血清β-胶原降解产物、组织蛋白酶K和骨保护素对绝经后骨质疏松患者诊断的研究

Diagnostic significance of serum β-collagen degradation products, cathepsin K, and osteoprotegerin in postmenopausal osteoporosis

目的观察血清β-胶原降解产物(β-CTX)、组织蛋白酶K(CatheK)和骨保护素(OPG)在绝经后骨质疏松患者的诊断意义。方法选择2011年1月至2017年12月在同济医院和第八医院就诊诊断为绝经后骨质疏松的患者110例,为骨质疏松组。选择同期在我院诊断为骨量减少者(65例)和骨量正常者(30例)分别为骨量减少组和骨量正常组。观察各组血清β-CTX,CatheK和OPG水平,骨质疏松患者血清β-CTX,CatheK和OPG与骨折的关系和椎体骨折严重程度的关系,骨质疏松患者血清β-CTX,CatheK和OPG水平的相关性分析,及血清β-CTX,CatheK和OPG的受试者工作特征曲线(ROC)在诊断椎体骨折的价值。结果骨质疏松组的血清β-CTX和CatheK水平明显高于骨量减少组和骨量正常组(P<0.01),骨量减少组明显高于骨量正常组(P<0.01),而骨质疏松组的OPG水平明显低于骨量减少组和骨量正常组(P<0.01),而骨量减少组明显低于骨量正常组(P<0.01)。骨折组的血清β-CTX和CatheK水平明显高于未骨折组(P<0.01),而骨折组的OPG水平明显低于未骨折组(P<0.01)。骨质疏松患者血清β-CTX和CatheK水平随着骨折严重程度的增加出现升高(P<0.01),而OPG水平随着严重程度增加而降低(P<0.01)。骨质疏松患者血清β-CTX与CatheK呈正相关(r=0.816,P<0.05),与OPG水平呈负相关(r=-0.763,P<0.05),CatheK与OPG水平呈负相关(r=-0.687,P<0.05)。通过ROC来预测骨质疏松发生椎体骨折的灵敏度和特异性,联合检测ROC曲线下的面积明显高于β-CTX(Z=2.389,P=0.017),CatheK(Z=2.707,P=0.007)和OPG(Z=2.926,P=0.003)检测,而β-CTX、CatheK和OPG的比较,差异无统计学意义(P>0.05)。结论联合检测β-CTX、CatheK和OPG对骨质疏松患者合并椎体骨折的诊断具有重要的临床价值。

Objective To investigate the diagnostic significance of serum β-cross-linked C-telopeptide of type 1 collagen (β-CTX), cathepsin K (Cathe K), and osteoprotegerin (OPG) in postmenopausal osteoporosis patients. Methods One hundred and ten post-menopausal patients in our hospital were selected in osteoporosis group from January 2015 to December 2017. At the same period, 65 patients were selected in bone mass loss and 30 patients in normal bone mass group. The levels of serum β-CTX, Cathe K, and OPG in each group were observed. The relationship among β-CTX, Cathe K, and OPG, and the severity of vertebral fractures were also observed in osteoporosis patients. ROC of serum β-CTX, Cathe K, and OPG were used in the diagnosis of vertebral fractures. Results The serum levels of β-CTX and Cathe K in osteoporosis group were significantly higher than those in bone loss group and normal bone mass group ( P <0.01), and the levels of those in bone loss group was significantly higher than those in the normal bone mass group ( P <0.01). The OPG levels in osteoporosis group were significantly lower than those in bone loss group and normal mass bone group ( P <0.01), while those in bone loss group were significantly lower than in the normal bone mass group ( P <0.01). The levels of serum β-CTX and Cathe K in fracture group were significantly higher than those in non-fracture group ( P <0.01), while the OPG levels in fracture group were significantly lower than those in non-fracture group ( P <0.01). The levels of serum β-CTX and Cathe K increased with the increase of fracture severity ( P <0.01), and the level of OPG decreased with the increase of the severity ( P <0.01). The serum β-CTX levels were positively correlated with Cathe K in patients with osteoporotic fractures ( r =0.816, P <0.05), but negatively correlated with OPG ( r =-0.763, P <0.05). There was a negative correlation between Cathe K and OPG ( r =-0.687, P < 0.05). ROC was used to predict the sensitivity and specificity of osteoporosis in vertebral fractures. The area under curve of combination detection was significantly higher than that of β-CTX ( z =2.389, P =0.017), Cathe K ( z =2.707, P =0.007), and OPG ( z =2.926, P =0.003). There was no significant difference among β-CTX, Cathe K, and OPG ( P >0.05). Conclusion Combination detection of β-CTX, Cathe K, and OPG has important clinical value in the diagnosis of vertebral fracture in patients with osteoporosis.