老年男性2型糖尿病患者骨钙素水平与糖脂代谢的相关性分析

Correlation analysis of osteocalcin levels and glucolipid metabolism in elderly men patients with type 2 diabetes mellitus

目的探讨老年男性2型糖尿病患者骨钙素水平与血糖、胰岛β细胞功能、胰岛素抵抗及血脂之间的关系。方法以55例老年男性2型糖尿病患者为研究对象(T2DM组),对照组52例,两组年龄相匹配,测定两组的骨钙素(BGP)、空腹血糖(FBG)、餐后2 h血糖(2h BG)、空腹胰岛素(FINS)、餐后2h胰岛素(2h INS)、空腹C肽(FCP)、餐后2h C肽(2h CP)、糖化血红蛋白(Hb A1c)、血清胱抑素(Cys-C)、血脂、血钙(Ca)和血磷(P),分析血清BGP与各项指标的相关性。结果 T2DM组FBG、2h BG、Hb A1c和Cys-C明显高于对照组[(8.26±3.08)mmol/L vs(5.34±0.47)mmol/L、(15.88±5.09)mmol/L vs(7.30±0.78)mmol/L、(7.71±2.01)%vs(5.35±0.72)%和(1.30±0.48)mg/L vs(1.02±0.38)mg/L,P<0.01],稳态模型评估胰岛素抵抗指数(HOMA-IR)和低密度脂蛋白-胆固醇(LDL-C)高于对照组[(2.72±1.48)vs(2.18±0.60)和(2.70±0.94)mmol/L vs(2.35±0.70)mmol/L,P<0.05];FINS、FCP、2h INS、2h CP和胰岛细胞功能指数(HOMA-β)明显低于对照组[(0.80±0.23)m IU/L vs(0.96±0.11)m IU/L、(2.52±0.37)pmol/L vs(2.68±0.19)pmol/L、(1.40±0.35)m IU/Lvs(1.78±0.20)m IU/L、(3.17±0.34)pmol/Lvs(3.48±0.18)pmol/L和(43.75±32.82)vs(109.80±50.10),P<0.01],BGP水平低于对照组[(2.17±1.32)μg/L vs(2.82±1.42)μg/L,P<0.05]。BGP与2型糖尿病患者的FBG、2h BG和Hb A1c呈负相关(r=-0.276、-0.268和-0.420,P=0.041、0.048和0.001),与FINS、2h INS、2h CP和HOMA-β呈正相关(r=0.226、0.245、0.250和0.325,P=0.029、0.018、0.016和0.015),与LDL-C和三酰甘油(TG)呈负相关趋势,但无统计学意义(r=-0.251和-0.245,P=0.065和0.072)。以BGP为因变量,以Hb A1c、FBG、FINS、2h BG、2h INS、FCP、2h CP、HOMA-IR和HOMA-β为自变量,多元逐步回归分析发现2h CP是BGP的独立影响因素。结论血清骨钙素水平与老年男性2型糖尿病患者的血糖水平、胰岛β细胞功能及胰岛素抵抗相关。

[ Objective ] To investigate the relationship between osteocalcin levels and blood glucose, islet [3-cell function, insulin resistance and blood lipids in elderly men patients with type 2 diabetes mellitus. [ Methods ] Fifty- five cases of elderly men patients with type 2 diabetes mellitus were chosen for the study （T2DM group）, 52 cases were included in control group,and two groups were matched in terms of age. Osteoealcin （Bone-Gla-Protein,BGP）, fasting blood glucose （FBG）, 2-hour postprandial blood glucose （2hBG）, fasting insulin （FINS）, 2-hour postprandial insulin （2bINS）, fasting C-peptide （FCP）, 2-hour postprandial C-peptide （2hCP）, glycated hemoglobin （HbAlc）, serum cystatin C （Cys-C）, cholesterol, calcium （Ca）, phosphorus （P） of two groups were measured, and the correla- tions between serum BGP and those indicators were analyzed. [Results] FBG, 2bBG, HbAlc and Cys-C in T2DM group were higher than those in the control group significantly [（8.26±3.08） mmol/L vs （5.34±0.47） mmol/L, （15.88±5.09） mmol/L vs （7.30±0.78） mmol/L, （7.71±2.01）% vs （5.35±0.72）% and （1.30±0.481） mg/L vs （1.02±0.38） mg/L, P 〈 0.01], and homeostasis model assessment of insulin resistance （HOMA-IR） index, low-density lipoprotein eholes- terol（LDL-C） in T2DM group were significantly higher than those in the control group [（2.72±1.48） vs （2.18±0.60）, （2.70±0.94） mmol/L vs （2.35±0.70） mmol/L, P 〈 0.05]; FINS, FCP, 2hlNS, 2hCP, homeostasis model assessment of islet 13-cell function （HOMA-[3） index in T2DM group were lower than those in the control group significantly [（0.80±0.23） mlU/L vs （0.96±0.11） mlU/L, （2.52±0.37） pmol/L vs （2.68±0.19） pmol/L, （1.40±0.35） mlU/L vs （1.78± 0.20） mlU/L, （3.17±0.34） pmol/L vs （3.48±0.18） pmol/L, （43.75±32.82） vs （109.8±50.1）, P 〈 0.01], and BGP in T2DM ~roup was lower than that in the control roup [（2.17±1.32）μ g/L vs （2.82±1.42） μL, P 〈 0.05]. Serum os- teocalcin concentration was negatively correlated with the levels of FBG, 2hBG, HbAlc （r = -0.276, -0.268, -0.420, P = 0.041, 0.048, 0.001） and positively correlated with the levels of FINS, 2hINS, 2hCP, HOMA-β in patients with type 2 diabetes mellitus （r = 0.226, 0.245, 0.250, 0.325, P = 0.029, 0.018, 0.016, 0.015）, and showed a negative cor- relation trend with LDL-C and triglyceride （TG）, but there was no statistical significance （r = -0.251, -0.245, P = 0.065, 0.072）. Multiple regression analysis showed that 2hCP was an independent factor of BGP. [ Conclusions] Serum calcium levels is related to blood sugar, islet [3-cell function and insulin resistance in elderly men patients with type 2 diabetes mellitus.