糖化血红蛋白与骨代谢生化指标相关性的探讨

摘要

Objective To investigate the correlation between glycosylated hemoglobin A1 c (HbA1 c ) and biochemical markers of bone metabolism.Methods According to the levels of HbA1 c ,240 patients with type 2 diabetes mellitus were classified into group A (HbA1c <6.5%),group B(6.5% ≤HbA1c <8.0%)and group C (HbA1c≥8.0%).A total of 80 healthy subjects were enrolled as healthy control group.Biochemical markers of bone metabolism [serum alkaline phosphatase(ALP),amino terminal and midcourse osteocalcin (N-MID Osteocalcin),beta-collagen specific sequence(β-CrossLaps),parathyroid hormone(PTH),25-hydroxy vitamin D(Vit D),total typeⅠcollagen N-terminal extension peptide (TP1 NP ),calcium and phosphorus ] were detected,and the results were analyzed and compared.The correlation between HbA1 c and biochemical markers of bone metabolism was analyzed.Results N-MID Osteocalcin,Vit D in group A,B and C were significantly lower than those in healthy control group (P<0.05 );β-CrossLaps in group A was significantly higher than that in healthy control group (P<0.05 ).ALP,TP1 NP in group B and TP1 NP,β-CrossLaps,PTH in group C were significantly lower than those in healthy control group (P<0.05 ). ALP,N-MID Osteocalcin,β-CrossLaps,Vit D in group B and N-MID Osteocalcin,TP1 NP,β-CrossLaps,PTH,Vit D in group C were lower than those in group A (P<0.05).N-MID Osteocalcin and PTH in group C were lower than those in group B (P <0.05 ),while ALP increased significantly (P <0.05 ).The other markers showed no statistical significance (P >0.05 ). There were negative correlations between HbA1 c and N-MID Osteocalcin,TP1 NP,β-CrossLaps,PTH and Vit D (rs were -0.49,-0.29,-0.23,-0.21 and -0.25,P<0.05).Conclusions HbA1 c effects the levels of N-MID Osteocalcin,TP1 NP,β-CrossLaps,PTH and Vit D.When the control of glucose is worse,N-MID Osteocalcin,TP1 NP,β-CrossLaps,PTH and Vit D are lower.Correcting the disorder of glucose metabolism can effectively improve the bone metabolism in patients with type 2 diabetes mellitus.%目的：探讨糖化血红蛋白（HbA1 c ）与骨代谢生化指标的相关性。方法将240例2型糖尿病患者根据HbA1c水平分为A组（HbA1c ＜6．5％）、B组（6．5％≤HbA1c ＜8．0％）和C组（HbA1c≥8．0％），以80名健康体检者作为正常对照组。分别测定4组骨代谢相关指标[包括血清碱性磷酸酶（ALP）、氨基端和中段骨钙素（N-MID Osteocalcin）、β-胶原特殊序列（β-CrossLaps）、甲状旁腺素（PTH）、25-羟基维生素D（Vit D）、总Ⅰ型胶原氨基端延长肽（TP1 NP）、钙、磷]水平并做比较，分析HbA1 c与骨代谢相关指标之间的相关性。结果 A、B、C 3组N-MID Osteocalcin、Vit D均明显低于正常对照组（P＜0．05）；A组β-CrossLaps明显高于正常对照组（P＜0．05）；B组ALP、TP1 NP 及 C 组 TP1 NP、β-CrossLaps、PTH 均明显低于正常对照组（P ＜0．05）；B 组 ALP、N-MID Osteocalcin、β-CrossLaps、Vit D及C 组 N-MID Osteocalcin、TP1 NP、β-CrossLaps、PTH、Vit D 明显低于 A 组（P＜0．05）；C组N-MID Osteocalcin、PTH明显低于B组（P＜0．05），而ALP则明显升高（P＜0．05）；其余各项指标各组间差异均无统计学意义（P＞0．05）。HbA1 c与N-MID Osteocalcin、TP1 NP、β-CrossLaps、PTH、Vit D呈负相关（rs值分别为-0．49、-0．29、-0．23、-0．21、-0．25，P均＜0．05）。结论 HbA1c对N-MID Osteocalcin、TP1 NP、β-CrossLaps、PTH、Vit D有影响。血糖控制越差，骨代谢指标N-MID Osteocalcin、TP1 NP、β-CrossLaps、PTH、Vit D水平越低。2型糖尿病患者通过严格控制血糖，纠正糖代谢紊乱，可有效改善患者骨代谢。