摘要
目的 观察骨化三醇胶丸联合胰激肽原酶对2型糖尿病微血管并发症患者外周血同型半胱氨酸(Hcy)、视黄醇结合蛋白4(RBP4)、淀粉样蛋白A(SAA)水平的影响.方法 前瞻性选取2020年1月至2022年12月秦皇岛市第二医院收治的104例2型糖尿病微血管并发症患者为对象,采用随机数字表法分为常规组(n=52)和骨化三醇组(n=52).两组均接受利拉鲁肽治疗,常规组加用胰激肽原酶治疗,骨化三醇组在常规组基础上联合骨化三醇胶丸治疗.比较两组糖代谢(空腹血糖、餐后2 h血糖)、Hcy、RBP4、SAA、正五聚蛋白3(PTX3)及骨代谢指标[25-羟基维生素D(25(OH)D)、骨碱性磷酸酶(BAP)、骨保护素(OPG)、Ⅰ型前胶原氨基端延长肽(P1NP)、Ⅰ型前胶原氨基端延长肽(β-CTX)、碱性磷酸酶(ALP)]的水平差异,统计两组不良反应发生情况.结果 治疗后,两组的空腹血糖、餐后2 h血糖均较治疗前降低,差异均有统计学意义(P＜0.05);但骨化三醇组和常规组组间比较,差异均无统计学意义(P＞0.05).治疗后,骨化三醇组和常规组的Hcy、RBP4、SAA、PTX3水平均较治疗前降低,差异均有统计学意义(P＜0.05),且骨化三醇组 Hcy、RBP4、SAA、PTX3 水平分别为(10.23±2.06)μmol/L、(32.85±5.15)mg/L、(23.01±3.86)μg/mL、(18.11±3.23)ng/mL,均低于常规组[(11.90±2.14)μmol/L、(37.25±6.58)mg/L、(29.23±3.74)μg/mL、(22.03± 4.01)ng/mL],差异均有统计学意义(P＜0.05).治疗后,骨化三醇组25(OH)D、BAP、OPG水平均较治疗前升高,P1NP、β-CTX、ALP水平均较治疗前降低,差异均有统计学意义(P＜0.05),常规组骨代谢指标治疗前后比较,差异均无统计学意义(P＞0.05);骨化三醇组 25(OH)D、BAP、OPG 水平分别为(21.89±2.23)ng/mL、(38.98±4.74)μg/L、(312.52±34.41)ng/L,均高于常规组[(18.96±2.41)ng/mL、(31.52±4.06)µg/L、(279.96±31.04)ng/L],骨化三醇组 P1NP、β-CTX、ALP 水平分别为(41.66±4.26)ng/mL、(0.38±0.11)ng/mL、(5.08±0.89)U/L,均低于常规组[(45.89±5.01)ng/mL、(0.46±0.14)ng/mL、(6.61±1.21)U/L],差异均有统计学意义(P＜0.05).骨化三醇组高钙血症、头痛或头晕、胃肠道反应、皮疹、泌尿道感染等不良反应发生率为11.54％,与常规组的7.69％比较,差异无统计学意义(P＞0.05).结论 骨化三醇胶丸联合胰激肽原酶治疗2型糖尿病微血管并发症可改善患者骨代谢指标,降低患者血清Hcy、RBP4、SAA、PTX3水平,且不增加不良反应.
Abstract
Objective To observe the effects of calcitriol capsules combined with pancreatic kininogenase on the levels of homocysteine(Hcy),retinol-binding protein 4(RBP4)and amyloid A(SAA)in peripheral blood of patients with microvascular complications of type 2 dia-betes mellitus.Methods A total of 104 patients with type 2 diabetes microvascular complications admitted to the Second Hospital of Qinhuangdao from January 2020 to December 2022 were prospectively selected and divided into conventional group(n=52)and calcitriol group(n=52)ac-cording to the random number table method.Both groups were treated with liraglutide,the conventional group plus pancreatic kininogenase,and the calcitriol group plus calcitriol capsules on the basis of the conventional group.The levels of glucose metabolism(fasting blood glucose,2 h postpranpranal blood glucose),Hcy,RBP4,SAA,pentamerin 3(PTX3)and bone metabolism indexes[25-hydroxyvitamin D(25(OH)D),bone alkaline phosphatase(BAP),osteopultin(OPG),type Ⅰ procollagen amino terminal propeptide(P1NP),c-terminal telopeptide of type Ⅰcollagen(β-CTX)and alkaline phosphatase(ALP)were compared between the two groups,and the adverse reactions between the two groups were analyzed].Results After treatment,the fasting blood glucose and 2-hour postprandial blood glucose of the two groups were lower than those before treatment,and the differences were statistically significant(P＜0.05);however,there was no statistically significant difference be-tween the calcitriol group and the conventional group(P＞0.05).After treatment,the levels of Hcy,RBP4,SAA,and PTX3 in the calcitriol group and the conventional group were lower than those before treatment,and the differences were statistically significant(P＜0.05),and the levels of Hcy,RBP4,SAA,and PTX3 in the calcitriol group were(10.23±2.06)μmol/L,(32.85±5.15)mg/L,(23.01±3.86)μg/mL,and(18.11±3.23)ng/mL,respectively,which were lower than those in the conventional group[(11.90±2.14)µmol/L,(37.25±6.58)mg/L,(29.23±3.74)μg/mL,(22.03±4.01)ng/mL],and the differences were statistically significant(P＜0.05).After treatment,the levels of 25(OH)D,BAP,and OPG in the calcitriol group were higher than those before treatment,while the levels of P1NP,β-CTX,and ALP were lower than those before treatment,and the differences were statistically significant(P＜0.05).There was no statistically significant differ-ence in bone metabolism indicators between the conventional group before and after treatment(P＞0.05).The levels of 25(OH)D,BAP,and OPG in the calcitriol group were(21.89±2.23)ng/mL,(38.98±4.74)µg/L,(312.52±34.41)ng/L,respectively,which were higher than those in the conventional group[(18.96±2.41)ng/mL,(31.52±4.06)µg/L,(279.96±31.04)ng/L],the levels of P1NP,β-CTX,and ALP were(41.66±4.26)ng/mL,(0.38±0.11)ng/mL,and(5.08±0.89)U/L,respectively,which were lower than those in the conventional group[(45.89±5.01)ng/mL,(0.46±0.14)ng/mL,and(6.61±1.21)U/L],and the differences were statistically sig-nificant(P＜0.05).The incidence of hypercalcemia,headache or dizziness,gastrointestinal reaction,rash,urinary tract infection and other ad-verse reactions in calcitriol group was 11.54％,compared with 7.69％in conventional group,there was no statistically significant difference(P＞0.05).Conclusion In the treatment of type 2 diabetes mellitus microvascular complications,calcitriol capsules combined with pancreatic kininogenase can improve bone metabolic indexes and reduce serum levels of Hey,RBP4,SAA and PTX3,without increasing adverse reactions.
基金项目
秦皇岛市科学技术研究与发展计划(201902A176)
维普
万方数据