骨代谢指标BAP、BGP、CTX-I、TRACP5b等变化对老年髋部骨折后骨密度的影响及在二次骨折中的风险预测

Effects of Bone Metabolic Markers Including BAP,BGP,CTX-I and TRACP5b on Bone Mineral Density in Elderly Patients with Hip Fracture and Their Risk Prediction for the Second Fracture

目的探究老年髋部骨折后骨代谢指标BAP、BGP、CTX-I、TRACP5b的变化对骨密度的影响,为二次骨折风险预测提供理论依据。方法选择我院2015年1月至2016年12月骨科收治入院的36例60岁以上老年髋部骨折患者作为观察组,42例健康老年人作为对照组。制定随访标准,观察组于骨折后1天、1个月、3个月、6个月、12个月进行骨代谢指标骨碱性磷酸酶(BAP)、骨γ-羧基谷氨酸蛋白(骨钙素,BGP)、Ⅰ型胶原羧基C端交联肽(CTX-Ⅰ)、清抗酒石酸酸性磷酸酶5b(TRACP5b)的测定,同时检测患者髋部骨密度。对照组健康老年人也监测上述各项数据指标作为对照分析。采用SPSS21.0软件对最后数据进行统计学分析。结果观察组髋部骨折患者骨折至愈合6个月,骨代谢指标BAP、BGP、CTXI、TRACP5b水平分别为11.11±1.21μg/L、7.38±0.82μg/L、0.44±0. 8μg/L和5.13±0. 42μg/L,显著高于对照组,髋部骨密度T值为-3.57±0.06,明显低于对照组-1.05±0.06,差异有统计学意义(P<0.05)。12个月BAP、BGP水平分别为11.16±1.18μg/L和6.89±0.59μg/L,与对照组比较,差异仍有统计学意义,且与骨密度变化显著相关。结论老年髋部骨折愈合后骨密度较正常人明显降低,发生二次骨折的风险大大增加。可通过监测患者血清BAP、BGP水平,可快速准确地判断骨密度变化,以降低罹患二次骨折的风险。

Objective To explore the effects of changes of bone metabolic markers BAP, BGP, CTX-I and TRACPSb on bone mineral density in elderly patients after hip fracture, and to provide theoretical basis for the prediction of the risk of second fracture. Methods 36 elderly patients with hip fracture admitted to our hospital from January 2015 to December 2016 were selected as the observation group, and 42 healthy old people were selected as the control group. We then established the follow-up standard： for the observation group, 1 day, 1 month, 3 months, 6 months and 12 months after fracture, the bone metabolism index of bone alkaline phosphatase （BAP）, bone gla protein （osteocalcin, BGP）, collagen type C carboxy terminal telopeptide （CTX-1 ） and Qing tartrate resistant acid phosphatase 5b （TRACP5b）were measured, with simultaneous detection of hip BMD. In the control group ,for healthy elderly people,we also monitored the above data indicators as a control analysis. SPSS21.0 software was used for statistical analysis. Results For the observation group patients with hip fracture and fracture healing in 6 months, the bone metabolism indexes of BAP, BGP, CTX-I, TRACP5b levels were 11.11 ± 1.21 μg/L,7.38 ± 0. 82μg/L,0. 44 ± 0.08μg/L and 5.13 ± 0.42μg/L, which were significantly higher than those of the control group, while the BMD of - 3.57 ± 0.06, - 1.05 ± 0.06 was significantly lower than the control group. At 12 months, the levels of BAP and BGP were 11.16 ± 1.18μg/L and 6. 89 ±0.59μg/L,respectively, still with the difference of statistically significance, and flaey were also significantly correlated with bone mineral density. Conclusion Bone mineral density in elderly patients with hip fracture is significantly lower than that in normal subjects, and the risk of the second fracture is greatly increased. By monitoring the serum levels of BAP and BGP, it faciliates to determine the bone mineral density rapidly and accurately, so to reduce the risk of the second fracture.