强直性脊柱炎男性患者骨特异性碱性磷酸酶、骨钙素、尿Ⅰ型胶原C末端肽与骨密度的关系

Relationships between Serum Bone-specific Alkaline Phosphatase、Serum Osteocalcin、Urinary C-terminal Telopeptide Fragments of Type I Collagen and Bone Mineral Density in Men with Ankylosing Spondylitis

目的通过测定强直性脊柱炎(AS)男性患者血清骨特异性碱性磷酸酶(BALP)、血清骨钙素(sOC)、尿Ⅰ型胶原C末端肽(CTX-Ⅰ)水平,以探讨与疾病活动性、骨密度(BMD)的关系。方法用ELISA方法测定35名AS患者血清BALP、sOC、尿CTX-Ⅰ;用双能X线吸收法(DEXA)测定腰椎正位(AP)L1-L4总体和股骨颈的BMD,根据Bath强直性脊柱炎疾病活动指数(BASDAI)对患者病情进行评分,并与70名健康者对照。结果AS患者尿CTX-Ⅰ水平显著高于对照组(P<0.05);直线相关显示,尿CTX-Ⅰ水平与股骨颈BMD呈负相关(r=-0.414,P<0.05),与BASDAI、C反应蛋白(CRP)呈正相关(r=0.445,P<0.05;r=0.491,P<0.01)。AS患者血清BALP、sOC水平与对照组无统计学意义,且与BMD、BASDAI无明显相关性。结论CTX-Ⅰ水平升高提示患者骨吸收增强、骨密度降低、疾病呈活动性。

Objective To determine the levels of serum bone-specific alkaline phosphatase （BALP）, serum osteocalcin（sOC） ,urinary C-terminal telopeptide fragments of type I collagen（ CTX- I ） in men with ankylosing spondylitis （AS） and to investigate their associations with disease activity, bone mineral density （BMD）. Methods Serum BALP,sOC, urinary CTX- I were determined by enzyme-linked immunosorbent assay in 35 men with AS,areal BMD at the posteroanterior lumbar, spine （L1-4） and femoral neck using dual energy X-ray absorptiometry （DEXA）. Bath AS Disease Activity Index （BASDAI） were evaluated. Levels of biochemical markers were compared with those of 70 age-matched healthy men. Results Patients with AS had significantly higher mean urinary CTX-I level than control subjects （P 〈 0. 05 ）. Urinary CTX-I levels showed significantly inverse correlations with femoral neck BMD （r = - 0. 414, P = 0. 030） but not with spinal BMD. There were significantly positive correlations between urinary CTX-I levels and BASDAI （r = O. 445, P = 0. 016） as well as between urinary CTX-I and CRP levels （r= 0. 491 ,P = 0. 006）. Mean serum BALP and osteocalcin levels did not differ between patients and controls and did not show any significant correlationswith BMD, BASDAI in men with AS. Conclusion Elevated CTX-I reflects bone resorption,loss of femoral BMD and disease activity.