脊柱结核病尿脱氧吡啶啉检测及其临床意义

Detection of urinary deoxypyridinoline in patients with spinal tuberculosis and its clinical significance

[目的]通过对脊柱结核(STB)患者骨代谢标志物尿脱氧吡啶啉(DPD)的测定,观察其变化与脊柱结核病的关系;评价其在判定继发于肺结核(PTB)的脊柱结核筛选诊断方面的临床意义。[方法]采用自动化学发光免疫分析法及自动化学分析法检测脊柱结核组、肺结核组和健康对照组的尿DPD水平,其中尿DPD以尿肌酐(Cr.)来校正(DPD/Cr.),将检测结果进行诊断有效性分析。[结果]脊柱结核患者、肺结核患者、健康对照组DPD的测定值分别为(14.9±9.8)μmol/molCr.、(6.4±2.6)μmol/molCr.和(6.3±2.0)μmol/molCr.,脊柱结核患者尿DPD较肺结核患者、健康成人对照组显著增高,差异具有显著性意义(P=0.001,P=0.000)。肺结核患者与健康对照组相比,尿DPD的检测差异均无显著性意义(P=0.751)。所检测的脊柱结核患者尿DPD的接受者工作特性曲线(ROC)下面积为0.83,在ROC曲线下,DPD测定值以8.4μmol/molCr.为截断点时,诊断脊柱结核的敏感性是87%,特异性是73%。[结论]脊柱结核可以引起骨代谢的改变,尿DPD能敏感地反映脊柱结核骨吸收的状况,尿液DPD检测有助于继发于肺结核的脊柱结核患者的早期筛选。

[ Objective] To investigate the changes of urinary deoxypyridinoline （DPD） in patients with spinal tuberculosis （STB） and evaluate their clinical sigmificance. [ Method] All subjects were divided into three groups： group 1, STB patients; group 2, Pulmonary TB patients： group 3, healthy controls. Their DPD was detected by ACS： 180 automated chemilumines- cence system. The values for urinary DPD were adjusted for urinary creatinine to overcome confounding variables such as body mass index and urine dilution. The results were analyzed. [ Resuit] The mean urinary concentrations of DPD in spinal tubercu- losis , pulmonary tuberculosis and healthy controls were 1 （4. 9 ±9. 8） μmol/mol Cr. , （6.4±2. 6） μmol/mol Cr, and （6.3 ± 2.0） μmol/mol Cr. , respectively （P value =0. 001,0. 000） . Patients with spinal tuberculosis had a higher urinary excretion of DPD than those without spinal tuberculosis. There was no difference in groups of pulmonary tuberculosis and healthy controis （P = 0. 751 ） . DPD had a better receiver operating characteristic （ROC） curve and the area under the ROC curve was 0. 83. For DPD, the sensitivity （87%） and specificity （73%） were seen at the cut - off level of 8.4 μmol/mol creatinine. [ Conclusion] Change of bone matabolic activities can be found in patients with STB. Bone resorption can increase sharply by DPD. The determination of urinary DPD may provide an important reference value for the assessment of STB from Pulmonary TB.