急性脊髓完全横断性损伤瘫痪患者血清骨转换生化标志物和骨密度检测的临床意义

Clinical significance of detecting biochemical markers of bone turnover in serum and bone mineral density of patients with acutely completely transverse spinal cord injury

目的检测急性脊髓完全横断性损伤瘫痪患者不同时间血清骨转换标志物和骨密度(BMD),评估继发骨质疏松的可能性,为临床治疗和预防急性脊髓损伤瘫痪后继发骨质疏松提供依据。方法选择2011年4月至2013年4月收治的38例胸-腰椎骨折患者,均为高处坠落伤,根据有无脊髓损伤及瘫痪症状分为观察组23例和对照组15例。观察组于术前、术后1个月及术后6个月应用酶联免疫吸附试验(ELISA)法或电化学发光免疫法(ECLIA)测定急性脊髓损伤瘫痪患者血清或尿液中骨转换生化标志物,应用双能X射线BMD仪检测腰椎和股骨颈BMD。结果观察组术后1个月与术前和对照组比较,骨形成标志物检测值即轻度升高,腰椎和股骨颈BMD检测轻度降低,但差异均无统计学意义(P>0.05);术后1个月骨吸收标志物检测值升高,差异有统计学意义(P<0.05);观察组术后6个月,与术前、术后1个月及对照组比较,骨转换生化标志物检测值除Ⅰ型原胶原羧基端延长肽(PICP)外均有明显升高,腰椎和股骨颈BMD检测值明显降低,差异均有统计学意义(P<0.05)。所有瘫痪患者术后及随访期内无神经功能恢复,两组患者切口无感染,随访期内无椎弓根螺钉松动、断裂。结论对急性脊髓损伤瘫痪患者,除PICP敏感性较差外,骨转换生化标志物结合BMD检查,可早期发现并预防骨质疏松及骨质疏松引起的骨折。

Objective To detect biochemical markers of bone turnover in serum and bone mineral density （BMD） of the paralyzed patients with acutely completely transverse spinal cord injury at different time ,and evaluate the possibility of secondary osteoporosis,in order to provide evidence for clinical treatment and prevention of secondary osteoporosis after paralysis of acute spinal cord injury. Methods Totally 38 patients with thoracolumbar vertebral fracture caused by falling from high place ,who were enrolled from April 2011 to April 2013,were selected,and divided into the observation group（n=23） and the control group （n=15） according to the symptoms of spinal cord injury or paralysis. Biochemical markers of bone turnover in serum or urine of the paralyzed patients with acute spinal cord injury were determined by enzyme linked immunosorbent assay （ELISA ） or electro-chemiluminescence immunoassay before operation ,1 month and 6 months after operation in observation group ,meanwhile dual energy X-ray absorptiometry（ECLIA） was adopted to detect the BMD of lumbar vertebra and femoral neck. Results Compared with pre-operation in observation group and control group ,the detection value of biochemical marker of bone formation in observa-tion group 1 month after operation increased slightly ,and the BMD detection value of lumbar vertebra and femoral neck decreased slightly,but the difference had no statistical significance（P〉0.05）;the detection value of biochemical marker of bone resorption evaluated 1 month after operation,and the difference had statistical significance（P〈0.05）;compared with pre-operation and 1 month after operation in observation group and control group ,the detection value of biochemical markers of bone turnover rose prominently in observation group 6 months after operation except procollagen type ⅠC-terminal peptide（PICP）,but the BMD detection value of lumbar vertebra and femoral neck decreased remarkably with statistically significant difference （P〈0.05）. All the paralyzed patients had no neural functional recovery after surgery or during follow-up period. All the patients in both groups had no incision infection,pedicle screw loose or disruption in follow-up period. Conclusion For the completely paralyzed patients with acute spinal cord injury,except the poor sensitivity of PICP,biochemical markers of bone turnover combining with BMD de-tection can early discover and prevent osteoporosis and bone fracture caused by osteoporotic.