男性骨代谢生化指标与年龄及骨密度相关分析

Age-related changes of bone biochemical markers and their relationships to bone mineral density in men

目的分析男性血清Ⅰ型原胶原氨基端前肽(PINP)、β-胶原降解产物(β-crosslaps)及N端骨钙素(N-MID)随年龄变化及其与骨密度(BMD)的关系。方法采用电化学发光免疫分析法分析血清PINP、β-crosslaps及N-MID的含量,采用美国GE公司生产的LunarProdigy双能X线(DXA)骨密度仪检测各部位BMD。结果 PINP、β-crosslaps及N-MID与年龄呈负相关(r=-0.240～-0.253,P<0.05),30～49年龄段处于较高且稳定的水平(PINP:46.98～46.79μg/L,β-crosslaps:0.46μg/L,N-MID23.65～23.08μg/L)。随年龄增长逐渐下降,PINP在60～69年龄段达最低水平(32.28μg/L),β-crosslaps及N-MID在80岁以后下降加速(0.30μg/L、14.75μg/L)。校正年龄、身高、体质量及体质量指数的偏相关分析显示,PINP和β-crosslaps与各部位BMD皆呈负相关(r=-0.155～-0.310,P<0.05);除L1-4外,N-MID与各部位BMD均呈负相关(r=-0.151～-0.189,P<0.05)。按BMD分组,方差分析显示70岁以上男性骨质疏松组PINP、β-crosslaps及N-MID高于正常骨量组(P<0.05),骨质疏松组β-crosslaps及N-MID高于低骨量组(P<0.05)。结论 PINP、β-crosslaps及N-MID是敏感且特异反映男性骨转换的指标;特异性强的骨形成和骨吸收指标增加为骨代谢转换率增高的表现,提示70岁以上男性骨质疏松症患者处于高骨转换状态,骨量快速丢失。

Objective To study the age-related changes of serum procollagen I N-terminal Propeptide （PINP）, β-crosslaps and N-MID Osteocalein （N-MID） of men, as well as their correlations with bone mineral density （BMD）. Methods The levels of serum PINP, β-crosslaps and N-MID were tested by electroehemiluminescence immunoassay; BMD of lumbar spine 1-4, femoral neck, wards, troch and femur were measured by American GE company＇s Lunar Prodi- gy dual energy X ray （DEXA） absorptiometry. Results ①PINP, 15 the-crosslaps and N-MID were negative correlated with age （r = -0. 240 - -0. 253, P 〈0. 05）, serum PINP, β-crosslaps and N-MID were relatively high and stable at the age of 30 - 49 （ PINP46. 98 - 46. 79 μg/L; β-crosslaps 0. 46 μg/L, N-MID 23.65 - 23.08 μg/L）, then PINP de- creased gradually with aging to a nadir level at the age group of 60 - 69 （ PINP 32. 28 μg/L）, while β-crosslaps and N-MID declined to the lowest point in age group of 80 - （0. 30 μg/L and 14. 75 μg/L）. ②After adjustment for age,height, weight and BMI, serum PINP andl3-crosslaps were nagatively correlated with BMD of multiple skeletal sites （r = - 0. 155 - 0. 310, P 〈 0. 05 ） ; N-MID was inversely associated with BMD of multiple skeletal sites except L1-4 （r= -0. 151 - -0. 189, P 〈0. 05）. ③ Analysis of variance showed, while men over 70 years divided into groups acorrding to BMD, the PINP, β-crosslaps and N-MID of osteoporosis group were significantly higher than that of normal bone mass group, P 〈 0. 05 ; 13-crosslaps and N-MID of osteoporosis group is significantly higher than that of the low bone mass group, P 〈0. 05. Conclusion PINP, β-crosslaps and N-MID are sensitive and specific bone biochemical markers which are indicators of the bone turnover in men. Monitoring these markers are helpful to the prevention and early treat- ment of osteoporosis. In men over 70 years old, the bone biochemical markers of low bone mass and osteoporosis group were significantly increased compared with that of the normal bone mass group, suggesting that bone turnover of these male osteoporosis patients was high, and high bone turnover caused quick lose of bone mass.