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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 study the effect of metformin on bone mineral density (BMD) and related cytokines in patients with type 2 diabetes mellitus (T2DM) complicated with hypertension and provide basis for the clinical treatment of T2DM patients with hypertension. Methods From January 2014 to December 2015, 92 patients with T2DM and hypertension treated in Hangzhou Normal University Affiliated Hospital were randomly divided into metformin group and control group, with 46 cases in each group. Both groups were given up to Meikang, conventional antihypertensive drug treatment and diabetes health education, metformin group with metformin, for 12 weeks. The levels of BMI, FPG, APN, LEP, TNF-α, IL-6, 6 (IL-6) and insulin-like growth factor-1 (IGF-1) levels were measured. BMD of lumbar 1-4 (L1-4) and left femoral neck were measured by dual energy X-ray absorptiometry. SPSS 17.0 software was used for statistical analysis. Paired t-test was used to compare the two groups before and after treatment. Independent samples t-test was used to compare the two groups. Pearson correlation analysis was used to analyze the correlation between the two groups. Results After 12 weeks of treatment, FPG and Hb A1C in both groups were significantly lower than those before treatment, with statistical significance (P <0.05). Metformin group BMI after treatment than before treatment decreased significantly, the difference was statistically significant (P <0.05). The levels of APN, IGF-1, L1-4 and the left femoral neck BMD of metformin group were significantly higher than those of the control group before treatment and after treatment (P <0.05) ). The LEP in metformin group was significantly lower than that before treatment, the difference was statistically significant (P <0.05). There was no significant difference between the two groups (P> 0.05). Correlation analysis showed that L1-4 and left femoral neck BMD were positively correlated with APN and IGF-1 (r = 0.353,0.326,0.291 and 0.314 respectively, P <0.05), but negatively correlated with LEP, TNF-αand 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 improve the BMD of hypertensive patients with T2DM by correcting the related cytokine disorders, which may reduce the risk of osteoporosis and fracture in T2DM patients with hypertension.