2 型糖尿病不同中医证型骨密度及骨代谢改变的临床研究.pdf

Z2UhD#M5许卫国null,易振佳,金益强(中南大学湘雅医院中西医结合研究所,长沙410008)K1null目的:探讨2型糖尿病不同证型骨密度和骨代谢改变的病理生理特征b方法:测定93例2型糖尿病阴虚热盛证a气阴两虚证a阴阳两虚证患者14腰椎(L1L4)前后位和髋部骨密度(BMD)以及血清骨钙素(OC)a抗酒石酸酸性磷酸酶(TRACP)水平,分析各证型上述指标的变化规律b结果:阴阳两虚证组各腰椎a髋部BMD和OC水平显著低于气阴两虚组a阴虚热盛组和健康人组,骨质疏松率高于其它各组,而TRACP水平各组无明显差异b结论:2型糖尿病患者BMD和骨形成减低与肾虚有关,印证了中医肾主骨生髓!的理论b1oMnull2型糖尿病；null阴虚热盛证；null气阴两虚证；null阴阳两虚证；null骨密度；null骨代谢ms|nullR259.871,R587.1nullnullnullDSMnullAnullnullnullcI|null1000null5625(2002)05null0432null03ClinicalstudyofbonemineraldensityandbonemetabolismindifferentTCMsyndromesoftype2diabetesmellitusXUWeinullguo,YIZhennulljia,JINYinullqiang(InstituteofCombinedTraditionalChineseMedicineandWesternMedicine,XiangyaHospital,CentralSouthUniversity,Changsha410008,China)Abstract:nullObjectivenullToinvestigatethepathophysiologicalcharacteristicsofbonemineraldensityandbonemetabolismindifferentTCMsyndromesoftype2diabetesmellitus.MethodsnullBonemineraldensity(BMD)oflumbarvertebrae14andthefemeur,osteocacin(OC),andtartrateresistantacidphosphatase(TRACP)in93patientswithtype2diabetesmellituswithYinnullXunullNeinullReZheng,QinullYinnullLiangnullXuZhengandYinnullYangnullLiangnullXuZhengwerestudied.ResultsnullTheBMDoflumbarvertebrae14andthefemeurandtheOClevelswerehigherintheYinnullYangnullLiangnullXuZhenggroupthanthoseintheYinnullXunullNeinullReZhenggroup,QinullYinnullLiangnullXuZhenggrouporhealthypersons.TherateofosteoporosiswashigherintheYinnullYangnullLiangnullXuZhenggroupthanthoseintheothergroups.NosighificantdifferencewasfoundintheTRACPlevelsinanyofthegroups.ConclusionnullThereductionoftheBMDandboneformationoftype2diabetesmellituspatientsisrelatedtothedificiencyofthekidney.Thisconfirmsthetheorythatthekidneyisconcernedwiththeboneandproducesbonemarrow!.Keywords:nulltype2diabetesmellitus；nullYinnullXunullNeinullReZheng；nullQinullYinnullLiangnullXuZheng；nullYinnullYangnullLiangnullXuZheng；nullbonemineraldensity；nullbonemetabolismBullHunanMedUniv,2002,27(5):0432null03nullnull2UhT&%h,vs,isb=EMS=2Uhv,-p,2Uhh1,92,.9F3bf42Uh,?CUh(h,Ws|9b；0lE4,OTUh5?Z?pgB,712UhS=b3?XLlE932UhD%(Bonemineraldensity,BMD),i_b(Osteocacin,OC)FF(Tarnulltrateresistantacidphosphatase,TRACP),sSW1,)2UhMh3+b4322DSvBULLHUNANMEDUNIVnull2002,27(5)Zl:2001null10null09nullTe:S(19null),3,2,V,VYD=s5TbnullC+u,L,8v,?