【摘要】 目的 研究阿伦膦酸盐联合钙尔奇D治疗老年女性2型糖尿病(T2DM)患者骨质疏松疗效的影响因素。方法老年女性T2DM骨质疏松患者67例,随机接受钙尔奇D或阿伦膦酸盐联合钙尔奇D治疗6个月，检测治疗前后骨密度(BMD)及生化、骨盐代谢指标。结果 阿伦膦酸盐联合钙尔奇D疗效优于钙尔奇D。与联合治疗6个月腰椎、髋骨BMD改善正相关的指标：空腹血糖(r=0.287和0.160)、糖化血红蛋白 (hemoglobin A1c ,HbA1C)(r=0.283和0.110)、糖尿病病程(r=0.137和0.072)、治疗中增加胰岛素的剂量(r=0.201和0.082)、HbA1C降低幅度(r=0.302和0.139)、尿钙/肌酐(r=0.115和0.096)、尿羟脯氨酸/肌酐(r=0.132和0.123)、血清抗酒石酸酸性磷酸酶(r=0.204和0.296)、血碱性磷酸酶(r=0.184和0.073)、骨钙素(r=0.149和0.065)、骨碱性磷酸酶(r=0.263和0.486)，P均<0.05。而与空腹C肽水平(r=-0.136和-0.212)、24小时尿白蛋白(r=-0.220和-0.077)和基线时的骨密度(股骨颈)(r=-0.316和-0.245)负相关，P均<0.05。结论 阿伦膦酸盐联合钙尔奇D治疗老年女性T2DM患者骨质疏松，病情越重者获益越多，但大量尿白蛋白影响疗效。

　　【关键词】 糖尿病, 2型;骨质疏松;治疗结果;阿伦膦酸盐;影响因素

　　Affecting factors of effect of Alendronate combining Caltrate D on elderly type 2 diabetic women with osteoporosis CHEN Hai-ling, DENG Li-li, LI Ju-fen. Department of Endocrinology, Beijing Jishuitan Hospital, Beijing 100035, China

　　Corresponding author: DENG Li-li, Email:

　　【Abstract】 Objective To investigate the affecting factors of effect of Alendronate combining Caltrate D on elderly type 2 diabetic women with osteoporosis. Methods Sixty-seven elderly type 2 diabetic women were randomized into Caltrate D group and Alendronate combining Caltrate D group. After treatment for 6 minths, the changes in bone mineral density (BMD) and biochemical and bone metabolism indices were determined for comparison. Results The effect of Alendronate combining Caltrate D was better than that of Caltrate D. Those positively related with the improvement of BMD of lumbar vertebrae and hipbone were fasting blood glucose (r=0.287 and 0.160), HbA1C (r=0.283 and 0.110), duration of diabetes (r=0.137 and 0.072), increased dosage of insulin (r=0.201 and 0.082), decreased amplitude of HbA1C (r=0.302 and 0.139), urinary Ca/Cr (r=0.115 and 0.096), urinary hydroxyproline/Cr (r=0.132 and 0.123), tartrate-resistant acid phosphatase -5b (r=0.204 and 0.296), alkaline phosphatase (r=0.184 and 0.073), osteocalcin (r=0.149 and 0.065), and bone-specific alkaline phosphatase (r=0.263 and 0.486), (all P<0.05). But it was negatively related with the fasting C-peptide (r=-0.136 and -0.212), 24h urinary albumin excretion (r=-0.220 and -0.077), and baseline BMD (femur neck) (r=-0.316 and -0.245), (all P<0.05). Conclusion Treatment with Alendronate combining Caltrate D is effective for elderly type 2 diabetic women with osteoporosis. The more serious the condition, the more benefit. High urinary albumin excretion affects the result.

　　【Key words】Diabetes mellitus, type 2; Osteoporosis; Therapeutic effect; Alendronate; Influencial factors