骨质疏松症与骨转换标志物的相关性研究

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童明宏, 肖国平, 丁慧. 骨质疏松症与骨转换标志物的相关性研究. 2013, 28(2): 111-113
TONG Minghong, XIAO Guoping, DING Hui. Study on the correlation of bone metabolism markers and osteoporosis. Labratory Medicine, 2013, 28(2): 111-113 复制到剪切板

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骨质疏松症与骨转换标志物的相关性研究

童明宏, 肖国平, 丁慧

上海市长宁区中心医院,上海 200336

作者简介：童明宏,女,1968年生,学士,副主任技师,主要从事免疫学技术和分子生物学技术的研究。

摘要

目的

探讨骨转换标志物在骨质疏松症患者中的检测意义和应有价值。

方法

应用双能X线骨密度仪测量脊柱和股骨骨密度(BMD)。根据骨密度值将74例受检者分为正常对照组19例,骨量减少组25例,骨质疏松组30例。同时用电化学发光免疫分析方法测定所有受检者骨转换标志物甲状旁腺素(PTH)、β-胶原特殊序列(β-CTX)、骨钙素(N-MID)和 25-羟基维生素D3水平。

结果

骨质疏松组:β-CTX、N-MID水平与正常对照组、骨量减少组比较差异有统计学意义(P<0.05);PTH、25-羟基维生素D3水平差异无统计学意义(P>0.05)。

结论

骨质疏松症患者血清骨代谢标志物水平与骨质疏松存在密切的相关性; 血清骨转换标志物β-CTX、N-MID是诊断骨质疏松症、预测骨折风险的理想指标。

关键词: 骨密度; 骨量减小; 骨质疏松; 甲状旁腺素; β-胶原特殊序列; 骨钙素; 25-羟基维生素D3

中图分类号:R446.1 文献标志码:A 文章编号:1673-8640(2013)02-0111-03

Study on the correlation of bone metabolism markers and osteoporosis

TONG Minghong, XIAO Guoping, DING Hui

Shanghai Changning District Central Hospital,Shanghai 200336, China

Abstract

Objective

To investigate the clinical significance of bone metabolism markers in patients with osteoporosis.

Methods

Bone mineral densities (BMD) of vertebral column and femur were measured by double functional X-ray digital bone density meter. A total of 74 patients were classified into 3 groups according to BMD: normal control (19 cases), bone-mass-reduction (25 cases) and osteoporosis (30 cases). Serum parathyroid hormone(PTH), beta-Crosslaps(β-CTX), osteocalcin (N-MID) and 25-OH Vitamin D3 levels were detected by electrochemiluminescence immunoassay.

Results

β-CTX and N-MID levels of osteoporosis group were significantly higher than those of normal control group and bone-mass-reduction group, and the difference had statistical significance (P<0.05). PTH and 25-OH Vitamin D3 levels had no statistical significance among the 3 groups (P>0.05).

Conclusions

There is a close relationship between bone metabolism markers and osteoporosis. Serum bone turnover markers of β-CTX and N-MID are good indicators in the diagnosis of osteoporosis and fracture risk prediction.

Keyword: Bone mineral density; Bone-mass-reduction; Osteoporosis; Parathyroid hormone; Beta-Crosslaps; Osteocalcin; 25-OH Vitamin D3

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引言

骨质疏松症(osteoporosis)是一种系统性骨病。其特征是骨量下降和骨的微细结构破坏,表现为骨的脆性增加,因而骨折的危险性大为增加,即使是轻微的创伤或无外伤的情况下也容易发生骨折。骨质疏松症是一种多因素所致的慢性疾病,在骨折发生之前,通常无特殊临床表现。该病女性多于男性,常见于绝经后妇女和老年人。随着我国老年人口的增加,骨质疏松症发病率处于上升趋势,在我国乃至全球都是一个值得关注的健康问题^{[ 1]}。

骨骼的生物标志物,是一类源于骨基质或骨细胞的代谢指标。对评估和治疗骨质疏松症具有重要的诊断意义,骨生物标志物不仅可以用来监控骨质疏松症患者治疗时的时效性和疗效,还可以用于预测骨折的风险^{[ 2]}。国际骨质疏松症基金会(international osteoporosls foundation,IOF)已发表导则推荐使用骨生物标志物。

