摘要目的 观察沙格列汀与二甲双胍单药治疗对初发2型糖尿病(T2DM)患者骨代谢及体脂分布的影响.方法 将2016年10月至2017年6月就诊于我院内分泌科门诊的60例初发T2DM患者按照随机数字表法分为沙格列汀治疗组(Sax组,30例)和二甲双胍治疗组(Met组,30例)进行为期24周的干预治疗,观察治疗前后两组患者的一般资料、糖、脂代谢、炎症、骨代谢等相关指标,包括25-羟基维生素D3[25(OH)D3]、Ⅰ型胶原羧基端肽β特殊序列(β-CTx)、骨钙素(OC)、总Ⅰ型胶原氨基端延长肽(tPINP),并采用Hologic Discovery A型双能X线骨密度仪测量分析各组患者腰椎、左侧股骨颈骨密度及体脂分布[包括全身脂肪百分比(Fat％)、内脏脂肪面积(VAT.Area)、腹/臀部脂肪比(A/G)、脂肪量指数(FMI)]的变化情况.组内前后比较采用配对t检验,组间差异比较采用两独立样本t检验,非正态分布数据用秩和检验.结果 经24周干预后,Met组与Sax组患者与治疗前相比体质指数(BMI)、体重、腰围、空腹血浆血糖(FPG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、超敏C反应白(hs-CRP)、VAT.Area、Fat％、A/G、FMI均明显下降(Met组t=2.1～8.3,Sax组t=1.9～6.9,均P<0.05),胰岛细胞分泌指数(HOMA-β)、OC、25(OH)D3均明显上升[分别为:Met组HOMA-β:51.29(34.66)比36.16(37.20),OC:(17.27±4.86)比(14.16±4.12)ng/ml,25(OH)D3:(18.89±6.06)比(14.64±5.74)ng/ml,t=-1.6、-5.6、-8.2;Sax组:HOMA-β:54.40(29.36)比50.78(42.64),OC:(17.93±3.81)比(14.30±3.77)ng/ml,25(OH)D3:(19.01±6.17)比(14.13±5.06)ng/ml,t=-0.5、-7.8、-8.0;均P<0.05];Sax组左侧股骨颈BMD较前增加[(0.81±0.09)比(0.79±0.09)g/cm2,t=-2.7;P<0.05].Met组VAT.Area、FMI较Sax组下降明显[VAT.Area:(81.14±19.11)比(92.62±22.84)cm2,FMI:6.33±1.48比6.78±1.34,t=-1.9、-1.2;P<0.05].结论 二甲双胍与沙格列汀均可增加OC、25(OH)D3水平,促进骨形成及改善T2DM患者的体脂分布,其中沙格列汀可增加初发T2DM患者股骨颈骨密度;而二甲双胍对内脏脂肪面积、脂肪量指数改善效果更佳.

abstractsObjective To observed the effects of saxagliptin and metformin monotherapy on bone metabolism and body fat distribution in patients with newly diagnosed type 2 diabetes. Method Sixty patients with newly diagnosed T2DM who visited endocrinology outpatient department of our hospital from October 2016 to June 2017 were randomly divided into the saxagliptin treatment group (Sax, n=30) and the&nbsp;metformin treatment group (Met, n=30) for a 24-week treatment. At the baseline and 24 weeks after treatment, general information, glycometabolism and lipid metabolism index, Inflammation index, bone metabolism index (25(OH)D3, β-CTx, OC, tPINP), BMD (L1-L4, FN) and Body Fat Distribution (Fat％, VAT. Area, A/G, FMI) were measured. Paired t was used to compare pre-and post treatment effect within group. Difference between groups was analyzed using independent samples t test, and the non-normal distribution data was tested with rank sum test. Results After 24 weeks of intervention, body mass index (BMI), body weight, waist circumference, fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), insulin resistance index (HOMA-IR), total Cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), hypersensitive C-reactive white (hs-CRP), VAT.Area, Fat％, A/G, and FMI were all significantly decreased (Met group: t=2.1-8.3; Sax group: t=1.9-6.9; all P<0.05). Islet cell secretion index (HOMA-β), OC, 25 (OH) D3 increased significantly [Met group:HOMA-β:51.29(34.66)vs 36.16(37.20),OC:(17.27±4.86)vs (14.16±4.12) ng/ml, 25(OH)D3: (18.89±6.06)vs(14.64±5.74) ng/ml, t=-1.6,-5.6,-8.2; Sax group:HOMA-β:54.40(29.36)vs 50.78(42.64), OC:(17.93±3.81)vs(14.30±3.77) ng/ml, 25(OH)D3: (19.01±6.17)vs(14.13±5.06) ng/ml, t=-0.5,-7.8,-8.0, all P<0.05];the left femoral neck BMD of the Sax group increased earlier [(0.81± 0.09) vs (0.79±0.09) g/cm2, t=-2.7, P<0.05]. The VAT.Area and FMI of the Met group were significantly lower than those of the Sax group [VAT.Area: (81.14±19.11) vs (92.62±22.84); FMI:6.33±1.48 vs 6.78±1.34, t=- 1.9, - 1.2, P<0.05]. Conclusions Both metformin and saxagliptin could increase OC and 25(OH)D3 levels, promote bone formation and improve body fat distribution in patients with T2DM. Saxagliptin could increase femoral neck bone mineral density in patients with newly diagnosed T2DM. While metformin have a better effect on the improvement of visceral fat area and fat mass index.