二甲双胍对2型糖尿病伴高血压患者骨密度及胰岛素抵抗、细胞因子的影响

目的: 观察二甲双胍对2型糖尿病(T2DM)伴高血压患者骨密度及胰岛素抵抗(IR)、细胞因子的影响。方法: 将125例T2DM伴高血压患者随机分为两组，观察组62例，对照组63例，两组均口服达美康治疗，观察组在此基础上加用二甲双胍，治疗12周，治疗前后分别检测两组患者的BMI、空腹血糖（FPG）、糖化血红蛋白（HbA1c）、空腹胰岛素(FINS)、胰岛素抵抗指数（HOMA-IR）、脂联素(APN)、瘦素(LEP) 、肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）、胰岛素样生长因子-1(IGF-1)，测定腰椎2-4（L2-4）骨密度（BMD）、左股骨颈BMD，比较两组治疗前后及组间各检测指标变化。结果: （1）治疗12周后，两组的FPG、HbAlc较治疗前均有明显下降，差异有统计学意义(P<0.05)；观察组BMI较治疗前明显下降，差异有统计学意义(P<0.05)。（2）与治疗前及对照组治疗后比较，观察组APN、IGF-1、L2-4及左股骨颈BMD均升高，FINS、HOMA-IR、TNF-α、IL-6均下降，差异均有统计学意义(P<0.05)；LEP与治疗前比较下降，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)。（3）相关分析显示，L2-4及左股骨颈BMD均与APN、IGF-1呈正相关，与HOMA-IR、LEP、TNF-α和IL-6呈负相关。结论:二甲双胍可以改善T2DM伴高血压患者的BMD，降低IR，纠正细胞因子紊乱，可能减少T2DM伴高血压患者骨质疏松和骨折风险。

Effect of metformin on bone mineral density,insulin resistance and cytokines in type 2 diabetes mellitus patients with primary hypertension

AIM: To investigate the changes of bone mineral density （BMD）, insulin resistance (IR) and cytokines in type 2 diabetes mellitus (T2DM) patients with primary hypertension． METHODS: 125 patients of T2DM patients with primary hypertension were randomly divided into Gliclazide plus melformin group (treatment group) and Gliclazide group(control group )．BMI, fasting blood glucose（FPG）, hemoglobin A1c（HbA1c）, fasting insulin(FINS), the index of insulin resistance（HOMA-IR）, adiponectin(APN), 1eptin(LEP), tumor necrosis factor-α(TNF-α), interleukin-6（IL-6）, insulin-like growth factor-1(IGF-1) and BMD of the lumbar vertebrae 2-4（L2-4）and the left femofal neck were measured and compared．RESULTS:（1）After treatment for 12 weeks，levels of FPG and HbA1c decreased in both groups (P<0.05)；BMI decreased compared with before therapy in treatment group (P<0.05).（2）Compared with before therapy and control group，levels of APN, IGF-1 and BMD of the L2-4 and the left femofal neck increased in treatment group(P<0.05)，levels of FINS, HOMA-IR, TNF-α and IL-6 decreased(P<0.05)；LEP decreased compared with before therapy (P<0.05)，but there was no significant difference after therapy between groups（P>0.05）.（3）The BMD of the L2-4 and the left femofal neck were positively correlated with the APN and IGF-1，yet negatively correlated with the HOMA-IR, LEP, TNF-α and IL-6. CONCLUSION: Metformin can improve BMD, IR and correct dysfunction of cytokines in T2DM patients with primary hypertension，which may reduce risk of osteoporosis and fracture.