用配对t检验,两组间比较采用独立样本t检验,各参考数间的相关性采用Pearson相关分析。结果治疗12周后,两组FPG、Hb A1C均较治疗前明显下降,差异均有统计学意义(P<0.05)。二甲双胍组BMI治疗后较治疗前明显下降,差异有统计学意义(P<0.05)。与治疗前及对照组治疗后比较,二甲双胍组APN、IGF-1、L1-4及左股骨颈BMD均升高,TNF-α、IL-6均下降,差异均有统计学意义(P<0.05);二甲双胍组治疗后LEP较治疗前明显下降,差异有统计学意义(P<0.05),与对照组治疗后比较,差异无统计学意义(P>0.05)。相关分析显示,L1-4及左股骨颈BMD与APN、IGF-1呈正相关(r值分别为0.353、0.326、0.291和0.314,P<0.05),与LEP、TNF-α和IL-6呈负相关(r值分别为-0.351、-0.338、-0.298、-0.371、-0.364、和-0.299,P<0.05)。结论二甲双胍可以通过纠正相关细胞因子紊乱,从而改善T2DM伴高血压患者的BMD,可能具有降低T2DM伴高血压患者骨质疏松和骨折的风险。
Objective To investigate the effects of metformin on the changes of bone mineral density（BMD） and cytokines in type2 diabetes mellitus（T2DM） patients with hypertension, and to provide the basis for clinical treatment of T2 DM patients with hypertension. Methods During January of 2014 to December of 2015, 92 T2 DM patients with hypertension served as the subjects.All subjects were randomly divided into Gliclazide plus metformin group（study group, 46 cases） and Gliclazide group（control group, 46 cases）.The subjects were treated with Gliclazide, conventional antihypertensive drugs and health education for 12 weeks.The study group was also treated with melformin. The body mass index（BMI）, fasting blood glucose（FPG）, hemoglobin A1C（Hb A1C）, adiponectin（APN）, 1eptin（LEP）, tumor necrosis factor-α（TNF-α）, interleukin-6（IL-6） and insulin-like growth factor-1（IGF-1） were detected, and the BMD of L1-4 and left femoral neck were measured by Dual energy X-ray bone density absorptiometry（DEXA） for all subjects before and after treatment. SPSS 17.0 software was used to analyze all data and the correlation. Results After treatment for 12 weeks, the levels of FPG and Hb A1 Cdecreased significantly in both groups; BMI decreased significantly in study group（P〈0.05）. As compared with before treatment and control group, APN, IGF-1 and BMD of L1-4 and the left femoral neck in study group increased significantly; TNF-α and IL-6 significantly decreased（P〈0.05）. The level of LEP in study group after treatment was significantly lower than that before treatment（P〈0.05）, but did not decline significantly as compare with control group（ P〈0. 05）. Also the BMD of the L1-4 and the left femoral neck was positively correlated with the APN and IGF-1（r values were 0.353, 0.326, 0.291 and 0.314, respectively, P〈0.05）, and negatively correlated with the LEP, TNF-α and IL-6（r values were-0.351,-0.338,-0.298,-0.371,-0.364 and-0.299, respectively, P〈0.05）.Conclusion Metformin can correct the dysfunction of cytokines and improve BMD in T2 DM patients with hypertension, may reduce risk of osteoporosis and fracture.
作者
宋美情
SONG Mei-qing(Department of Endocrinology, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province 310015, China)
出处
《中国慢性病预防与控制》
CAS
2017年第4期249-252,共4页
Chinese Journal of Prevention and Control of Chronic Diseases
关键词
糖尿病
2型
高血压
二甲双胍
细胞因子
骨密度
Diabetes mellitus
type 2
Hypertension
Metformin
Cytokines
Bone mineral density
