-
随着当代社会老龄化发展与生活方式的改变,2型糖尿病(T2DM)和骨质疏松(OP)的发病率均呈增长趋势,是常见的两大慢性疾病,严重影响患者的生活质量和预期寿命[1]。大量临床研究表明2型糖尿病患者的骨折风险明显增加,而且T2DM患者病程越长,骨质疏松的风险越高,糖尿病患者若血糖控制不佳,长期处于高血糖状态会引起骨代谢紊乱,最终导致糖尿病性骨质疏松(DOP),是糖尿病患者常见的严重并发症之一[2-3]。DOP主要表现为骨密度(BMD)低、骨脆性增加、骨质量下降和骨折风险增加等,但它的发病机制目前尚不明确,可能与高血糖、氧化应激、晚期糖基化产物及微血管病变等有关[4-5]。虽然在临床中糖尿病和骨质疏松常被认为是两个相互独立的疾病,但它们之间存在着相互关系,笔者通过分析、探讨1例糖尿病伴骨质疏松患者的药物治疗方案,以期为临床积极防治DOP提供治疗参考。
Pharmaceutical care of a patient with type 2 diabetes and osteoporosis
-
摘要:
目的 探讨糖尿病合并骨质疏松患者的疾病特点及药学监护要点,为临床合理有效用药提供参考。 方法 临床药师通过参与1例2型糖尿病伴骨质疏松患者的用药分析,结合患者疾病特点及病理特征,并提出药学建议,协助治疗方案的优化。 结果 治疗方案重整及药学监护后,患者的治疗效果得到明显改善。 结论 糖尿病性骨质疏松发病机制复杂,当前的治疗以降血糖联合抗骨质疏松药物为主,通过慢病用药管理、药学监护,可以促进合理用药。 Abstract:Objective To investigate the disease characteristics and key factors of pharmaceutical care in patients with diabetes and osteoporosis, and provide references for clinical rational and effective medication. Methods Clinical pharmacist participated in the drug analysis of a patient with type 2 diabetes and osteoporosis. The pharmaceutical recommendations were proposed to assist physicians in optimizing the treatment plan, combined with the patient’s disease characteristics and pathological characteristics. Results After the reorganization of the treatment plan and pharmaceutical care, the patient's treatment effect had been significantly improved. Conclusion The pathogenesis of diabetic osteoporosis is complex. The current treatment is based on hypoglycemic combined with anti-osteoporosis drugs. Through chronic disease drug management and pharmaceutical monitoring, rational drug use could be promoted. -
[1] 胡治勇, 崔龙, 董晓颖, 等. 糖尿病患者骨质疏松评估、危险因素及相关机制的研究进展[J]. 重庆医学, 2020, 49(4):660-664. doi: 10.3969/j.issn.1671-8348.2020.04.033 [2] ALAM, JAFARIRM, DEHPOURAR. Diabetes mellitus and osteoporosis correlation: challenges and hopes[J]. Curr Diabetes Rev,2020,16(9):984-1001. doi: 10.2174/1573399816666200324152517 [3] 吕茵, 周围, 何文娜, 等. 2型糖尿病合并骨质疏松影响因素研究[J]. 新医学, 2020, 51(1):33-36. doi: 10.3969/j.issn.0253-9802.2020.01.007 [4] 黄燕霞, 梅思. 糖尿病性骨质疏松的研究进展[J]. 临床与病理杂志, 2020, 40(1):182-187. doi: 10.3978/j.issn.2095-6959.2020.01.031 [5] 倪利华. 糖尿病性骨质疏松症的研究进展[J]. 临床与病理杂志, 2020, 40(7):1897-1901. doi: 10.3978/j.issn.2095-6959.2020.07.043 [6] PASCHOU S Α, DEDE A D, ANAGNOSTIS P G, et al. Type 2 diabetes and osteoporosis: a guide to optimal management[J]. J ClinEndocrinolMetab,2017,102(10):3621-3634. [7] 李弘磊, 杨涛, 范红旗. 2型糖尿病合并骨质疏松的相关因素分析[J]. 中国医药, 2015, 10(5):644-648. doi: 10.3760/cma.j.issn.1673-4777.2015.05.012 [8] POIANA C. Osteoporosis and fracture risk in patients with type 2 diabetes mellitus[J]. ActaEndo (Buc),2019,15(2):231-236. doi: 10.4183/aeb.2019.231 [9] 易云平, 张思伟, 潘虹. 老年2型糖尿病骨质疏松相关因素分析[J]. 中国骨质疏松杂志, 2017, 23(1):59-61,111. doi: 10.3969/j.issn.1006-7108.2017.01.013 [10] ARDAWI M S M, AKHBAR D H, ALSHAIKH A, et al. Increased serum sclerostin and decreased serum IGF-1 are associated with vertebral fractures among postmenopausal women with type-2 diabetes[J]. Bone,2013,56(2):355-362. doi: 10.1016/j.bone.2013.06.029 [11] 韩栋, 王奔, 卢晓栋, 等. 中老年2型糖尿病患者发生骨质疏松的影响因素[J]. 中国慢性病预防与控制, 2020, 28(2):149-151. doi: 10.16386/j.cjpccd.issn.1004-6194.2020.02.016 [12] XU H, WANG Z D, LI X R, et al. Osteoporosis and osteopenia among patients with type 2 diabetes aged ≥50: role of sex and clinical characteristics[J]. J Clin Densitom,2020,23(1):29-36. doi: 10.1016/j.jocd.2019.04.004 [13] 郑倩莲, 徐家林. 唑来膦酸注射液在糖尿病骨质疏松患者中的实施意义[J]. 糖尿病新世界, 2020, 23(16):78-80. doi: 10.16658/j.cnki.1672-4062.2020.16.078 [14] SCHWARTZ A V. Efficacy of osteoporosis therapies in diabetic patients[J]. Calcif Tissue Int,2017,100(2):165-173. doi: 10.1007/s00223-016-0177-8 [15] SEALAND R, RAZAVI C, ADLER R A. Diabetes mellitus and osteoporosis[J]. CurrDiabetes Rep,2013,13(3):411-418. [16] 赵蕾, 王立, 鲁梅花, 等. 唑来膦酸与阿仑膦酸钠治疗绝经后骨质疏松症的效果和安全性比较[J]. 中国综合临床, 2017, 33(12):1134-1137. doi: 10.3760/cma.j.issn.1008-6315.2017.12.019 [17] KURRA S, FINK D A, SIRIS E S. Osteoporosis-associated fracture and diabetes[J]. EndocrinolMetabClinN Am,2014,43(1):233-243. [18] 马远征, 王以朋, 刘强, 等. 中国老年骨质疏松症诊疗指南(2018)[J]. 中国骨质疏松杂志, 2018, 24(12):1541-1567. [19] 孙军平, 徐向阳, 吕刚. 糖尿病性骨质疏松症的治疗进展[J]. 医学综述, 2017, 23(13):2634-2638. doi: 10.3969/j.issn.1006-2084.2017.13.030
计量
- 文章访问数: 2913
- HTML全文浏览量: 1052
- PDF下载量: 40
- 被引次数: 0