中年男性2型糖尿病伴血脂异常患者骨钙素与股动脉内膜中层厚度及下肢动脉斑块的关系

Association of osteocalcin with femoral artery intima-media thickness and lower extremity atherosclerotic plaque in middle-aged male type 2 diabetes mellitus with dyslipidemia

目的探讨中年男性2型糖尿病(T2DM)患者不同血脂水平血清骨钙素与股动脉内膜中层厚度(FIMT)及下肢动脉斑块的关系。方法采用随机数字表法选取自2017年1月至2019年1月在唐山市工人医院内分泌二科就诊的304例新诊断男性T2DM患者作为研究对象,年龄(52.0±6.0)岁。将研究对象分为血脂异常组(156例)和血脂正常组(148例),检测空腹血糖(FPG)、空腹胰岛素、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)及超敏C反应蛋白(hs-CRP)以及骨钙素,计算稳态模型评估胰岛素抵抗指数(HOMA-IR)。应用彩色超声测量FIMT及下肢动脉斑块,分析骨钙素与FIMT及下肢动脉斑块的关系。组间比较采用t检验、秩和检验、χ^2检验。相关性分析采用Pearson、Spearman相关分析及多因素logistic回归分析。结果血脂正常组的骨钙素水平明显高于血脂异常组[(17.84±6.71)比 (16.36±6.25)ng/ml,t=1.993,P=0.047];相关分析显示骨钙素与年龄、FPG、HbA1c、HOMA-IR、TC、TG、LDL-C及hs-CRP均呈负相关(r=-0.172^-0.137,均P<0.05)。多元线性回归分析显示,在血脂异常组中,骨钙素与FIMT呈负相关(β=-0.184,P<0.05)。应用多因素logistic回归分析调整其他因素后,整体人群中低水平骨钙素是下肢动脉斑块的独立危险因素(比值比:0.946,95%可信区间:0.908~0.985,P<0.01),血脂异常组低水平的骨钙素仍与下肢动脉斑块独立相关(比值比:0.935,95%可信区间:0.880~0.993,P=0.028),而在血脂正常组低水平的骨钙素与下肢动脉斑块无关(比值比:0.956,95%可信区间:0.901~1.015,P>0.05)。结论在新诊断中年男性T2DM血脂异常者中,骨钙素与FIMT呈负相关,且低水平骨钙素是下肢动脉斑块发生的独立危险因素。

Objective To investigate the association of serum osteocalcin with femoral artery intima-media thickness(FIMT)and lower extremity atherosclerotic plaque in middle-aged male type 2 diabetes mellitus(T2DM)with different lipid status.Methods Newly diagnosed male T2DM patients aged(52.0±6.0)years in the Second Department of Endocrinology of Tangshan Gongren Hospital from January 2017 to January 2019 were selected as the objects of study by random number method.The subjects were divided into two groups:the dyslipidemia group(156 cases)and the normal lipid group(148 cases).Fasting plasma glucose(FPG),fasting insulin,glycated hemoglobin A1c(HbA1c),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),hypersensitive C-reactive protein(hs-CRP)and osteocalcin were detected,and the homeostasis model assessment of insulin resistance(HOMA-IR)was calculated to evaluate insulin resistance.The FIMT and plaques in lower limb arteries were measured by ultrasonography measurements.The relationship between serum osteocalcin and FIMT as well as lower extremity atherosclerotic plaque were evaluated.The t test,rank sum test andχ2 test were used for comparison between groups.Pearson and Spearman correlation analysis and multivariate logistic regression analysis were used for correlation analysis.Results The osteocalcin level in the normal lipid group was significantly higher than that in the dyslipidemia group[(17.84±6.71)vs(16.36±6.25)ng/ml,t=1.993,P=0.047].Osteocalcin was inversely associated with age,FPG,HbA1c,HOMA-IR,TC,TG,LDL-C and hs-CRP by correlation analysis(r=-0.172--0.137,all P<0.05).In multivariate linear regression analysis,osteocalcin was negatively associated with FIMT in the dyslipidemia group(β=-0.184,P<0.05).The low osteocalcin level was independent risk factors for lower extremity atherosclerotic plaque in the overall population using Logistic regression analysis after adjusting other factors(odds ratio:0.946,95%confidence interval:0.908-0.985,P<0.01).In multivariate logistic regression analysis,the low osteocalcin level still significantly increased the risk of lower extremity atherosclerotic plaque in the dyslipidemia group(odds ratio:0.935,95%confidence interval:0.880-0.993,P=0.028),while the low osteocalcin level didn’t increase the risk of lower extremity atherosclerotic plaque in the normal group(odds ratio:0.956,95%confidence interval:0.901-1.015,P>0.05).Conclusion Osteocalcin is correlated negatively with FIMT in newly diagnosed middle-aged male T2DM patients with dyslipidemia,and the low osteocalcin level was independent risk factor for the occurrence of lower extremity atherosclerotic plaque in these patients.