绝经后妇女骨转换生化标志物与骨密度相关性分析

doi:10.3969/j.issn.1673-8640.2017.05.003

摘要/Abstract

摘要：

目的分析绝经前后妇女骨转换生化标志物水平的变化及与骨密度的关系,同时探讨骨密度降低妇女绝经前期及绝经后期骨代谢生化指标的水平。方法用双能X线骨密度仪测定225例骨质疏松症门诊女性就诊者腰椎（L1~L4）及股骨颈骨密度,选取其中185例45~65岁的绝经女性根据骨密度值分为骨量正常组（50名）、骨量减少组35例和骨质疏松组（100例）;选取其中45例51~70岁的骨密度降低者作为绝经后期骨密度降低组,选取其中25例42~50岁的未绝经骨密度降低者作为绝经前期骨密度降低组。采用酶联免疫吸附试验（ELISA）检测所有受检者血清组织蛋白酶K（Cathe K）、骨碱性磷酸酶（B-ALP）、抗酒石酸酸性磷酸酶（TRAP）水平;同时用电化学发光免疫分析法检测骨钙素、β-胶原降解产物（β-crosslaps）、Ⅰ型前胶原氨基端前肽（PⅠNP）水平。结果骨质疏松组绝经后妇女血清Cathe K、PⅠNP、β-crosslaps、骨钙素、TRAP水平明显高于骨量正常组（P<0.05）,且与腰椎（L1~L4）或股骨颈骨密度呈明显负相关（P<0.05）;B-ALP水平稍低于骨量正常组,但差异无统计学意义（P>0.05）。绝经后期骨密度降低组血清Cathe K、TRAP水平明显低于绝经前期妇女（P<0.01）,血清PⅠNP、骨钙素水平明显高于绝经前期骨密度降低组（P<0.01）,而2个组之间腰椎（L1~L4）、股骨颈骨密度及β-crosslaps、B-ALP水平差异均无统计学意义（P>0.05）。结论绝经后女性骨质疏松症为高转换型。血清骨钙素、β-crosslaps、PⅠNP、B-ALP、TRAP、Cathe K水平变化可反映骨代谢活动。骨密度及骨转换生化指标联合检测有利于骨质疏松症患者的预防、治疗和疗效观察。

关键词: 骨转换生化标志物, 骨质疏松症, 骨密度, 绝经妇女

Abstract:

Objective To analyze the correlation of bone mineral density with bone turnover biochemical markers in premenopausal and postmenopausal women,and to investigate the levels of bone metabolism biochemical markers of women with decreasing bone mineral density in premenopause and postmenopause. Methodse Bone mineral densities of lumbar spine（L1-L4）and femoral neck were determined by dual energy X-ray. According to bone mineral densities,185 postmenopausal 45-65-year-old women were classified into bone mass normal group（50 cases）,bone mass loss group （35 cases）and osteoporosis group （100 cases）. A total of 45 postmenopausal 51-70-year-old women with decreasing bone mineral density were enrolled as postmenopausal decreasing bone mineral density group. A total of 25 premenopausal 42-50-year-old women with decreasing bone mineral density were enrolled as premenopausal decreasing bone mineral density group. Enzyme-linked immunosorbent assay（ELISA）was used to determine the levels of serum cathepsin K （Cathe K）,bone alkaline phosphatase（B-ALP）and tartrate-resistant acid phosphatase （TRAP）. The levels of osteocalcin,beta-collagen degradation product（β-crosslaps）and type Ⅰ procollagen N-terminal propeptide （PⅠNP）were determined by electrochemiluminescence. Results The levels of serum Cathe K,PⅠNP,β-crosslaps,osteocalcin and TRAP in osteoporosis group were higher than those in bone mass normal group （P<0.05）,which showed negative correlations with the bone mineral density of lumbar spine or femoral neck （P<0.05）,and B-ALP level was slightly lower than that in bone mass normal group without statistical significance （P>0.05）. Serum Cathe K and TRAP levels were lower in postmenopausal decreasing bone mineral density group than those in premenopausal decreasing bone mineral density group（P<0.01）,and serum PⅠNP and osteocalcin levels were higher（P<0.01）. The bone mineral densities of lumbar spine and femoral neck and the levels of β-crosslaps and B-ALP in the premenopausal and postmenopausal groups had no statistical significance（P>0.05）. Conclusions Postmenopausal women with osteoporosis is high turnover type. The levels of serum osteocalcin,β-crosslaps,PⅠNP,B-ALP,TRAP and Cathe K can reflect bone metabolism. Bone mineral density examination combined with bone turnover biochemical markers can be used for the prevention and treatment monitoring of osteoporosis.

