Pedrazzoni M, Ciotti G, Pioli G, Girasole G, Davoli L, Palummeri E, Passeri M
Institute of Clinica Medica Generale E Terapia Medica, University of Parma, Italy.
Calcif Tissue Int. 1989 Dec;45(6):331-6. doi: 10.1007/BF02556002.
Because a series of reports suggests the existence of altered bone and mineral metabolism in diabetes mellitus, we studied 106 diabetic subjects (42 insulin-dependent (IDD) and 64 noninsulin dependent (NIDD] to determine whether a difference in bone turnover (evaluated by serum osteocalcin (OC] could be found in comparison with normal controls. OC levels in diabetic subjects were lower than the age- and sex-specific predicted values. The reduction was especially evident in male and female NIDD (Z-score: - 1.12 +/- 0.92, t = 8.4, P less than 0.001 and -0.84 +/- 0.86, t = 4.0, P less than 0.01, respectively) and male IDD (Z-score: - 0.90 +/- 0.86, t = 4.5, P less than 0.01). The mean Z-score for female IDD, albeit negative (-0.31 +/- 0.79; t = 1.6; 0.2 greater than P greater than 0.1), was not significantly different from normal. Total serum calcium (Ca) and calcitonin (CT) showed an opposite pattern, being higher in all the diabetic subgroups (with the exception of Ca in female IDD), whereas parathyroid hormone (PTH) was lower than expected in each diabetic subset. By multiple regression analysis, the reduction of OC was related to PTH and CT levels and to the type of treatment. Subjects controlled with diet showed differences of greater magnitude from the expected normal values than those treated with oral hypoglycemic agents or insulin (Z-score: -1.28 +/- 1.05 vs. -0.85 +/- 0.90 and -0.63 +/- 0.97, respectively; P = 0.05). However, the variance explained by these three factors was small, suggesting that other variables (possibly 1 alpha,25(OH)2D) exerted important influences on OC levels.
由于一系列报告提示糖尿病患者存在骨与矿物质代谢改变，我们对106例糖尿病患者（42例胰岛素依赖型[IDD]和64例非胰岛素依赖型[NIDD]）进行了研究，以确定与正常对照组相比，是否能发现骨转换（通过血清骨钙素[OC]评估）存在差异。糖尿病患者的OC水平低于年龄和性别特异性预测值。这种降低在男性和女性NIDD中尤为明显（Z值：-1.12±0.92，t = 8.4，P＜0.001；以及-0.84±0.86，t = 4.0，P＜0.01），在男性IDD中也很明显（Z值：-0.90±0.86，t = 4.5，P＜0.01）。女性IDD的平均Z值虽然为负（-0.31±0.79；t = 1.6；0.2＞P＞0.1），但与正常情况无显著差异。总血清钙（Ca）和降钙素（CT）呈现相反模式，在所有糖尿病亚组中均较高（女性IDD中的Ca除外），而甲状旁腺激素（PTH）在每个糖尿病亚组中均低于预期。通过多元回归分析，OC的降低与PTH和CT水平以及治疗类型有关。饮食控制的患者与预期正常值的差异幅度大于口服降糖药或胰岛素治疗的患者（Z值分别为：-1.28±1.05、-0.85±0.90和-0.63±0.97；P = 0.05）。然而，这三个因素所解释的方差较小，表明其他变量（可能是1α,25(OH)2D）对OC水平有重要影响。
