骨代谢标志物与多发性骨髓瘤的关系

Bone turnover markers in multiple myeloma

目的研究骨代谢标志物在多发性骨髓瘤（MM）骨病中的作用。方法对38例MM患者在治疗前、治疗3个月及6个月检测血清抗酒石酸酸性磷酸酶-5b（sTRACP-5b）、骨特异性碱性磷酸酶（sBAP）、骨钙素（sOC）、尿I型胶原氮端尾肽（uNTX）浓度。结果初治、复发及难治患者尿NTX明显高于健康对照、平台期患者；sTRACP-5b明显高于健康对照，与平台期患者差异无统计学意义；sBAP明显低于健康对照、平台期患者。初治MM、复发及难治、平台期患者和健康对照血清OC之间差异无统计学意义。初治患者uNTX、sBAP与疾病分期相关，Ⅲ期患者uNTX明显高于I、Ⅱ期，呈正相关；sBAP明显低于I、Ⅱ期，呈负相关。初治患者uNTX与sTRACP-5b水平正相关。初治患者治疗3个疗程骨代谢标志物uNTX明显降低，sBAP升高，sTRACP-5b、sOC变化不大；6个疗程有效者uNTX、sTRACP-5b明显降低，sBAP和sOC升高。而治疗6个疗程时X线检查骨质破坏未出现明显改善。结论骨代谢标志物与多发性骨髓瘤骨质破坏密切相关。监测骨代谢标志物可监测疾病进展及治疗疗效。

Objective To study the role of bone turnover markers in multiple myeloma （MM） bone disease. Methods Thirty-eight MM patients were studied. Serum and urine samples were taken before, after 3 months and 6 months therapy. Serum samples of tartrate resistant acid phosphatase isoform-5b（sTRACP-5b）, bonespesific alkaline phosphatase（sBAP）, osteocslcin（sOC）, urine samples of N-telopeptides of type I collagen （NTX） were measured. Results Urine NTX concentrations were significantly higher in newly diagnosed and relapsed or refractory patients than that in pleateum patients and controls, serum TRACP-5b concentrations were significantly higher in newly diagnosed and relapsed or refractory patients than that in controls. There were no statistical significance compared with pleateum patients. Serum BAP concentrations were significantly lower than that in pleateum patients and controls. Serum OC concentrations were not statistically significant among the newly diagnosed patients, relapsed or refractory patients, pleateum patients and control. In newly diagnosed patients, urine NTX levels were significantly higher in stage Ⅲ than that in stage I / Ⅱ, serum BAP levels were significantly lower in stage m than that in stage I /Ⅱ. There was a positive relationship between urine NTX and serum TRACP-5b in newly diagnosed patients. Urine NTX levels were significantly decreased, and serum BAP levels were significantly increased after 3 cycles effective therapy. There was no change in serum TRACP-5b and OC. Urine NTX and serum TRACP-5b were significantly diseased, serum BAP and OC were significantly increased after 6 cycles of effective therapy. But bone lesions on X-ray did not diminish at that time. Conclusion There is a closely relationship between bone turnover markers and bone lesions in MM. The bone turnover markers may be useful in monitoring MM progress and therapy.