中老年人骨转换标志物联合测定的指标分析

The measuring and index analysis of bone turnover markers in the middle-aged and elderly person

目的：通过对存在骨质疏松等骨病患者血清骨标志物的测定，结合X线影像分析，探讨骨标志物在骨质疏松性疾病诊断中的表达及意义。方法收集2011年10月至2012年9月期间到我院就诊的骨病患者400例，骨质疏松组200例，骨折事件组200例，分别于早上7：00~9：00进行静脉采血和X线摄影，血液样本同时测定骨转换标志物组合血清β-胶原降解产物（β-crosslaps）、N 端骨钙素（N-MID）、甲状旁腺素（PTH），收集骨标志物结果和X线影像结果，对照X线影像结果进行分析。结果结合X线摄影结果判断，2组 X线影片结果均显示存在不同程度的骨质退行性改变或骨质疏松症，骨折患者合并有骨质疏松性骨折表现。400例患者骨标志物组合显示，单独检测β-crosslaps阳性率占72.7%，N-MID阳性率占13.0%，PTH阳性率占7.5%。联合检测阳性率占75.5%。结论作为骨标志物，β-胶原交联C末端肽（β-CTX）可作为骨质疏松症的独立风险预测指标，联合测定或结合X线影像结果分析有利于提高骨质疏松症的风险评估。

Objective To investigate the sensitivity expression of bone markers in the diagnosis of osteoporosis and osteoporotic fractures by measuring bone markers between the osteoporosis and bone disease patients and combined with the X-ray analysis. Methods Four hundred patients from October 2011 to September 2012 in our hospital were collected, 200 cases were in the osteoporosis group while 200 cases were in the bone fractures group. At 7-9 o′clock in the morning, all cases underwent both venous blood collection and X-ray photography. At the same time, all blood samples also had been measured bone turnover markers including serum β-collagen degradation products（β-crosslaps）, N-terminal osteocalcin （N-MID） and parathyroid hormone （PTH）. Analyse the sensitivity and specificity of the bone turnover maker results with X-ray images results. Results With X-ray photography judgement, two X-ray image results showed that all patients had different degrees of bone degenerative changes , especially the patients in fracture group had osteoporotic fractures. The bone turnover markers results of 400 patients showed the positive rate was respectively 72.7%, 13.0% and 7.5% by β-CTX、N-MID and PTH, and the positive rate was 75.5% by combined detection of both bone turnover maker and X-ray. Conclusion β-crosslaps could be used as a more independent predictor of osteoporosis , and combined with X-ray results, it could improve the osteoporosis diagnosis.