老年人低骨量向骨质疏松患者转化时血清骨标志物水平的临床研究

Clinical Study of Serum Bone Markers Levels from Patients with Low Bone Mass Transferring to Osteoporosis in the Elderly

目的探讨老年人低骨量向骨质疏松（osteoporosis，OP）患者转化时血清骨标志物[同型半胱氨酸（homocysteine，HCY），总I型前胶原氨基端延长肽（total procollagen type 1 amino-terminal propeptide，TP1NP），I型胶原羧基端肽B特殊序列（β-isomerized C-terminal crosslinking of type 1 collagen，β-CTX），全段甲状旁腺激素（intact para-thyroid hormone，iPTH）]水平的临床意义。方法采用化学发光免疫分析、电化学发光免疫分析和生化法测定155例OP患者，161例低骨量患者和80名正常对照组的血清HCY、TP1NP、β-CTX、iPTH、钙和磷水平并进行了对比性分析。ROC曲线评估低骨量向OP患者转化时的预测性能。结果OP患者血清HCY、TP1NP、B-CTX和iPTH水平较之低骨量患者增高（P〈0．05、P〈0．01、P〈0．01、P〈0．01）。ROC曲线分析显示：血清HCY、TP1NP、β-CTX和iPTH的AUC分别为0．884、0．875、0．866和0．852；临界值分别为23．00μmol／L、310．21ng／mL、1，163．35ng／mL和256．85ng／L；敏感度分别为86．3％、85．6％、84．2％和82．8％；特异度分别为92．8％、91．4％、90．2％和88．7％。结论骨标志物（HCY、TP1NP、β-CTX和iPTH）水平是预测老年人低骨量向OP患者转化时的有价值指标。

Objective To explore serum bone markers levels from patients with low bone mass transferring to osteoporosis （OP） in the elderly. Methods The serum HCY, TP1NP, β -CTX, iPTH, calcium and phosphate levels were determined in 155 patients with OP, 161 patients with low bone mass and 80 controls by chemiluminescence immunoassay, electrochemiluminescence immunoassay and biochemistry, and compared analysis was done. The ROC curve was plotted to analyze HCY, TP1NP, β-CTX and iPTH as a prognostic clinical value indicator of low bone mass found out OP. Results The serum HCY, TP1NP, β -CTX and iPTH levels in patients with OP were significantly higher than those in patients with low bone mass （P 〈 0.05, P 〈 0.01, P 〈 0.01 and P 〈 0.01 respectively）. The ROC curve analysis showed： the AUC of serum HCY, TP1NP,β-CTX and iPTH were 0.884, 0.875, 0.866 and 0.852 respectively, the cut off value were 23.00 μ mol/L, 310.21 ng/mL, 1,163.35 ng/mL and 256.85 ng/L respectively, the sensitivity were 86.3%, 85.6%, 84.2% and 82.8% respectively, the specificity were 92.8%, 91.4%, 90.2% and 88.7% respectively. Conclusion The bone markers （HCY, TP1NP, β -CTX and iPTH）levels were valuable indexes of low bone mass found out OP in the elderly.