目的 探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者血清骨钙素水平及其与胰岛素抵抗、胰岛β细胞功能的相关性.方法 研究对象为403 例T2DM住院患者,记录患者性别、年龄、身高、体重、病史等一般信息.测定其骨钙素(osteocalcin,OC)、钙(calcium,Ca)、镁(magnesium,Mg)、磷(phosphorus,P)、甲状旁腺素(parathyroid hormone,PTH)、25羟维生素D(25-hydroxyvitamin D,25(OH)D)、空腹血糖(fasting blood glucose,FBG)、空腹胰岛素(fasting insulin,FINS)、糖化血红蛋白(glycosylated hemoglobin,HbA1c),行葡萄糖耐量实验后测定其2 小时血糖(2-hours blood glucose,2hBG)、2 小时胰岛素(2-hours Insulin,2hINS),计算体重指数(body mass index,BMI)、稳态模型胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)、稳态模型胰岛素分泌指数(homeostasis model assessment of βcell,HOMA-β).将研究对象分别按年龄、性别、BMI、骨钙素水平分组比较其代谢水平,根据研究对象骨钙素中位数水平分为低骨钙素组(OL组,n＝201)和高骨钙素组(OH组,n＝202),分析骨钙素水平与胰岛素抵抗及胰岛 β细胞功能相关性.结果 青年组的 Ca 水平高于老年组(P＜0.05).女性组患者的OC(Z＝4.596,P＜0.001)、PTH(Z＝3.150,P＝0.002)、P(t＝5.258,P＜0.001)水平高于男性组患者(P＜0.05).男性组患者的25(OH)D水平高于女性组患者(Z＝3.196,P＝0.001).肥胖组患者的25(OH)D水平低于超重组和正常体重组(P＜0.05).超重组的OC水平低于正常体重组(P＜0.05).OL组患者的HbA1c(t＝4.479,P＜0.001)、FBG(Z＝3.579,P＜0.001)、2hBG(Z＝4.413,P＜0.001)水平高于OH组患者(P＜0.05);OL组患者的2hINS(Z＝3.482,P＜0.001)、HOMA-β(Z＝2.397,P＝0.017)低于OH组(P＜0.05).OC水平与2hINS(r＝0.152)和HOMA-β(r＝0.121)呈正相关(P＜0.05),与HbA1c(r＝-0.244)、FBG(r＝－0.176)、2hBG(r＝－0.241)呈负相关(P＜0.001).结论 2型糖尿病患者骨代谢等相关指标存在差异性,血清OC与糖代谢之间存在显著的相关性,血清OC可能通过改善胰岛β细胞功能、促进胰岛素分泌等途径参与血糖代谢调节.%Objective To investigate the correlations between serum osteocalcin level and insulin resistance and islet beta cell function in patients with type 2 diabetes mellitus.Methods The study was conducted in 403 hospitalized patients with type 2 diabetes.Their general information including gender,age,height,weight,medical history,etc.were recorded.The levels of OC,Ca,Mg,P,PTH,25(OH)D,FBG,FINS,HbA1c and 2hBG and 2hINS after the glucose tolerance test were detected.Their BMI,HOMA-IR and HOMA-β were calculated.The participants were grouped by age,sex,BMI and osteocalcin level to compare their metabolic status.According to the median level of osteocalcin,the participants were divided into low osteocalcin group(OL group,n＝201)and high osteocalcin group(OH group,n＝202).The correlations between serum osteocalcin level and insulin resistance and islet beta cell function were analyzed.Results The level of Ca in the younger age group was higher than that in the older age group(P ＜0.05).The level of OC(Z＝4.596,P＜0.001),PTH(Z＝3.150,P＝0.002)and P(t＝5.258,P＜0.001)were higher in females than males(P ＜0.05).The level of 25(OH)D in males was higher than that in females(Z＝3.196,P＝0.001).The level of 25(OH)D in the obese group was lower than that in overweight group and normal weight group(P＜0.05).The level of OC in the overweight group was lower than that in the normal weight group(P ＜0.05).In OL group,HbA1c(t＝4.479,P＜0.001),FBG(Z＝3.579,P＜0.001)and 2hBG(Z＝4.413,P＜0.001)were higher than those in OH group(P ＜0.05).The 2hINS(Z＝3.482,P＜0.001)and HOMA-β(Z＝2.397,P＝0.017)in OL group were lower than those in OH group(P ＜0.05).The level of OC was positively correlated with 2hINS(r＝0.152)and HOMA-β(r＝0.121),but was negatively correlated with HbA1c(r＝－0.244),FBG(r＝－0.176)and 2hBG(r＝－0.241)(P＜0.001).Conclusion Patients with type 2 diabetes showed differences in bone metabolic markers,and there were significant correlations between serum OC and blood glucose metabolism.OC may participate in glycemic regulation by improving the function of islet beta cells and promoting insulin secretion.
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