uNTX、sICTP及sBALP表达在恶性肿瘤骨转移中的临床意义

The Clinical Significance of Measurement of Urine NTX,Serum ICTP and BALP in Patients with Bone Metastasis from Malignant Tumors

目的探讨尿Ⅰ型胶原交联氨基末端肽(uNTX)、血清Ⅰ型胶原羧基末端肽(sICTP)及骨碱性磷酸酶(sBALP)表达在恶性肿瘤骨转移患者中的临床意义。方法对32例恶性肿瘤骨转移患者,在治疗前后分别采用酶联免疫吸附法(ELISA)、小麦菌凝集素沉淀法,测定uNTX、sICTP及sBALP水平。随访骨相关事件(SREs)及生存状况。结果患者基线uNTX/Cr、sICTP及sBALP水平明显高于正常,其浓度与骨转移负荷呈正相关性,与疼痛强度无显著相关性。治疗3个月时uNTX/Cr、sICTP及sBALP水平明显降低,而放射性核素全身骨显像(ECT)尚无明显改变;32例患者中24例基线uNTX/Cr水平高于正常水平,治疗后降至正常水平的15例患者骨相关事件发生率为53%,而治疗后仍维持在较高水平的9例患者为89%(P=0.039);32例患者中27例基线sICTP水平高于正常,治疗后16例降至正常,11例仍维持在较高水平,两者骨相关事件发生率为50%和91%(P=0.032);26例基线sBALP水平高于正常值,治疗后16例降至正常水平,10例仍维持在较高水平,两者骨相关事件发生率为50%和90%(P=0.038)。uNTX/Cr、sICTP及sBALP水平与肿瘤患者生存率无明显相关性。结论骨代谢标记物uNTX、sICTP及sBALP对恶性肿瘤骨转移的诊断、疗效的监测及骨相关事件的预测具有一定的价值。

Objective To study the value of measurement of urine amino-terminal telopeptide of typeⅠcollagen（uNTX）,serum Pyridinoline crosslinked C-telopeptides of Type I collagen（sICTP）and bone spesific alkaline phosphatase（sBALP）in patients with bone metastasis from solid tumors.Methods 32 patients with bone metastasis from malignant tumor were recruited.UNTX,sICTP and sBALP were measured before and during the chemotherapy.UNTX and sICTP was measured by ELISA assays.Serum BALP was measured by precipitation with wheat germ lectin.Skeletal-related events（SREs）were recorded during the follow-up and survival were calculated.Results The concentration of uNTX,sICTP and sBALP in patients with bone metastases was higher than the upper limit of normal range.A positive correlation was observed between the markers value and the extent of bone metastases.At the third month,the concentrations of uNTX,sICTP and SBALP were significantly decreased,but radionuclide whole-body bone imaging had no change.Of the 32 patients,24 had initially elevated uNTX values.After treatment 15 of the 24 patients finished with normal uNTX values,while 9 of the 24 patients had their uNTX values remained abnormally elevated.The proportions of patients with SREs in these two subgroups were 53% and 89%（P=0.039）.Of the 32 patients,27 had initially elevated sICTP values.After treatment 16 of the 27 patients finished with normal sICTP values,while 11 of the 27 patients had their sICTP values remained abnormally elevated.The proportions of patients with SREs in these two subgroups were 50% and 91%（P=0.032）.Of the 32 patients,26 had initially elevated sBALP values.After treatment 16 of the 26 patients finished with normal sBALP values,while 10 of the 26 patients had their sBALP values remained abnormally elevated.The proportions of patients with SREs in these two subgroups were 50% and 90%（P=0.038）.The level of uNTX/Cr,sICTPand sBALP was not correlated with survival.Conclusion Urinary NTX,serum ICTP,BALP may be useful in the diagnosis,prognosis and prediction of SREs of patients with bone metastasis from malignant tumors.