%；#|:eP,9%,Hp,4,vL,lLb,z*,8,H,H,%bD:Uhv=S%6,vSMDypS7b1.2null排除标准nullnull0.05)b1.4null骨密度测定nullSLUNARnullDPXnullIQ?XLlcN,14%(L1L4)98(TOTAL)#P(NECK)(g)cm-2)b(SD=sSib1.5null标本的采集及测定nulls_EaJ#3D0f/,bV12h,Q68|,sb-74bQibOCbfE,b01Z3/,20.2ng)ml-1,=Ms10%bTRACP1E,012y3bT(b1.6null统计学处理null9(S(nullx(s)VU,FW1Zs,sq1null2_b2nullnullnullT2.1null2型糖尿病不同证型组及健康人对照组第一至四腰椎(L1L4)正位及总体髋部(TOTAL)a左侧髋部股骨颈(NECK)BMD比较nullrBF1,|FBMD(A(P0.05)；|FBMDA|F|9F(P0.05,P0.01)(V1)bV1nullUhF#rBFL1L4BMD1(nullx(s,g)cm-2)FYL1L2L3L4TOTALNECK|9F30null0.936(0.112null0.981(0.129null1.036(0.137null1.043(0.151null0.866(0.079null0.828(0.078|F320.901(0.1190.939(0.1130.988(0.1341.004(0.1510.823(0.0810.792(0.082|F310.83(0.108null0.873(0.106null0.909(0.115null0.93(0.129null0.761(0.089null0.729(0.087nullrBF300.923(0.1120.972(0.1211.022(0.1291.032(0.1270.859(0.0800.823(0.074nullnullnullrBF#|9F1,P0.01；|F1,P0.052.2null2型糖尿病各证型组骨质疏松发生率与健康人组比较null|F?3qArBF|9F(P0.01),A|F(P0.01)(V2)b2.3null2型糖尿病各证型组及健康人组骨钙素(OC)a抗酒石酸酸性磷酸酶(TRACP)比较nullrBF1,2UhFOC(Ah(P0.01,P0.05)；|FOC|9F|FAh(P0.01),|FOC|9FAh(P0.05)(V3)bV2null2UhF#rBvFq1FY?3q(%)|9F301033.3null|F321443.7null|F312270.9nullrBF301033.3nullnullnullnullrBFa|9Fa|F1,P0.054332UhD#M5nullS,V3null2Uh#rBvFOC,TRACP1T(nullx(s)FYOC(ng)ml-1)TRACP(U)ml-1)|9F306.89(1.32null6.76(1.71|F325.86(1.53&6.72(1.59|F314.39(2.48#6.85(2.25rBF308.31(2.24null6.90(2.51nullnullnull|9F|F1,P0.05；|F1,P0.01；#|9F|F1,P0.01；&|9F1,P0.053null)nullnull2UhDhW!ah!S,h|,2S,=yT,hkaa/,71o/bh%#/,|#,V|./|bv5gV,2Uh|9a|a|s,Q*aah38bTAU|FBMDrBFFAh,qFA9,7|F|9FBMDaqrBFsA,Vid2UhBMD(9,7+:hfh,|9,iAM；V%h(|)7S,XC/t；|,5Ahb52Uhi?BilbV2Uh|,?3X9Ft,#F!,53,h,c,/.,.!(.3Y?%)bBMDah,q9/M1,BZ/!,6BZ94UUhVV/mb1/2Uhi?#/EUh,Bb致谢湘雅医院内分泌科雷闽湘副教授在骨密度检测方面给予了热情指导和帮助,在此一并致谢bID:1nullGregorioF,CristalliniS,SanteusanioP,etal.Osteopeniaassociatedwithnonnullinsulinnulldependeddiabetesmellitus:whatarethecause?J.DiabetesResClinPract,1994,23:43-54.2nullSosaM,DominguezM,NavarroMC,etal.BonemineralmetabolismisnormalinnonnullinsulinnulldependentdiabetesmellitusJ.JDiabetesComnullplications,1996,10:201-5.3nullPaulusLA,RonadP,BurgerH,etal.Bonedensityinnonnullinsulinnulldenullpendentdiabetesmellitus,TheRotterdamStudyJ.AnnInternMed,1995,122:409-14.4null/,.UhDWM54J.D,1998,39(10):597-598.5nullS3.0055M.B.:3.1993.215-216.6null=I.=SM.5.:3,2000.810.7nullSMDSSF.SypS(=)J.S,2000,6(1):1-4.8nullI.DUhM.:SD0S/,1999.106-108.9nullY,J,.RIAk4#5J.D,1994,14(3):167.10null,q.