摘要
目的:探讨女性骨代谢生化指标与年龄及骨密度的关系。方法选取不同年龄组女性309例(25~84岁),以电化学发光法检测患者血清总Ⅰ型胶原氨基端延长肽( TPⅠNP )、β胶原特殊序列(β.CTX)的含量,ELISA检测患者血清25.羟基维生素D(25-OH-VitD)、抗酒石酸酸性磷酸酶5b(TRACP-5b),采用双能X线(DXA)骨密度仪测其股骨颈及腰椎L1~4部位的骨密度(BMD)。将309例患者根据年龄和BMD进行分组,比较组间骨代谢生化指标差异,采用SPSS 17.0软件对数据进行两样本t检验、方差分析或χ2检验。结果血清TPⅠNP、β-CTX在45~54岁组高于在35~44岁组:(55.63±19.24)比(40.90±14.63)μg/L,(597.10±198.70)比(404.79±147.22) ng/L(t=4.156、5.319,均P<0.01),随后随年龄增长呈下降趋势;血清25-OH-VitD 随年龄增长呈下降趋势;血清TRACP.5b在45~54岁组高于在35~44岁组(t=5.934,P<0.01),55~64岁组进一步升高至(5.05±1.63) U/L,后随年龄增长呈下降趋势。骨量减少组(100例)和骨质疏松组(111例)血清TPⅠNP、β.CTX、25-OH-VitD、TRACP.5b与骨量正常组(98例)相比差异均具有统计学意义( F=225.908、253.208、252.927、313.265,均P<0.01)。以BMD结果为“金标准”,4项骨生化指标对于BMD异常的诊断特异性和阳性预测值均大于95%,血清25.OH.VitD、TRACP.5b的灵敏度[91.47%(193/211)、88.15%(186/211)]高于血清TPⅠNP[65.40%(138/211);χ2=42.381、30.621,均P<0.01]和β-CTX的灵敏度[51.66%(109/211);χ2=82.164、66.783,均P<0.01]。阴性预测值的比较亦有类似结果(χ2:15.367~38.126,均P<0.01)。结论女性骨代谢生化指标均与年龄及BMD存在密切相关性,检测骨代谢生化指标在早期诊断骨质疏松中非常重要。
Objective To investigate the age-related changes of osseous metabolic markers and their relationships to bone mineral density ( BMD) in females. Methods A total of 309 females with differ.ent ages (25-84 years) were enrolled. The total collagen type I amino-terminal extension peptide (TPⅠNP) and beta collagen specific sequences (β-CTX) were measured by electrochemical luminescence method. 25-hydroxy vitamin D( 25-OH-VitD) and tartrate.resistant acid phosphatase.5b( TRACP-5b) were measured u.sing ELISA. BMD of femoral neck, lumbar spine 1-4 were measured with a bone densitometer ( GE Lunar Prodigy dual energy X-ray absorptiometry, DXA). The differences among different age and BMD groups were compared by two.sample t test, one.way analysis of variance,χ2 test with SPSS 17.0 software. Results The serum TPⅠNP , β-CTXlevels in the 45-54 years group were higher than those in the 35-44 years group:(55.63±19.24) μg/L vs (40.90±14.63) μg/L, (597.10±198.70) ng/L vs (404.79±147.22) ng/L ( t=4.156, 5.319, both P〈0.01) , and decreased slightly with increasing age. The serum 25-OH-VitD level decreased with increasing age. The serum TRACP-5b in the 45-54 years group increased significantly com. pared to that in the 35-44 years group (t=5.934,P〈0.01); and it reached the highest level of (5.05± 1.63) U/L in the 55-64 years group, then decreased slightly. The serum levels of TPⅠNP,β-CTX,25-OH-VitD,TRACP-5b in osteopenic and osteoporosis groups were significantly different from those in the nor.mal group ( F=225.908, 253.208, 252.927, 313.265, all P〈0.01) . The specificities and positive predic-tive values of all four osseous metabolic markers were all over 95% for the diagnosis of abnormal BMD. The sensitivities of both serum 25-OH-VitD and TRACP-5b levels were higher than those of TPⅠNP ( 91. 47%(193/211), 88.15%(186/211) vs 65.40%(138/211); χ2=42.381, 30.621, both P〈0.01) and β-CTX(51.66%(109/211); χ2=82.164, 66.783, both P〈0.01). Negative predictive values of both serum 25-OH-VitD and TRACP-5b levels were higher than those of TPⅠNP(χ2=23.103, 15.367, both P〈0.01) andβ-CTXχ2=38.126, 28.514, both P〈0.01) . Conclusions The osseous metabolic markers might be close-ly related to the changes of BMD and age in females. It was important to measure the bone metabolism mark.ers in the early diagnosis of osteoporosis.
出处
《中华核医学与分子影像杂志》
CAS
北大核心
2015年第6期478-482,共5页
Chinese Journal of Nuclear Medicine and Molecular Imaging
基金
国家自然科学基金(81273090)
江苏省自然科学基金(BK2012608)