材料和方法

一、研究对象

上海市长宁区中心医院2010年1月至2010年6月骨质疏松门诊的首次就诊患者74例,其中男20例,女54例,年龄4589岁。之前没有接受骨质疏松的相关治疗。所有患者用双能X线骨密度仪测量脊柱和股骨骨密度(BMD),同时抽取空腹静脉血4 mL,分离血清后,立即上机测定甲状旁腺素(PTH)、β-胶原特殊序列(β-CTX)、骨钙素(N-MID)、25-羟基维生素D3。

二、方法

1.仪器与试剂

罗氏(Roche)公司Elecsys提供全面的骨代谢血清检测指标及配套试剂测定,电化学发光免疫分析方法测定。

2.BMD检测

双能X线骨密度仪测量脊柱和股骨BMD。

3.骨质疏松症诊断标准

世界卫生组织及中国骨质疏松学会将双能X线BMD吸收测定法作为骨质疏松症诊断的“金标准”。参照世界卫生组织标准,按照BMD值将受检者分为3组:0~-1.1为正常;-1.2~-2.4为骨量减少;-2.5~以上为骨质疏松。

三、统计学方法

所有数据采用 ±s表示,组间比较用 t检验, P<0.05表示差异有统计学意义。

一、3组BMD检测结果见表1。

表1 3组BMD检测结果

二、3组骨生物标志物检测浓度

骨质疏松组β-CTX、N-MID水平与正常对照组、骨量减少组比较差异有统计学意义( P<0.05);骨质疏松组PTH、25-羟基维生素D3水平与正常对照组、骨量减少组比较差异无统计学意义( P>0.05)。骨量减少组PTH、β-CTX、N-MID、25-羟基维生素D3水平与正常对照组比较差异无统计学意义( P>0.05),结果见表2。

表2 3组骨生物标志物检测结果

讨论

目前BMD检测是诊断骨质疏松症的金标准。由于骨骼是具有代谢活性的动态的组织,并且在不断的重建,在检测出BMD变化前,骨重吸收标志物浓度已明显的升高,提示骨质大量流失。相对的,BMD不能预测将来的骨密度,而骨生物标志物却可以作到。并且,骨折风险的降低与BMD升高也并不总是相关,而骨生物标志物却与之显示出较好的相关性^{[ 2]}。

N-MID是由成骨细胞产生并沉积在骨基质,是骨形成指标,从骨髓中快速释放入血的N-MID能真实反映骨组织的N-MID水平,其降解与转化过程迅速,可直接反映瞬间成骨细胞活性与数量变化。血清β-CTX是骨中惟一的胶原成分,占骨基质的90%以上,是骨吸收指标。检测血清β-CTX的含量不仅对了解骨代谢瞬间变化,观察成骨细胞的功能状态和破骨细胞的活性具有重要意义,而且为内分泌代谢性疾病、老年骨质疏松症的诊断及治疗提供了有价值的指标。随着年龄的增长,尤其是女性绝经后由于雌激素水平的下降,破骨细胞活性增加,BMD下降,增加了骨转换率,使血清β-CTX升高导致骨基质形成不足,影响钙盐沉积,使骨消融增加,骨量丢失加速,破坏了骨形成和骨吸收间的平衡作用,使骨吸收明显强于骨形成,最终导致骨质疏松症^{[ 3, 4]}。本研究结果显示,骨质疏松组β-CTX、N-MID水平与正常对照组、骨量减少组比较差异有统计学意义( P<0.05)。骨质疏松组血清中高水平的β-CTX、N-MID反映了成骨细胞的活性降低、破骨细胞活性增加和骨转换率增加。

PTH与钙分泌相关,PTH可动员骨钙入血,PTH分泌过多可引起骨质疏松。绝经后骨质疏松症(I型)由于雌激素缺乏,血钙增高,可代偿性地使PTH分泌减少。老年性骨质疏松(Ⅱ型)由于肠钙吸收减少,血钙水平低,可继发性地使PTH分泌增加。因此,患有骨质疏松症后检查PTH的变化情况再结合其他检查的结果即可明确是I型骨质疏松症还是Ⅱ型骨质疏松症,以及是否是甲状旁腺机能亢进性骨质疏松症^{[ 2]}。本研究结果显示骨质疏松组PTH、25-羟基维生素D3水平与正常对照组、骨量减少组比较差异无统计学意义( P>0.05)。提示PTH、25-羟基维生素D3只是间接的作用,与钙吸收相关。可用于监测骨质疏松症等疾病的治疗效果。

结合BMD的检测,进一步证实了血清骨生物标志物水平与骨质疏松存在密切的相关性。

The authors have declared that no competing interests exist.

