糖皮质激素应用患者血清骨钙素与骨密度的相关性

Correlation of serum osteocalcin levels and bone mineral density in patients receiving corticosteroid therapy

目的探讨糖皮质激素（GCs）应用患者血清骨钙素与腰椎、股骨骨密度的相关性。方法选取长期应用GCs治疗的22例患者（其中侣例骨密度异常），采用ELISA法测定其治疗前及治疗后3、6个月的血清骨钙素水平，同时采用双能X线吸收法测定其治疗前及治疗后3、6个月的腰椎、股骨骨密度，比较治疗前后血清骨钙素及腰椎、股骨骨密度的变化，并对血清骨钙素和腰椎、股骨骨密度作相关性分析。结果骨密度异常的18例患者，治疗3个月后9例来院复查骨密度。其中8例复查血清骨钙素；治疗6个月后14例来院复查骨密度，其中9例复查血清骨钙素。与治疗前比较，治疗3个月后腰椎及股骨骨密度均未发生明显变化（均P〉0，05），但血清骨钙素明显降低（P〈0.05）；治疗6个月后腰椎骨密度明显升高（P〈0.05）、血清骨钙素明显降低（P〈0，05），但股骨骨密度并无明显变化（P〉0.05）。GCs应用患者血清骨钙素水平与腰椎及股骨骨密度显著负相关（r=-0．41、-0．38，P〈0.05或0．01）。结论GCs应用患者经二膦酸盐联合钙尔奇D治疗后，其骨转换变化的敏感性高于骨密度。

Objective To investigate the correlation of serum osteocalcin levels and bone mineral density （BMD） in patients receiving long-term corticosteroid therapy. Methods Twenty two patients receiving long-term corticosteroid therapy were included in the study. Serum osteocalcin was examined by ELISA before and 3-month, 6-month after therapy of alendronate combined with calcium ＆ vitamin D, meanwhile the BMD of lumber spine and femoral neck were measured by DXA. Bivariate correlation analysis and Paired-samples T test were performed using SPSS15.0. Results BMD showed no significant changes after alendronate therapy for 3 months in 9 patients, 8 of whom had a decreased serum osteocalcin level （t=2.48, P 〈 0.05）; while BMD was significant increased after alendronate therapy for 6 months in 14 patients （t=-2.18,P 〈 0.05 ）, among whom serum osteocalcin level was significant decreased in 9 （t=2.59, P〈 0.05）. Among patients on corticosteroid therapy, the serum osteocalcin levels were negatively correlated with the BMD on lumber spine and femoral neck with a Pearson correlation coefficient of -0.41 and -0.38 （P=0.01 and 0.026）. Conclusion The serum osteocalcin levels are negatively correlated with BMD and are more sensitive for bone turnover in patients on long-term corticosteroid therapy receiving alendronate therapy.