糖化血红蛋白与骨代谢生化指标相关性的探讨

目的探讨糖化血红蛋白(HbA1c)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(HbA1c6.5%)、B组(6.5%≤HbA1c8.0%)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(NMID 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(TP1NP)、钙、磷]水平并做比较,分析HbA1c与骨代谢相关指标之间的相关性。结果 A、B、C 3组NMID Osteocalcin、Vit D均明显低于正常对照组(P0.05);A组β-CrossLaps明显高于正常对照组(P0.05);B组ALP、TP1NP及C组TP1NP、β-CrossLaps、PTH均明显低于正常对照组(P0.05);B组ALP、N-MID Osteocalcin、β-CrossLaps、Vit D及C组N-MID Osteocalcin、TP1NP、β-CrossLaps、PTH、Vit D明显低于A组(P0.05);C组N-MID Osteocalcin、PTH明显低于B组(P0.05),而ALP则明显升高(P0.05);其余各项指标各组间差异均无统计学意义(P0.05)。HbA1c与N-MID Osteocalcin、TP1NP、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、TP1NP、β-CrossLaps、PTH、Vit D有影响。血糖控制越差,骨代谢指标N-MID Osteocalcin、TP1NP、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。

Investigation on the correlation between glycosylated hemoglobin A1c and biochemical markers of bone metabolism

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 imp