放疗对鼻咽癌患者颌骨骨代谢生化指标的影响及意义

The effects and significance of radiotherapy on biochemical markers of bone metabolism in patients with nasopharyngeal carcinoma

目的:观察鼻咽癌放疗患者血、尿中骨代谢生化指标的改变,探讨放疗对颌骨代谢的影响及这些指标改变的意义。方法:采集22例鼻咽癌初诊患者在单纯放疗前、放疗30Gy后、放疗50Gy 3个时段的血、尿标本,检测标本中骨代谢生化指标:用酶联免疫吸附法测定血清BAP、TRACP-5b水平,用偶氮胂三法测定尿Ca水平,同时为减少尿液浓度对尿Ca水平的影响,用苦味酸不除蛋白法测定尿Cr,用尿Ca/Cr表示尿Ca水平的变化。采用SPSS17.0软件包,以配对t检验分析3个时段血清BAP、TRACP-5b水平差异,以Mann-Whitney检验分析3个时段尿Ca/Cr水平差异。结果:患者血清BAP水平随放疗剂量增加呈下降趋势,在50Gy时较放疗前有统计学差异(P<0.05);血清TRACP-5b水平变化在放疗前后无统计学差异(P>0.05);尿Ca/Cr水平随着放疗剂量增加呈明显下降趋势,在30Gy及50Gy时较放疗前均有统计学差异(P<0.05)。结论:放疗抑制鼻咽癌患者颌骨的正常代谢,骨代谢生化指标血清BAP、尿Ca/Cr能够敏感反映颌骨早期的放射性改变。

PURPOSE：To detect the changes and evaluate the effect of radiotherapy in patients with nasopharyngeal carcinoma on biochemical markers of bone metabolism on the jaw bones.METHODS：Twenty two patients with nasopharyngeal carcinoma receiving radiotherapy were included in this study.Concentration of serum BAP,TRACP-5b prior to radiotherapy,after 30Gy and 50Gy of radiotherapy were detected by enzyme-linked immunosorbent assay（ELISA）;Concentration of urine Ca was assayed by arsenazo Ⅲ spectrophotometric and the urine creatinine（Cr） was determined by carbazotic acid method;Data were compared by paired t test and Mann-Whitney nonparametric test using SPSS17.0 software package.RESULTS：The serum BAP decreased with increase of radiation dose.Compared with serum BAP prior to radiotherapy,there was a significant decrease in patients after 50Gy of radiotherapy（P0.05）;The serum TRACP-5b was not significantly changed before and after radiotherapy（P0.05）;Ionizing radiation-induced decrease in the urinary Ca/Cr was found,and there was significant difference not only between the dose of 0Gy and 50Gy but also between the dose of 0Gy and 30Gy（P0.05）.CONCLUSION：Radiation can inhibit the activities of jaw bone,the biochemical markers of bone metabolism in BAP and U Ca/Cr can reflect the effects of radiation on jaw bone metabolism.