老年2型糖尿病并存非酒精性脂肪肝病患者血清骨钙素水平与糖脂代谢的相关性研究

Relationship between serum osteocalcin levels and glucolipid metabolism in elderly type 2 diabetic patients with non-alcoholic fatty liver disease

目的探讨老年2型糖尿病（T2DM）并存非酒精性脂肪性肝病（NAFLD）患者血清骨钙素水平与糖脂代谢的关系。方法回顾性分析2014年6月至2015年4月于郑州大学第一附属医院老年内分泌科住院的T2DM患者97例，根据病情分为T2DM未并存NAFLD组（非脂肪肝组）47例和T2DM并存NAFLD组（脂肪肝组）50例。另选同期在我院门诊体检的健康者30例为对照组。比较3组的体质指数、骨钙素、空腹血糖、空腹胰岛素、胰岛素分泌指数、胰岛素抵抗指数、糖化血红蛋白、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇水平，并进行统计学分析。结果非脂肪肝组和脂肪肝组空腹血糖、空腹胰岛素、糖化血红蛋白、总胆固醇、三酰甘油、低密度脂蛋白胆固醇和胰岛素抵抗指数均高于对照组；高密度脂蛋白胆固醇、胰岛素分泌指数和骨钙索水平均低于对照组（P〈0．05）。脂肪肝组体质指数、空腹血糖、空腹胰岛素、糖化血红蛋白、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、胰岛素抵抗指数高于非脂肪肝组；骨钙素水平低于非脂肪肝组（P〈0．05）。脂肪肝组Person相关分析结果显示，血清骨钙素与空腹血糖、糖化血红蛋白、胰岛素抵抗指数、体质指数呈负相关（r=-0．701，-0．442，-0．337，-0．543，均P〈0．05），与胰岛素分泌指数呈正相关（r=0．341P％0．05）。脂肪肝组以血清骨钙素为因变量进行多重线性回归分析，结果表明空腹血糖（β=-1．57，P=0.018）是血清骨钙素的独立影响因素。结论老年T2DM并存NAFLD患者的血清骨钙素水平下降，与糖脂代谢密切相关。血清骨钙素水平对老年2型糖尿并存非酒精脂肪肝病的预防和治疗有重要的临床意义。

Objective To explore the relationship between serum osteocalcin levels and glucolipid metabolism in elderly type 2 diabetic patients with non-alcoholic fatty liver disease （NAFLD）. Methods Data collected from 97 patients with type 2 diabetes mellitus（T2DM）admitted to the Department of Geriatric Endocrinology of the First Affiliated Hospital of Zhengzhou University from June 2014 to April 2015 were retrospectively analyzed. Patients were divided into the T2DM group（type 2 diabetic patients without NAFLD, n= 47）and the NAFLD group（T2DM patients with NAFLD, N = 50）. Healthy elderly subjects（n= 30）from the same period served as the control group. Body mass index（BMI）, osteocalcin, fasting blood glucose, fasting insulin, homeostasis model assessment for insulin secretion index （HOMA-β）and insulin resistance （HOMA-IR）, glycosylated hemoglobin（HbAlc）, total cholesterol, triglyceride, high-density lipoprotein cholesterol（HDL-C） and low-density lipoprotein cholesterol（ LDL-C） were compared between the 3 groups. Results Levels of fasting blood glucose, fasting insulin, HbAtc, total cholesterol, triglyceride, LDL-C and HOMA-IR were higher, while levels of HDL-C, HOMA-β and osteocalcin were lower in the T2DM and NAFLD groups than in the control group（all P〈0.05）.Levels of BMI, fasting glucose, fasting insulin, HbAlc, total cholesterol, triglyceride, LDL C and HOMA-IR were higher and levels of osteocalcin were lower in the T2DM group than in the NAFLD group（all P〈0.05）. Pearson correlation analysis showed that the osteocalcin level was negatively correlated with fasting blood glucose, HbA1C, HOMA-IR and BMI（r= 0.701, 0.442, -0.337 and -0.543, P〈0.05 or P〈0.01）, and positively correlated with HOMA-β （r = 0. 341, P 〈 0.05） in the NAFLD group . With serum osteocalcin as the dependent variable, multiple linear regression results showed that fasting blood glucose was an independent influencing factor for serum osteocalcin（β=- 1.57, P〈0.05）in the fatty liver group. Conclusions Serum osteocalcin levels significantly decrease in elderly T2DM patients with NAFLD, are closely correlated with glucolipid metabolism, and may have some important clinical significance in the prevention and treatment of NAFLD in elderly patients with type 2 diabetes.