尿NTX、血清BAP在多发性骨髓瘤的临床意义

The clinical significance of urine NTX,serum BAP in multiple myeloma

背景与目的:近年尿Ⅰ型胶原氨基末端肽(uNTX)、血清骨特异性碱性磷酸酶(sBAP)在监测实体瘤骨转移的作用已得到肯定,本研究旨在了解其在多发性骨髓瘤(multiple myeloma,MM)的意义。方法:对38例MM患者(22例初治、12例复发/难治、4例平台期),在治疗前、治疗3个月和6个月留取血清和晨起第2次中段尿,10名健康人作对照。应用ELISA法检测uNTX、sBAP浓度。结果:初治、复发/难治患者uNTX明显高于平台期和健康对照者;sBAP明显低于平台期和健康对照。Ⅲ期患者uNTX明显高于Ⅰ/Ⅱ期;sBAP明显低于Ⅰ/Ⅱ期。治疗3个月时uNTX、sBAP已有明显变化,有效者uNTX明显降低,sBAP升高;治疗6月时有效者uNTX继续降低,sBAP继续升高。而6个月时复查X线平片骨损害部位尚无明显改变。结论:骨代谢标志物uNTX、sBAP与多发性骨髓瘤骨质破坏密切相关,其变化明显早于X线平片。检测uNTX、sBAP有助于监测MM疾病进展及骨髓瘤治疗的疗效。

Background and purpose： The role of urine N-telopeptides of type [ collagen（uNTX） and serum bone spesific alkaline phosphatase（sBAP）was confirmed in osseous metastasis of solid tumors. The aim of this article was to study their role in multiple myeloma （MM）. Methods： Thirty eight MM patients （22 new diagnosed, 12 relapsed or refractory, 4 plateau patients ） were examined. Ten age-matched healthy volunteers were used as controls. Urine and serum samples were taken from all patients and controls before therapy, after 3 months and 6 months chemotherapy. Urine samples of NTX, serum samples of BAP were measured with enzyme-linked immunosorbent assays （ELISA）. Results： Urine NTX concentrations were significantly higher in newly diagnosed and relapsed or refractory patients than that in plateau patients and controls. Serum BAP concentrations were significantly lower than that in plateau patients and controls. In newly diagnosed patients, urine NTX values were significantly higher in stage Ⅲ disease than in stage Ⅰ / Ⅱ disease, serum BAP values were significantly higher in stage Ⅰ / Ⅱ disease than stage Ⅲ disease. At the third month, urine NTX were significantly lower and serum BAP were significantly higher as well as at the sixth month. But osteolytic lesions in X -ray had no change at the sixth month. Conclusions： Bone turnover markers uNTX, sBAP and bone destruction are closely interrelated in multiple myeloma, they change much earlier than X-ray. They are useful in monitoring progression and the therapeutic effect of myeloma.