血清sRANKL/OPG比值在判断多发性骨髓瘤骨病中的意义

Significance of sRANKL/OPG Ratio in Diagnosis of Multiple Myeloma Bone Disease

本研究探讨多发性骨髓瘤(MM)患者血清中可溶性核转录因子-κB受体活化因子的配体(sRANKL)和护骨蛋白(OPG)的水平与多发性骨髓瘤骨病(MBD)之间的关系。采用酶联免疫吸附法检测了42例初诊的MM病人(观察组)以及25例健康体检者(对照组)外周血清中sRANKL和OPG的水平以及破骨细胞代谢指标抗酒石酸酸性磷酸酶-5b(TRAP-5b)与Ⅰ型胶原蛋白羧基末端交联肽(CTP-Ⅰ)的水平,同时根据全身X光摄片判断MM患者骨损害情况并分析sRANKL/OPG比值与TRAP-5b、CTP-Ⅰ水平和骨损害发生及其程度之间的关系。结果发现:观察组患者血清中sRANKL水平升高(中位水平9.33μg/L),OPG水平下降(中位水平4.93μg/L),sRANKL/OPG比值明显升高(比值2.65),与对照组相比各对应指标之间的差异均具有显著性(p<0.05);MM患者血清中sRANKL/OPG比值与TRAP-5b(r=0.512,p<0.05)和CTP-Ⅰ(r=0.481,p<0.05)水平之间均存在相关性。将观察组患者按有无骨损害分组发现,骨损害组(29例)和无骨损害组(13例)的sRANKL/OPG比值分别为5.13和1.12,有骨损害组的比值明显升高(p<0.05);如果按骨损害程度分组还发现,sRANKL/OPG比值与骨损害程度密切相关(r=0.445,p<0.05),但不同临床分型和不同临床分期(ISS分期)的MM患者之间,血清sRANKL/OPG比值的差异均无统计学意义(p>0.05)。结论:MM患者血清中sRANKL/OPG比值明显升高,不仅与破骨细胞代谢增强有关,还与骨损害的发生及其程度相关,所以sRANKL/OPG比值可作为判断MBD的一个参考指标。

This study was purposed to investigate the relationship between the levels of soluble receptor activator of nuclear factor kappa B ligand （sRANKL） and osteoprotegerin （OPG） in serum of the patients with multiple myeloma （MM） and multiple myeloma bone disease （MBD）. The serum levels of sRANKL, OPG, tartrate-resistant acid phosphatase-5b（TRAP-5b） and C-terminal telopeptide of collagen Ⅰ （CTP-Ⅰ ） which both are indexes for metabolism of osteoclast （OC） in newly diagnosed MM patients （ n = 42, experimental group） and healthy persons （ n = 25, control group） were detected by enzyme-linked immunosorbent assay. The roentgenography was used to determine bone damage in MM patients at the same time. According to these results acquired, the correlation of sRANKL/OPG ratio with levels of TRAP-5b,/CTP-Ⅰ, the incidence and degree of bone destruction were analyzed. The results indicated that the level of sRANKL（median value 9. 33 μg/L ） increased and level of OPG （median value 4. 93 μg/L） decreased and the sRANKL/OPG ratio （2. 65 ） increased significantly in experimental group. Compared with control group, the differences in all the corresponding indicators were statistically significant （p 〈 0.05 ）. The sRANKL/OPG ratio was closely related to levels of TRAP-5b （ r = 0.512 ,p 〈 0.05 ） and CTP-Ⅰ （ r = 0.481,p 〈 0.05 ） in MM patients. After all patients in experimental groups were divided into group with bone destruction （n = 29） and without bone destruction （n = 13 ）, the sRANKL/OPG ratio in the group with bone destruction was 5.13 and much higher than that in group without bone destruction （ 1. 12 ） （p 〈 0. 05 ）. A close correlation between the sRANKL/OPG ratio and degree of bone destruction （ r = 0. 445, p 〈 0.05 ） was acquired when all MM patients were divided into three groups according to degree of bone destruction, but no difference between the ratio and clinical classification and International Staging System （ISS） in MM patients was found. It is concluded that the sRANKL/OPG ratio in serum of MM patients is significantly elevated, which may be closely related to increase metabolism of OC along with the incidence and degree of bone destruction. In short, the sRANKL/OPG ratio can be used as a reference index for the diagnosis of MBD.