不同剂量二甲双胍对老年2型糖尿病男性患者骨密度和骨代谢的影响

目的: 观察不同剂量二甲双胍对老年2型糖尿病患者骨密度和骨代谢的影响。 方法: 未经治疗的老年2型糖尿病患者102例随机分为二甲双胍低剂量组（n=34）、二甲双胍中剂量组（n=34）和二甲双胍高剂量组（n=34）。3组分别给予：二甲双胍0.5 g，每日2次；二甲双胍0.5 g，每日3次；二甲双胍0.5 g， 每日4次。3组均连续口服3个月。服药前和服药后1、3个月分别测定患者腰椎（L_2-4）与股骨颈（Neck）的骨密度（BMD）及血骨特异性碱性磷酸酶（BAP）、骨钙素（BGP）以及抗酒石酸酸性磷酸酶（TRACP）、护骨因子（OPG）、空腹血糖（FBG）和糖化血红蛋白水平（HbAlC）。结果: 3组治疗后FBG和HbAlC均明显降低，与治疗前比较差异有统计学意义（P<0.05），但3组间同期比较无统计学差异（P>0.05）。3组治疗前、后反映骨代谢的骨抑制指标TRACP和OPG无明显变化；反映骨转换与形成的指标BGP和BAP治疗后均升高，治疗前、后有统计学差异（P<0.05）。其中，二甲双胍高剂量组和中剂量组的BGP和BAP同期高于低剂量组，组间比较有统计学差异（P<0.05），而二甲双胍中剂量组和高剂量组的BGP和BAP同期无统计学差异（P>0.05）。3组治疗3个月后腰椎（L_2-4）与股骨颈（Neck）的BMD均明显增加，二甲双胍高剂量组和中剂量组分别与低剂量组比较有统计学差异，但二甲双胍高剂量组和中剂量组并没有明显差异。结论: 二甲双胍对老年性2型糖尿病患者在发挥降糖作用的同时，还能使患者BMD得到改善，该作用可能主要是通过促进骨形成实现的，且疗效有一定剂量相关性。

Effects of different doses of metformin on bone metabolism and bone mineral density in elderly male patients with type 2 diabetes

AIM: To observe the effect of different doses of metformin on bone metabolism and bone mineral density in elderly male patients with type 2 diabetes. METHODS: 102 untreated elderly male patients with type 2 diabetes were randomly divided into 3 groups. 3 groups were given low doses of metformin group (1 g/d, n=34), medium doses of metformin group (1.5 g/d, n=34) and high doses of metformin group (2 g/d, n=34). Phase of treatment lasted for 3 months. The levels of bone mineral density (BMD) of lumbar L2-4 and the femoral neck, serum bone specific alkaline phosphatase (BAP), blood gla protein (BGP), Tartrate Resistant Acid Phosphatase (TRACP), osteoprotegrin (OPG), fasting blood glucose (FBG) and hemoglobin A1C (HbA1C) were measured before treatment, 1 month and 3 months after administration. RESULTS:The levels of FBP and HbA1C in 3 groups were decreased significantly after treatment (P<0.05), but there was not significant difference among 3 groups (P>0.05). The indicators of bone metabolism TRACP and OPG in 3 groups reflected no significant change before and after treatment (P>0.05); BGP and BAP which reflected indicators of bone turnover and formation were increased after treatment, there was significant difference among 3 groups (P<0.05). The levels of BGP and BAP in the medium doses and the high doses of metformin groups was higher than counterpart in low doses of metformin group (P<0.05), there were significant differences among groups. But the levels of BGP and BAP in the medium and high doses of metformin group were not obvious difference over the same period (P>0.05). After 12 weeks of treatment, the levels of BMD in 3 groups were increased, there was statistical significance among groups (P<0.05). The levels of BMD in the medium doses and the high doses of metformin groups was higher than counterpart in low doses of metformin group (P<0.05), there were significant differences among groups. But the levels of BMD in the medium and high doses of metformin group were not obvious difference over the same period (P>0.05). CONCLUSION:Metformin not only can regulate the levels of blood glucose in elderly male with type 2 diabetes, but also improve the BMD of patients. This effect may depend on promoting bone formation, and curative effects have a certain dose of relevance.