骨胶原代谢指标在乳腺癌骨转移诊断中的应用

The application of bone collagen metabolism markers in bone metastases of breast carcinoma

目的探讨特异性溶骨性骨代谢指标-血Ⅰ型胶原吡啶交联羧基末端肽（serum type I collagen carboxyterminal telopeptide，sICTP）、尿Ⅰ型胶原吡啶交联氨基末端肽（urinary nitrogen—terminal cross—linked telopeptides，uNTx）和尿吡啶酚（urinary pyridinoline crosslinks，uPYD）诊断乳腺癌患者骨转移的临床应用价值。方法应用酶联免疫吸附试验（ELISA），测定72例乳腺癌患者的sICTP、uNTx和uPYD水平，并计算此三项指标诊断骨转移的特异度及灵敏度。以核素全身骨扫描为标准，并以CT、X线、MRI等影像学方法确诊，将72例患者分为骨转移组和无骨转移组两组。比较两组患者三项指标浓度的差别，并根据骨痛程度及骨转移范围分为亚组比较其在不同组间浓度差别。结果骨转移组患者sICTP、uNTx和uPYD浓度均明显高于无骨转移组（P〈0．05）；三项指标之间显著相关（r〉0．5，P〈0．05）。sICTP、uNTx和uPYD诊断骨转移的灵敏度分别为80．56％、72．00％与80．56％（P〈0．05），特异度为97．22％、83．33％和80．56％（P〈0．05）；各项指标水平在不同骨痛程度及骨转移范围组间差异有统计学意义（P〈0．05）；各指标浓度水平升高和发生骨转移有明显相关性。结论溶骨性骨代谢指标sICTP、uNTx和uPYD浓度的测定对于乳腺癌患者骨转移的诊断具有较高的参考价值，其与骨转移临床表现的关系对肿瘤骨转移的病情判断有一定意义。

Objective To evaluate the values of using specific osteolytic bone metabolic markers such as serum type Ⅰ collagen carboxyterminal telopeptide （sICTP）, urinary nitrogen-terminal cross-linked telopeptides of type Ⅰ collagen （uNTx）, urinary pyridinoline crosslinks （uPYD） in bone metastasis of breast cancer. Methods The levels of sICTP, uNTx and uPYD in 72 patients with breast cancer were measured using ELISA. The sensitivity and specificity of diagnostic value in bone metastasis of breast cancer were calculated. Seventy-two patients with breast carcinoma were divided into two groups depending on the presence of bone metastasis according to bone scan findings and confirmed by X-ray and/or CT. The level of bone markers was compared between the two groups. Further relation between bone metabolic marker and tumor behavior in the patients with bone metastases was studied detailedly. Results The levels of all bone markers in patients with bone metastasis were significantly higher than those of in ones without bone metastasis （P〈 0.05）. A significant correlation was seen between each two markers （r〉0.5, P〈 0.01）. The sensitivity and specificity was 72.00% and 83.33% in uNTx; 80.56% and 80.56% in uPYD; 80.56% and 97.22% in sICTP, respectively. Evident differences were seen between the extent of skeletal infiltration and the levels of the three biomarkers （P〈 0.05）. The correlations were seen between the levels of the three biomarkers and the risk of occurrence of bone metastasis （P〈 0.05）. Conclusion The measurement of sICTP, uNTx and uPYD are of significant utility as biochemical markers of bone metastasis in patients with breast cancer and can be used to achieve a timely diagnosis for bone metastasis of breast cancer.