骨钙素在不同糖耐量人群的水平变化及对糖脂和骨代谢的影响

Osteocalcin levels in people with different glucose tolerance and its effects on glucose,lipid,and bone metabolism

目的观察不同糖耐量人群血清骨钙素(OC)水平并探讨其对糖脂和骨代谢的影响。方法选取内分泌科就诊患者373例,根据口服葡萄糖耐量试验(OGTT)结果分为三组,正常对照组(NGT组)99例,糖调节受损组(IGR组)43例,2型糖尿病组(T2DM组)231例。抽取所有研究对象空腹静脉血,检测血液各项生化指标,检测腰椎1、腰椎2、腰椎3、腰椎4、腰椎1～4、腰椎2～4的骨密度(BMD1、BMD2、BMD3、BMD4、BMD1～4、BMD2～4)及脂肪含量,比较分析三组血清OC水平及其与糖、脂和骨代谢的相关性。结果 T2DM组、NGT组与IGR组血清OC水平分别为15. 09(11. 60～19. 30)、19. 32(14. 90～24. 45)、21. 12(16. 15～25. 25)ng/m L,T2DM组与NGT组、IGR组比较差异有统计学意义(P均<0. 05)。NGT组中,OC与腰臀比(WHR)呈正相关(r=0. 561,P=0. 037),与空腹葡萄糖(FPG)、脂肪含量(Fat-content)、BMD1、BMD2、BMD3、BMD4、BMD1～4、BMD2～4、胰岛素抵抗指数(HOMA-IR)呈负相关(r分别为-0. 339、-0. 237、-0. 409、-0. 383、-0. 393、-0. 422、-0. 418、-0. 421、-0. 543,P分别为0. 001、0. 024、0. 001、0. 003、0. 002、0. 001、0. 001、0. 001、0. 011);多元线性回归分析显示,BMD2～4是OC的独立影响因素。IGR组中,OC与年龄呈正相关(r=0. 323,P=0. 048),与胰岛β细胞功能(HOMA-β)呈负相关(r=-0. 487,P=0. 025)。T2DM组中,OC与HOMA-β呈正相关(r=0. 135,P=0. 049),与体质量、UA、FPG、Ca、Fat-content、BMD1、BMD2、BMD3、BMD4、BMD1～4、BMD2～4呈负相关(r分别为-0. 210、-0. 156、-0. 187、-0. 151、-0. 135、-0. 329、-0. 327、-0. 304、-0. 323、-0. 344、-0. 323,P分别为0. 002、0. 022、0. 007、0. 027、0. 046、0. 001、0. 001、0. 001、0. 001、0. 001、0. 001);多元逐步回归分析显示BMD2～4、Fat-content、FPG、Ca是OC的独立影响因素。结论血清OC在糖调节受损者中升高,在T2DM患者中降低;OC通过调节胰岛β细胞功能及胰岛素敏感性影响糖代谢,抑制脂肪细胞的蓄积而影响脂代谢,通过调控骨密度而影响骨代谢。

Objective To explore the serum level of osteocalcin(OC)in people with different glucose tolerance and to investigate the effects of OC on glucose,lipid,and bone metabolism.Methods Totally 373 patients were selected from the department of endocrinology,according to oral glucose tolerance test(OGTT),the subjects were divided into the following three groups:normal glucose tolerance group(NGT group,n=99),impaired glucose regulation group(IGR group,n=43)and type 2 diabetes group(T2DM group,n=231).The fasting venous blood was collected to detect the blood biochemical indexes,bone mineral density(BMD),including BMD1,BMD2,BMD3,BMD4,BMD1-4,and DM2-4 and fat-content,and then we compared the level of serum osteocalcin and its correlation with the glucose,lipid,and bone metabolism in these three groups.Results The T2DM group had a significantly lower number of OC than NGT group and IGR group[15.09(11.60-19.30)vs.19.32(14.90-24.45)vs 21.12(16.15-25.25)ng/mL,P<0.05].In the NGT group,OC was positively correlated with WHR(r=0.561,P=0.037),and negatively correlated with FPG,fat-content,BMD1,BMD2,BMD3,BMD4,BMD1-4,BMD2-4,and HOMA-IR(r=-0.339,-0.237,-0.409,-0.383,-0.393,-0.422,-0.418,-0.421 and-0.543,P=0.001,0.024,0.001,0.003,0.002,0.001,0.001,0.001,and 0.011).According to multiple regression analysis,BMD2-4 was an independent influencing factor for OC in the NGT group.In the IGR group,OC was positively correlated with age(r=0.323,P=0.048),and negatively correlated with HOMA-β(r=-0.487,P=0.025).In the T2DM group,OC was positively correlated with HOMA-β(r=0.135,P=0.049),and negatively correlated with weight,UA,FPG,Ca,fat-content,BMD1,BMD2,BMD3,BMD4,BMD1-4 and BMD2-4(r=-0.210,-0.156,-0.187,-0.151,-0.135,-0.329,-0.327,-0.304,-0.323,-0.344 and-0.323,P=0.002,0.022,0.007,0.027,0.046,0.001,0.001,0.001,0.001,0.001,and 0.001).According to multiple regression analysis,BMD2-4,fat-content,FPG,and Ca were independent influencing factors for OC.Conclusions Serum OC increases in IGR patients and decreases in T2DM patients.Serum OC may influence glucose metabolism by regulating insulin sensitivity and the function of isletβ-cell and inhibiting the accumulation of adipose tissues.OC may also play a role in the development of diabetic osteoporosis and served as an important marker for the reduction of BMD.