目的 探讨成人1型糖尿病(T1 DM)患者的骨钙素水平及其在T1 DM糖代谢调节中的作用.方法 纳入T1 DM患者105例(T1 DM组)及同期性别、年龄相匹配的非糖尿病住院患者92例(对照组),收集其一般资料及相关实验室检查指标,并进行比较分析.结果 T1 DM组的骨钙素水平较对照组明显降低(P<0.05).骨钙素与糖化血红蛋白(HbA1 c)呈负相关(P=0.002),与碱性磷酸酶(ALP)、血磷、甲状旁腺激素(PTH)、1型胶原羧基端肽 β特殊序列(β-CTX)、1型胶原氨基端延长肽(P1 NP)呈正相关(P<0.05),与血钙、降钙素、25羟维生素D3[25(OH)D3]均无明显相关性(P>0.05).多元线性回归分析结果显示,骨钙素是影响T1 DM组患者HbA1 c的独立保护因素(P=0.024),骨钙素水平每升高1 ng/ml,HbA1 c下降0.18％.根据骨钙素水平对T1 DM患者进行亚组分析结果显示,高骨钙素组的HbA1 c水平更低(P<0.05),空腹C肽更高(P<0.05).结论 T1 DM患者的骨钙素水平较非糖尿病患者明显降低,骨钙素水平越高提示血糖控制及胰岛功能相对更好,骨钙素可能参与了T1 DM的糖代谢调节.%Objective To investigate the level of osteocalcin in adult type 1 diabetes mellitus (T1DM)and its role in the regulation of glucose metabolism.Methods A total of 105 T1DM patients (T1DM group)and 92 non-diabetic hospitalized patients(control group)were included.The general data and laboratory measurements were collected and analyzed.Results T1DM group showed significantly decreased level of osteocalcin compared to control group(P <0.05).Osteocalcin was negatively related to glycosylated hemoglobin (HbA1 c,P =0.002 ),while positively associated with alkaline phosphatase (ALP),serum phosphorus,parathyroid hormone (PTH),β-C-terminal telopeptide of type I collagen (β-CTX)and procollagen type 1 N-terminal propeptide(P1 NP).Osteocalcin was not related to serum calcium,serum calcitonin and 25 hydroxy-vitamin D3 [25 (OH)D3 ](P >0.05 ).Multivariate linear regression analysis revealed that osteocalcin was an independent protective factor for HbA1 c(P =0.024). For every 1 ng/ml increase of osteocalcin,HbA1c decreased by 0.18％.Subgroup analysis based on the level of osteocalcin in T1 DMpatients showed that patients with higher osteocalcin had significantly lower HbA1c(P <0.05 )and higher fasting C peptide (P <0.05 ).Conclusion The level of osteocalcin decreases significantly in T1DM patients.Higher osteocalcin in T1DM is associated with better glycemia and islet function,indicating the involvement of osteocalcin in the regulation of glucose metabolism in T1DM patients.
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