参考文献

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[1]	张春萍, 陆惠华, 江尧湖. 老年Ⅰ型胶原特异性序列及骨密度与骨质疏松相关性分析[J]. 中国老年学杂志, 2002, 22(4): 258-259. [本文引用:1]
[2]	Merchant R, Udani A, Puri V, et al. Evaluation of osteopathy in thalassemia by bone mineral densitometry and biochemical indices[J]. Indian J Pediatr, 2010, 77(9): 987-991. [本文引用:3] [JCR: 0.715]
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[4]	易伟莲, 廖德权, 林柏云, 等. 绝经后骨质疏松症患者性激素、细胞因子及骨代谢指标的变化及关系[J]. 检验医学, 2012, 27(4): 296-298. [本文引用:1]

2002

0.0

... 随着我国老年人口的增加,骨质疏松症发病率处于上升趋势,在我国乃至全球都是一个值得关注的健康问题^[1] ...

2010

0.715

0.0

. 2010, 77(9):987-991 DOI:10.1007/s12098-010-0158-2

Evaluation of osteopathy in thalassemia by bone mineral densitometry and biochemical indices

1.Department of Pediatrics, Dr Balabhai Nanavati hospital Mumbai, 501, Rangmahal 5th floor, 2 Mount mary road, Bandra (west), Mumbai, 400050 India 2.Department of RIA, P. D. Hinduja National Hospital and Medical Research Centre Mumbai, Mumbai, India 3.Department of Radiology, Dr. Balabhai Nanavati Hospital Mumbai, Mumbai, India

Objective To evaluate osteopathy in thalassemia by bone mineral densitometry (BMD) and biochemical indices.

... 对评估和治疗骨质疏松症具有重要的诊断意义,骨生物标志物不仅可以用来监控骨质疏松症患者治疗时的时效性和疗效,还可以用于预测骨折的风险^[2] ...

... 并且,骨折风险的降低与BMD升高也并不总是相关,而骨生物标志物却与之显示出较好的相关性^[2] ...

... 型骨质疏松症,以及是否是甲状旁腺机能亢进性骨质疏松症^[2] ...

2002

6.128

0.0

. 2002, 17(11):1961-1967

Decreased Bone Density, Elevated Serum Osteoprotegerin, and β-Cross-Laps in Wilson Disease

D. Hegedus,V. Ferencz,P. L. Lakatos,S. Meszaros,P. Lakatos,C. Horvath andF. Szalay M.D., Ph.D. *

First Department of Medicine, Semmelweis University, Budapest, Hungary * First Department of Medicine, Semmelweis University, Korányi S 2/A, H-1083 Budapest, Hungary

> Osteopathia has been reported in Wilson disease (WD), but bone density has not been measured; therefore, we performed bone mineral density (BMD), bone mineral content (BMC), and quantitative bone ultrasound (QUS) assessments, as well as measured the serum levels of osteocalcin (OCN), β-cross-laps (β-CTx's), and the recently discovered osteoprotegerin (OPG) and its ligand RANKL to investigate the underlying mechanism of osseous disorders. Serum OCN, β-CTx, OPG, and RANKL levels were measured by ELISA in 21 WD patients and in 20 age- and gender-matched healthy subjects. BMD, BMC, and QUS parameters were also determined. Osteoporosis was present in 9/21 (43%) WD patients. Abnormal QUS parameters were found in 7 (33%) of the patients. Although serum OCN levels were similar in patients and controls (29.93 ± 24.65 mg/ml vs. 29.84 ± 6.89 mg/ml), β-CTx and OPG levels were significantly increased in WD compared with the healthy controls (625.4 ± 312.3 pg/ml vs. 423.6 ± 144.3 pg/ml and p = 0.022 and 7.2 ± 3.4 pM vs. 3.5 ± 1.0 pM and p r = 0.55; p = 0.01). We proved high occurrence of osteoporosis in WD. Negative bone remodeling balance is a consequence of increased bone resorption, which is indicated by elevated β-CTx. The novel finding of elevated serum OPG may reflect a compensatory reaction to enhanced osteoclast activity, despite the normal OCN level.

... -CTX升高导致骨基质形成不足,影响钙盐沉积,使骨消融增加,骨量丢失加速,破坏了骨形成和骨吸收间的平衡作用,使骨吸收明显强于骨形成,最终导致骨质疏松症^[3,4] ...

2012

0.0