动态监测骨代谢标志物在诊治强直性脊柱炎中的意义

Significance of dynamic monitoring of bone metabolites in patients with ankylosing spondylitis

目的通过对血清骨代谢指标的动态检测探讨其与强直性脊柱炎(AS)发生发展的相关性,为AS的诊断预后及治疗提供客观依据。方法根据AS患者骶髂关节的病损程度分早期、进展期、晚期3期,选择各50例门诊及住院患者。对照组选择年龄及性别相匹配的50名健康对照者,取患者晨起空腹血样,采用电化学发光免疫(ECLIA)及酶联免疫吸附试验(ELISA)检测骨代谢相关指标:甲状旁腺素(PTH),总Ⅰ型前胶原氨基末端(N端)前肽(tPINP),骨钙素N端中分子片段(N-MID OT),I型胶原C端肽(β-CTX),25-羟基维生素D3[25-(OH)D3],Ⅰ型胶原交联羧基末端肽(ICTP)。对3期各组间数据进行比较及相关分析。结果①AS组血清中NMID OT、25-(OH)D3低于健康对照组,β-CTX、ICTP高于健康对照组,组间比较差异均有统计学意义(P<0.01);tPINP、PTH浓度水平在AS患者组与健康对照组组间无显著差异性(P>0.05)。②AS晚期组血清中N-MID OT、25-(OH)D3低于早期组,组间比较差异具有统计学意义(P<0.05);晚期组β-CTX、ICTP浓度水平高于早期组,组间比较差异均有统计学意义(P<0.05);晚期组与早期组tPINP、PTH在组间差异无统计学意义(P>0.05);随着AS疾病的进展,血清中N-MID OT、25-(OH)D3浓度水平逐渐降低,β-CTX、ICTP浓度水平显著升高。结论血清骨代谢指标在分期不同的AS患者中存在异常,不同指标参与了AS的骨吸收及骨转换过程,可为AS的诊断预后及治疗提供客观依据。

Objective To investigate the dynamic changes in serum markers of bone metabolism in patients with ankylosing spondylitis （AS） and their association with the development of AS, thus providing objective rationales for the diagnosis and prognosis. Methods We recruited patients with AS from in- and out-patient clinics based on their clinical staging and grouped as early stage （n=50）, progression stage （n=50） and advanced stage （n=50） and 50 sex-matched healthy subjects. Blood was sampled in the morning when fasting for electrochemical immunoassay （E- CLIA） and enzyme-linked immunosorbent assay （ELISA） to determine bone metabolism-related indices, including parathyroid hormone （PTH）, total procollagen type 1 N-terminal peptide （tPINP）, N-terminal midfragment osteocalcin telopeptide （N-MID OT）, 13-CTX C-telopeptides of type I collagen （[3-CTX）, 25-dihydroxy vitamin D3 [25-（OH）D3] and carboxy terminal telepeptide type I collagen （ICTP）. Results In patients with AS, the levels of serum N-MID and 25- （OH）D3 were markedly lower and 13-CTX and ICTP significantly higher than those of healthy controls （all P〈0.01）. However, the difference in tPINP and PTH between patients with AS and healthy controls did not reach statistical sig- nificance （both P〉0.05）. Patients with advanced AS yielded markedly lower levels of serum N-MID and 25-（OH）D3 and higher levels of 13 -CTX and ICTP than those at early stage of AS （all P〈0.05）. There were no differences in tPINP and PTH between advanced AS and early stage AS （/9〉0.05）. There was a trend towards gradually decreased serum N-MID OT and 25-（OH）D3 and increased 13-CTX and ICTP with the progression of AS. Conclusion Serum bone metabolic markers that involve bone absorption and bone transformation are abnormal in different stages of AS, which may pro- vide objective rationale for the diagnosis, prognosis and treatment of AS.