免疫性血小板减少性紫癜患者糖皮质激素治疗前后血清P1NP、β-CTX水平的变化

Changes of serum P1NP and β-CTX levels before and after glucocorticoid therapy in patients with ITP

目的观察糖皮质激素(GC)治疗对免疫性血小板减少性紫癜(ITP)患者骨代谢指标的影响。方法检测30例健康体检者(对照组)、52例ITP患者(观察组)糖皮质激素治疗前及治疗24周内的血清总I型前胶原氨基端延长肽(P1NP)、I型胶原羧基端肽β特殊序列(β-CTX)水平及骨密度(BMD)指标,比较ITP患者治疗期间P1NP、β-CTX及骨密度水平的变化。结果观察组治疗前血清P1NP、β-CTX、骨密度与对照组比较差异无统计学意义(P>0.05);治疗24周后ITP患者血清P1NP、β-CTX与治疗前比较,差异有统计学意义(P<0.05);治疗24周后患者髋部骨密度明显低于治疗前,差异有统计学意义(P<0.05);ITP患者P1NP、髋部BMD水平与GC的使用时间呈负相关(P<0.01),β-CTX与GC使用时间呈正相关(P<0.01)。结论经GC治疗后ITP患者的BMD下降,骨代谢处于高分解低成骨转换状态,存在骨质疏松风险,需要提高对ITP患者糖皮质激素性骨质疏松的认识和防治。

Objective To observe the effect of glucocorticoid(GC) treatment on bone metabolism in patients with immune thrombocytopenic purpura(ITP). Methods Serum total type I procollagen amino-terminal extension peptide(P1 NP), type I collagen carboxylase and bone mineral density(BMD) were measured in 30 healthy subjects(control group) and 52 ITP patients(observation group) before and after treatment with glucocorticoid hormone. The levels of P1 NP,β-CTX and BMD were compared in patients with ITP during treatment. Results There was no statistical significance on the difference in serum P1 NP,β-CTX, and bone mineral density between the observation group before treatment and the control group(P>0.05). There was statistical significance on the difference of serum P1 NP and β-CTX in patients with ITP after treatment for 24 weeks, compared with that before treatment(P<0.05). After 24 weeks of treatment, the hip bone density of patients was significantly lower than before treatment(P<0.05);P1 NP and hip BMD levels were negatively correlated with Glucocorticoid use time in patients with ITP(P<0.01), and β-CTX is positively correlated with GC use time(P<0.01). Conclusion The BMD of patients with ITP decreased after GC treatment, and the bone metabolism was in a state of high decomposition and low osteogenesis, and there was a risk of osteoporosis. It was necessary to improve the understanding and prevention of glucocorticoid-induced osteoporosis in patients with ITP.