2型糖尿病患者强化治疗前后血清骨钙素的变化

目的了解2型糖尿病（Type2 diabetes T2DM）患者在严格控制血糖后血清骨钙素（Osteocalcin，OC）水平的变化及其影响因素。方法按1999年WHO诊断标准筛选T2DM患者44例，应用胰岛素泵强化治疗12～15天，同时给予调脂、降压等综合治疗。记录人体测量参数，计算体质量指数（Body mass index，BMI）、腰臀比（Waist-to-hip ratio，WHR），监测治疗前、后生化指标，以及空腹血清OC、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）、白介素-6（interleakin-6，IL-6）的变化。结果强化治疗后血清OC水平由（7．624±3．23）ns／L上升至（11．92±4．45）ng／L，有显著意义（P〈0．01）。Pearson相关分析显示，治疗前后血清骨钙素的增值（AOC）与WHR（r=-0．339，P=0．024）、A空腹血糖（Fasting plasma glucose，FPG r=-0．890，P=0．000）、△餐后两小时血糖（2hour post-meal blood glucose，2h PBG r=-0．364，P=0．015）、△超敏C反应蛋白（high-sensitivity C—reaction protein，hs-CRP r=-0．372，P=0．013）以及△IL-6（r=-0．334，P=0．027）成负相关。多元逐步回归分析显示，△FPG是影响△OC的独立相关因素。结论T2DM患者强化治疗后血清OC水平比治疗前显著升高，且其增值与△FPG水平呈负相关，揭示了体内骨代谢与能量代谢之间存在密切关系。

Changes of the serum osteocalcin levels in the patients with type 2 diabetes mellitus before and after intensive insulin treatment

Objective To investigate the changes of the serum osteocalcin levels in the patients with type 2 diabetes mellitus before and after intensive insulin treatment and its influencing factors. Methods By the diagnosis standards of WHO for T2DM in 1999, 44 patients were selected. Their anthropometric parameters were measured and their WHR as well as BMI were calculated. The clinical biochemical parameters, osteocalcin, tumor necrosis factor-α （TNF- α） and interleukin-6 （IL-6） were determined. The above-mentioned parameters were determined again after an intensive insulin therapy for 12 - 15 days. Results The serum osteoealcin levels were increased significantly after the treatment, from （7.62 ±3.23） ng/L to （11.92 ±4.45） ng/L, （P 〈0.01）. The increment of the serum osteocalcin levels （△OC） was inversely correlated with the WHR （r = -0. 339, P=0. 024） , the △fasting plasma glucose （r= -0. 890, P = 0. 000）, the △2 hour post-meal blood glucose （ r = - 0. 364, P = 0. 015 ）, the △high-sensitivity C-reaction protein （ r = - 0. 372, P = 0. 013） and the △IL-6 （ r = - 0. 334, P = 0. 027）. The multiple regression analysis showed that the AFPG was an independent related factor in the influence of the Aosteocalcin levels. Conclusion The serum osteocalcin levels in the T2DM patients were increased significantly after an intensive insulin treatment and the increment was inversely correlated with the FPG. It might indicate that there was a close relationship between the bone metabolism and the energy metabolism in the body.