绝经后骨质疏松症相关骨代谢指标的分析

doi:10.3969/j.issn.1673-8640.2013.08.008

摘要/Abstract

摘要： 目的观察调控破骨细胞活性的主要因子和骨吸收及骨形成标志物在绝经后骨质疏松症(PMOP)患者体内水平的变化,为临床早期防治骨质疏松提供依据。方法测定38例PMOP患者、50例骨量减低患者及94名绝经后骨量正常者(正常对照组)血清骨保护素(OPG)、核因子-kβ受体活化因子配体(RANKL)、骨源性碱性磷酸酶(BAP)、血清抗酒石酸酸性磷酸酶(TRACP)-5b、雌二醇(E2)、血浆同型半胱氨酸(Hcy)水平。剔除年龄、E2因素后对部分指标进行偏相关分析;对所有指标进行独立危险因素分析及二分类Logistic回归分析;采用受试者工作特征(ROC)曲线评价诊断准确度。结果 PMOP组、骨量减低组与正常对照组之间E2、Hcy、OPG、RANKL、TRACP-5b、BAP水平差异有统计学意义(P<0.05、P<0.01、P<0.001);PMOP组BAP水平明显高于骨量减低组及正常对照组(P<0.001),E2水平则明显低于骨量减低组(P<0.001)及正常对照组(P<0.05)。正常对照组与骨量减低组之间E2、BAP水平无明显差异(P＞0.05)。控制年龄因素后,E2与TRACP-5b、BAP呈负相关[r值分别为-0.198(P=0.007)、-0.157(P=0.035)];控制年龄、E2因素后,Hcy与RANKL、TRACP-5b、BAP呈正相关(r值分别为0.368(P<0.001)、0.193(P=0.009)、0.224(P=0.002)],与OPG呈负相关(r值＝-0.330,P<0.001)。OPG与TRACP-5b呈负相关(r=-0.458,P=0.008),RANKL与BAP呈正相关(r=0.228,P=0.044)。E2、Hcy、OPG、RANKL、TRACP-5b、BAP诊断骨质疏松的ROC曲线下面积分别为0.819、0.686、0.803、0.776、0.731和0.719。骨质疏松影响因素的Logistic回归分析表明,独立于年龄,E2、OPG、TRACP-5b、Hcy对骨质疏松有显著影响,优势比(OR)分别为0.901、0.046、4.165、9.112。结论 TRACP-5b、Hcy和BAP对骨质疏松症的诊断准确度较好,可以作为临床早期防治PMOP的依据。

关键词: 骨保护素, 核因子-kβ受体活化因子配体, 骨源性碱性磷酸酶, 抗酒石酸酸性磷酸酶, 雌二醇, 同型半胱氨酸, 骨代谢, 绝经后骨质疏松症

Abstract: Objective To observe the changes of the main factor for regulating osteoclast activity and bone resorption and bone formation markers in vivo of patients with postmenopausal osteoporosis(PMOP), and provide the reference for clinical early prevention of osteoporosis. Methods The levels of serum osteoprotegerin(OPG),nuclear factor-k beta receptor activator ligand(RANKL),bone alkaline phosphatase(BAP),serum tartrate-resistant acid phosphatase(TRACP)-5b,estradiol (E2), plasma homocysteine(Hcy) were determined in 38 patients with PMOP, 50 patients with bone mass reducing and 94 subjects with normal bone mass(control group). Partial correlation analysis was used for some of the indicators excluding age and E2. Independent risk factor analysis and binary Logistic regression analysis were used for all indicators. Receiver operating characteristic (ROC) curve evaluation was used for the diagnosis accuracy. Results A statistical significance in E2,Hcy,OPG,RANKL,TRACP-5b and BAP levels was observed in patient groups and control group(P<0.05, P<0.01, P<0.001). BAP levels of PMOP group were higher than those of bone mass reducing and control groups(P<0.001). However, E2 levels were lower than those of bone mass reducing group(P<0.001) and control group(P<0.05). There was no significant difference in E2 and BAP levels between bone mass reducing group and control group(P>0.05). There was a negative correlation between E2 level with TRACP-5b level(r=-0.198, P=0.007)and BAP level (r=-0.157, P=0.035) excluding age. Excluding age and E2, there was a positive correlation between Hcy with RANKL, TRACP-5b and BAP(r=0.368, P<0.001; r=0.193, P=0.009 and r=0.224, P=0.002) and a negative correlation between Hcy with OPG(r=-0.330, P<0.001). There was a negative correlation between OPG and TRACP-5b(r=-0.458, P=0.008), and there was a positive correlation between RANKL and BAP (r=0.228, P=0.044), excluding age and E2. The areas under the ROC curve of E2, Hcy, OPG, RANKL, TRACP-5b and BAP for the diagnosis of osteoporosis were 0.819, 0.686, 0.803, 0.776, 0.731 and 0.719, respectively. The Logistic regression analysis showed that E2, OPG, TRACP-5b and Hcy had evident effect to osteoporosis excluding age, which the odd ratios(OR) were 0.901, 0.046, 4.165 and 9.112, respectively. Conclusions TRACP-5b, Hcy and BAP are better for the diagnosis of osteoporosis, and they can be used as the reference for the clinical early prevention of PMOP.

Key words: Osteoprotegerin, Nuclear factor-k beta receptor activator ligand, Bone alkaline phosphatase, Tartrate-resistant acid phosphatase, Estradiol, Homocysteine, Bone metabolism, Postmenopausal osteoporosis

中图分类号:

R446.1

杨立顺,袁海生,沈兴娅,康建华,王艾云. 绝经后骨质疏松症相关骨代谢指标的分析[J]. 检验医学, 2013, 28(8): 685-689.

YANG Lishun,YUAN Haisheng,SHEN Xingya,KANG Jianhua,WANG Aiyun.. The analysis of related bone metabolism indicators in postmenopausal osteoporosis[J]. , 2013, 28(8): 685-689.

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