摘要目的 观察2型糖尿病患者不同HbA1c水平对骨代谢指标骨γ-羧谷氨酸包含蛋白(骨钙素)、Ⅰ型胶原交联羧基端肽(CTX-Ⅰ)、碱性磷酸酶(ALP)的影响.方法 选取2013年10月—2014年1月在哈尔滨医科大学附属第二医院内分泌科住院的120例男性2型糖尿病患者和来自体检中心的40名健康男性作为研究对象.将120例2型糖尿病患者根据HbA1c水平分为为HbA1c≤7％组、HbA1c 7％～ 9％组、HbA1c≥9％组,将40名健康男性作为对照组.采集其年龄、体重指数、病程及血钙、血磷、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶等临床指标,检测血清HbA1c、骨钙素、CTX-Ⅰ、ALP等指标.对4组间HbA1c水平与骨钙素、CTX-Ⅰ、ALP进行相关性和回归分析.结果 与对照组相比,HbA1c≤7％组、HbA1c 7％～9％组及HbA1c≥9％组血清骨钙素水平显著降低(F=7.211,P<0.05),血清ALP、CTX-Ⅰ水平显著升高(F=4.382、809.475,P<0.05);与HbA1c≤7％组相比,HbA1c7％～ 9％组和HbA1c≥9％组血清ALP水平显著降低(P<0.05),血清CTX-Ⅰ水平显著升高(P<0.05);与HbA1c7％～9％组相比,HbA1c≥9％组血清骨钙素水平显著降低(P<0.05),血清CTX-Ⅰ水平显著升高(P<0.05).Spearman相关分析发现,骨钙素与空腹血糖(r=-0.249,P=0.002)、糖化白蛋白(GA,r=-0.321,P=0.000)、HbA1c(r=-0.288,P=0.000)水平呈负相关,ALP、CTX-Ⅰ与空腹血糖(r=0.218、0.321)、GA(r =0.302、0.291)、HbA1c(r =0.321、0.238)水平呈正相关(P均<0.01).进一步经线性回归分析发现,骨钙素水平与GA(β=-0.086,P=0.008)、HbA1c(β=-0.502,P=0.001)呈负相关,CTX-Ⅰ水平与空腹血糖(β=0.042,P =0.003)、GA (β=0.007,P=0.015)、HbA1c(β=0.037,P=0.009)呈正相关.结论 2型糖尿病患者存在骨代谢指标异常,且HbA1 c与骨钙素、CTX-Ⅰ水平相关.

abstractsObjective To study the effects of different HbA1c levels on bone γ-carboxyglutamic-acid-containing protein(BGP), cross linked C-telopeptide of type Ⅰ collagen (CTX-Ⅰ), alkaline phosphatase(ALP) in type 2 diabetic patients.Methods A total of 120 male patients with type 2 diabetes mellitus(T2DM) newly admitted to the Department of Endocrinology, the Second Affiliated Hospital of Haerbin Medical Collage from October 2013 to January 2014 and 40 male healthy subjects from the physical examination center were included.Patients with T2DM were divided into HbA1c≤7％ group, HbA1c 7％-9％ group and HbA1c ≥9％ group according to their HbA1c levels, and 40 male healthy subjects were served as control group.Data of age, body mass index (BMI) , course of disease and serum calcium, phosphorus, alanine aminotransferase, aspartate aminotransferase levels were acquired and serum HbA1 c, BGP, CTX-Ⅰ ,ALP levels were detected.Correlation and regression analysis were used to investigate the correlation between HbA1c and BGP, CTX-Ⅰ , ALP.Results Compared with control group, serum BGP levels in HbA1c≤7％ group, HbA1c 7％-9％ group and HbA1c≥9％ group were significantly decreased (F=7.211,P<0.05), while serum ALP, CTX-Ⅰ levels were significantly increased (F=4.382, 809.475, all P <0.05).Compared with HbA1c≤7％ group, ALP levels in HbA1c 7％-9％ group and HbA1c ≥9％group were significantly decreased (P < 0.05), whereas serum CTX-Ⅰ levels were significantly increased(P <0.05).Compared with HbA1c 7％-9％ group, serum BGP level in HbA1c ≥9％ group was significantly decreased (P < 0.05), while serum CTX-Ⅰ level was significantly increased (P < 0.05).Spearman analysis revealed that BGP level was negatively correlated with fasting blood glucose (FBG, r =-0.249,P=0.002), glycated albumin (GA, r=-0.321, P=0.000), HbA1c (r=-0.288, P=0.000),whereas ALP, CTX-Ⅰ level were positively correlated with FBG (r =0.218, 0.321), GA (r =0.302,0.291) and HbA1c (r =0.321, 0.238) , all P <0.01.Further regression analysis revealed that BGP level was negatively correlated with GA (β =-0.086, P =0.008), HbA1c (β =-0.502, P =0.001), while CTX-Ⅰ level was positively correlated with FBG (β =0.042, P =0.003), GA (β =0.007, P =0.015)and HbA1 c (β =0.037, P =0.009).Conclusion Bone metabolic parameters are abnormal in type 2 diabetic patients, and BGP, CTX-Ⅰ levels are correlated with HbA1c.