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目的 探讨胰岛素治疗对延缓2型糖尿病( T2DM)患者膝骨性关节炎骨赘形成及关节间隙狭窄的研究进展.方法 选取2015年7月至2016年8月山西省运城市中心医院关节外科收治的311例膝骨性关节炎患者(共622膝),根据有无合并T2DM及胰岛素使用情况分为3组,有T2DM但无任何治疗干预或使用口服降糖药的99例患者为非胰岛素组,有T2DM并使用胰岛素治疗和降糖药配合胰岛素治疗的112 例患者为胰岛素组,无 T2DM 但行膝关节疼痛及康复治疗的100例患者为常规对照组.通过Lequesne指数和Kellgren-Lawrence(K-L)分级对所有患者的膝关节进行评分和分级,分析胰岛素与膝骨性关节炎骨赘形成及关节狭窄程度的相关性.结果 非胰岛素组、胰岛素组与常规对照组性别差异有统计学意义(P<0.05),3组患者Lequesne指数比较,差异无统计学意义(P >0.05),3 组患者糖化血红蛋白% (HbA1C%)比较,差异有统计学意义(P <0.05),合并T2DM的两组患者HbA1C %比较,差异无统计学意义(P>0.05). 3组患者平均K-L分级比较,差异无统计学意义(P>0.05);胰岛素组的关节间隙狭窄(89.7% )与常规对照组(86.0% )比较,差异有统计学意义(P<0.05);胰岛素组的骨赘形成(19.7% )与常规对照组(11.6% )比较,差异有统计学意义(P<0.01);非胰岛素组的骨赘形成和关节间隙狭窄(36.0% 、99.5% )与胰岛素组(19.7% 、89.7% )比较,差异有统计学意义(P<0.05).多元回归分析结果表明,经年龄、性别、HbA1C% 、Lequesne指数调整后,胰岛素组分别与非胰岛素组、常规对照组比较,胰岛素是影响膝骨性关节炎骨赘形成的独立因素(OR=0.294,P<0.05;OR=0.098,P<0.001).结论 胰岛素治疗可有效延缓T2DM合并膝骨性关节炎患者骨赘形成及关节间隙狭窄.

Objective To investigate the insulin therapy on the osteophyte formation and joint space stricture in knee osteoarthritis ( OA) with type 2 diabetes mellitus ( T2DM) patients. Methods A retrospective study was performed on 311 cases (622 knees) of patients with OA who were admitted from July 2015 to August 2016.According to whether complicated with T2DM, patients were divided into 3 groups,99 patients with T2DM without any treatment intervention or oral hypoglycemic drugs were in the non-insulin group,112 patients with T2DM who were treated with insulin and hypoglycemic drugs combined with insulin were in the insulin group,and 100 patients without T2DM who were treated with knee joint pain and rehabilitation were in the control group. The knee joints of all patients were graded and graded using the Lequesne index and kellgren-lawrence ( K-L) grades,and the correlation between insulin and osteoarthritis osteophyte formation and joint stenosis was analyzed. Results The gender of the non-insulin,insulin group and control group difference was statistically significant ( P <0.05 ).Lequesne index among the three groups of patients had no statistically significant difference (P>0.05).The HbA1C% among the 3 groups had statistically significant difference (P < 0.05);the HbA1C% between the two groups of patients combined with T2DM had no statistically significant difference (P>0.05).There was no statistically sig-nificant difference in K-L classification among the three groups (P>0.05).There was a statistically signifi-cant difference between the insulin group (89.7% )and the control group (86.0% )in joint space stenosis (P<0.05). Osteophyte formation in insulin group (19.7% )was significantly different from that in control group ( 11.6% , P < 0.01 ).Osteophyte formation and joint space stenosis in the non-insulin group (36.0% ,99.5% )were significantly different from those in the insulin group (19.7% ,89.7% ,P<0.05) .Multivariate regression analysis showed that,after adjusting for age,gender,HbA1C% ,and Lequesne in-dex,insulin was an independent factor affecting osteophyte formation in osteoarthritis of the knee ( OR=0.294,P <0.05) compared with non-insulin group and control group,respectively (OR =0.098,P <0.001). Conclusion Insulin treatment can effectively delay osteophyte formation and joint space narro-wing in T2DM patients with knee osteoarthritis.