血清中巨噬细胞炎症蛋白水平在判断多发性骨髓瘤骨病中的临床意义

Clinical Significance of Level of Macrophage Inflammation Protein in Serum for the Diagnosis of Multiple Myeloma Bone Disease

【目的】探讨多发性骨髓瘤(MM)患者血清中巨噬细胞炎症蛋白(MIP)水平与多发性骨髓瘤骨病(MBD)之间的关系。【方法】采用酶联免疫吸附法检测了42例初诊MM病人(观察组)以及25例健康体检者(对照组)外周血清中MIP-1α及MIP-1β的水平、其下游信号传导因子可溶性核转录因子-κB受体活化因子的配体(sRANKL)和骨保护素(OPG)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,分析MIP-1α及MIP-1β与sRANKL/OPG比值、TRAP-5b和CTP-Ⅰ及MBD之间的相关性。【结果】观察组患者血清中MIP-1α及MIP-1β中位水平为125.18 ng/mL和134.35ng/mL,均明显高于对照组(P<0.05);将观察组患者按X光结果分为有MBD组(29例)和无MBD组(13例)发现:MBD组的MIP-1α及MIP-1β水平高于无MBD组(P<0.05),且MIP-1α及MIP-1β水平与骨病分级之间均存在相关性(γ分别为0.381和0.429,P<0.05);进一步分析发现:MIP-1α及MIP-1β与sRANKL/OPG比值(γ分别为0.641和0.451,P<0.05)、TRAP-5b(γ分别为0.547和0.529,P<0.05)和CTP-Ⅰ(γ值分别为0.476和0.512,P<0.05)水平之间均存在相关性。【结论】MM患者血清中MIP-1α及MIP-1β水平不仅升高,还与MBD分级有关,它可通过调节sRANKL/OPG比值和增加破骨细胞代谢来引起MBD,所以MIP-1α及MIP-1β水平可作为判断MBD的一个较好的参考指标。

[Objective]To investigate the relationship between the level of macrophage inflammation protein （MIP） in serum oi the patients with multiple myeloma （MM） and multiple myeloma bone disease （MBD）. [Method] The serum levels of MIP-la and MIP-Iβ, soluble ligand of receptor activator of nuclear factor kappaB （sRANKL） and osteoprotegerin （OPG） which are in the downstream signaling factors of MIP-Ia and MIP-1β, tartrate-resistant acid phosphatase-5b （TRAP-5b） and C-terminal telopeptide of collagen I （CTP- I ） which are indexes for metabolism of osteoelast （OC） were detected in MM patients with first diagnosed （n = 42, experimental group） and healthy persons （n = 25,control group） by enzyme-linked immunosorbent assay. X-ray was also used to determine bone damage in these patients with MM at the same time. According to these results acquired, we analyzed the correlation between the levels of MIP-la and MIP-Iβ and the ratio of sRANKL/OPG, levels of TRAP-5b and CTP- I and MBD. [Result] The levels of MIP-1 a （median value was 125.18 ng/mL ） and MIP-1β （median value was 134.35 ng/mL ） were higher than that of in the control group,respectively （P 〈 0.05）. All patients in experimental group were divided into group with MBD （n = 29） and group without MBD （n = 13）. We found the levels of MIP-lct and MIP-Iβ in group with MBD were higher than that in group without MBD（P 〈 0.05 ）. meanwhile, we also found the levels of MIP-1 ct and MIP-1 β was closely related to the ratio of sRANKL/OPG values were0.641 and 0.451, respectively, P 〈 0.05）, the level of TRAP-5b （~ values were 0.547 and 0.529, respectively, P 〈 0.05） and CTP- I （Y values were 0.476 and 0.512, respectively, P 〈 0.05）. [Conclusion] The levels of MIP-la and MIP-Iβ in MM patients are not only significantly elevated but also closely related to the degree of MBD and they could increase the metabolism of OCs and result in MBD by mediating the ratio of sRANKL/OPG. Therefore, The levels of M1P-la and MIP-Iβ might be used as a better reference index for the diagnosis of MBD.