目的:探讨血清25-羟基维生素D(25-hydroxyvitaminD,25-OH-VD)和骨钙素(osteocalcin,OC)水平对2型糖尿病(type 2 diabetes mellitus,T2DM)病程转归的预警价值.方法:选取2013年1月至12月在复旦大学附属金山医院内分泌科住院治疗的T2DM患者116例作为病例组,对照组为2013年在我院门诊体检的健康体检者50例,比较两组的年龄、体质指数(body mass index,BMI)、空腹血糖(fasting blood glucose,FBG)、血脂、血压、25-OH-VD及OC等生理指标.分析病例组25-OH-VD和OC与糖尿病肾病的相关性,进一步采用多元逐步回归分析25-OH-VD和OC水平与血脂、血压、BMI、FBG、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、空腹胰岛素(fast insulin,FINS)、胰岛素抵抗指数(homeostasis model assessment for insulin resistance index,HOMA-IR)、肌酐(creatinine,CR)、尿酸(uric acid,UA)和颈动脉内膜中层厚度(carotid artery intimal medial thickness,CA-IMT)之间的相关性.结果:病例组与对照组在年龄、血压、BMI和血脂间的差异无统计学意义,但病例组25-OH-VD水平低于正常对照组[(13.91±7.13) ng/mL vs (30.35±19.7) ng/mL,P=0.000],病例组OC也低于对照组[(4.02±1.66) ng/mL vs (6.62±1.68) ng/mL,P=0.000].病例组中,肾病患者的25-OH-VD水平明显低于尿微量白蛋白(urine microalbumin,U-MA)正常者[(10.33±3.46) ng/mL vs (16.45±7.95) ng/mL,P=0.000],而两者之间OC水平差异无统计学意义[(3.91±1.67) ng/mL vs (4.09±1.67) ng/mL, P=0.558].T2DM患者的25-OH-VD水平与BMI、血脂、血压、FBG、HbA1c、FINS、HOMA-IR、CR、UA和CA-IMT均无明显相关性.T2DM患者的OC水平与FBG、HbA1c和HOMA-IR负相关,而与FINS、CR和CA-IMF正相关,HbA1c和FBG是OC的独立影响因素.结论:血清25-OH-VD和OC可作为T2DM病情进展的预警信号,25-OH-VD与糖尿病肾脏并发症的发生发展相关,OC则与糖尿病微血管病变的进展相关.%Objective:To explore the warning effect of serum levels of 25-hydroxy vitamin D (25-OH-VD) and osteocalcin(OC) with the prognosis of type 2 diabetes mellitus (T2DM).Methods:The case group of 116 cases of T2DM were selected from the patients hospitalizedin the department of endocrinology, Jinshan Hospital, Fudan University from Jan.to Dec.in 2013, and 50 cases of health volunteers from the outpatient of physical examination in our hospital were collected as the control group.The age, body mass index(BMI), fasting blood glucose (FBG), blood lipid, blood pressure and 25-OH-VD and OC were compared between the two groups.In the case group, the correlation of 25-OH-VD and OC with nephropathy were analyzed, and then multiple stepwise regression was used to analyze the statistical relationship of 25-OH-VD and OC with blood lipid, blood pressure, BMI, FBG, glycosylated hemoglobin (HbA1c), fast insulin (FINS), homeostasis model assessment for insulin resistance index (HOMA-IR), creatinine (CR), uric acid (UA)and carotid artery intimal medial thickness (CA-IMT).Results:There was no statistical difference in age, blood pressure, BMI and blood lipid between the case group and the control group, while the levels of 25-OH-VD and OC were lower in the case group compared with the control group ([13.91±7.13] ng/mL vs [30.35±19.7] ng/mL, P=0.000;[4.02±1.66] ng/mL vs [6.62±1.68] ng/mL, P=0.000).In the case group, patients with nephropathy had lower 25-OH-VD level than those with normal urine microalbumin (U-MA) ([10.33±3.46] ng/mL vs [16.45±7.95] ng/mL,P=0.000), while there was no statistical difference in OC level ([3.91±1.67] ng/mL vs [4.09±1.67] ng/mL, P=0.558).25-OH-VD level of T2DM patients has no correlation with BMI, blood lipid, blood pressure, FBG, HbA1c, FINS, HOMA-IR, CR, UA and CA-IMT.OC level of T2DM patients has negative correlation with FBG, HbA1c and HOMA-IR, and positive correlation with FINS, CR and CA-IMF, therefore HbA1c and FBG were the independent influence factor of OC.Conclusions:Serum levels of 25-OH-VD and OC can be seen as the warning singles of T2DM progression.25-OH-VD has correlation with diabetic nephropathy, and OC has correlation with diabetic microangiopathy.
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