Key words: Bone turnover biochemical markers, Osteoporosis, Bone mineral density, Postmenopausal women

中图分类号:

R446.1

王蓉, 陈广洁, 沈安达, 黄克亮, 周赢梁. 绝经后妇女骨转换生化标志物与骨密度相关性分析[J]. 检验医学, 2017, 32(5): 361-366.

WANG Rong, CHEN Guangjie, SHEN Anda, HUANG Keliang, ZHOU Yingliang. Correlation of bone mineral density with bone turnover biochemical markers in postmenopausal women[J]. Laboratory Medicine, 2017, 32(5): 361-366.

图/表 4

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组别	例数	Cathe K （ng/L）	PⅠNP （ng/mL）	β-crosslaps （ng/mL）	骨钙素（ng/mL）	B-ALP （pg/mL）	TRAP （pg/L）
骨量减少组	35	23.8±20.4	46.6±6.4	0.6±0.3	12.9±3.8	1 852.3±200.9	2 433.2±474.9
骨质疏松组	100	33.0±22.8^*	79.7±5.9^*	0.9±0.3^*	17.7±5.6^*	1 638.8±430.4	2 727.5±1 297.2^*
骨量正常组	50	24.6±12.6	53.2±4.6	0.6±0.1	11.8±2.9	1 651.2±237.5	2 403.2±408.1

组别	例数	Cathe K （ng/L）	PⅠNP （ng/mL）	β-crosslaps （ng/mL）	骨钙素（ng/mL）	B-ALP （pg/mL）	TRAP （pg/L）
骨量减少组	35	23.8±20.4	46.6±6.4	0.6±0.3	12.9±3.8	1 852.3±200.9	2 433.2±474.9
骨质疏松组	100	33.0±22.8^*	79.7±5.9^*	0.9±0.3^*	17.7±5.6^*	1 638.8±430.4	2 727.5±1 297.2^*
骨量正常组	50	24.6±12.6	53.2±4.6	0.6±0.1	11.8±2.9	1 651.2±237.5	2 403.2±408.1

项目	股骨颈骨密度	腰椎（L1~L4 ）骨密度	Cathe K	PⅠNP	β-crosslaps	骨钙素	B-ALP
腰椎（L1~L4）骨密度
r值	0.759
P值	0.007
Cathe K
r值	-0.098	-0.312
P值	0.664	0.036
PⅠNP
r值	-0.146	-0.383	0.268
P值	0.246	0.028	0.042
β-crosslaps
r值	-0.459	-0.389	0.262	0.945
P值	0.028	0.028	0.048	0.000
骨钙素
r值	-0.069	-0.322	0.364	0.516	0.517
P值	0.334	0.033	0.029	0.016	0.016
B-ALP
r值	-0.128	-0.123	-0.357	0.485	0.509	0.496
P值	0.324	0.483	0.030	0.024	0.017	0.022
TRAP
r值	-0.141	-0.292	0.263	0.481	0.537	0.483	0.520
P值	0.383	0.040	0.048	0.024	0.005	0.024	0.011

项目	股骨颈骨密度	腰椎（L1~L4 ）骨密度	Cathe K	PⅠNP	β-crosslaps	骨钙素	B-ALP
腰椎（L1~L4）骨密度
r值	0.759
P值	0.007
Cathe K
r值	-0.098	-0.312
P值	0.664	0.036
PⅠNP
r值	-0.146	-0.383	0.268
P值	0.246	0.028	0.042
β-crosslaps
r值	-0.459	-0.389	0.262	0.945
P值	0.028	0.028	0.048	0.000
骨钙素
r值	-0.069	-0.322	0.364	0.516	0.517
P值	0.334	0.033	0.029	0.016	0.016
B-ALP
r值	-0.128	-0.123	-0.357	0.485	0.509	0.496
P值	0.324	0.483	0.030	0.024	0.017	0.022
TRAP
r值	-0.141	-0.292	0.263	0.481	0.537	0.483	0.520
P值	0.383	0.040	0.048	0.024	0.005	0.024	0.011

组别		例数	骨密度（g/cm²）				Cathe K（ng/L）		PⅠNP（ng/mL）
组别		例数	腰椎（L1~L4）		股骨颈		Cathe K（ng/L）		PⅠNP（ng/mL）
绝经前期骨密度降低组		25	0.78±0.09		0.71±0.09		28.00±9.60		43.10±22.80
绝经后期骨密度降低组		45	0.76±0.10		0.74±0.09		20.70±7.40^**		69.60±30.90^*
组别	β-crosslaps（ng/mL）			骨钙素（ng/mL）		B-ALP（pg/mL）		TRAP（pg/L）
绝经前期骨密度降低组	0.44±0.27			10.70±6.60		1 554.90±529.4		2 931.40±1 196.00
绝经后期骨密度降低组	0.40±0.30			16.10±8.90^*		1 726.10±457.7		2 534.90±1 254.90