135例脊髓损伤患者骨代谢标志物的回顾性分析

Bone Metabolism Biochemical Markers for Spinal Cord Injury:A Retrospective Study of 135 Patients

目的观察脊髓损伤患者骨代谢标志物与临床特点的关系。方法2018年7月至2019年12月,在本院住院康复治疗的脊髓损伤患者共135例,评定患者美国脊柱损伤协会残损分级(AIS),检测患者空腹血清β-I型胶原羧基端肽(β-CTX)、总I型前胶原N端前肽(TP1NP)、25-OH-维生素D[25(OH)D]、甲状旁腺激素(PTH)、血清钙和血清磷水平。分析性别、年龄、病程、AIS等临床特点与TP1NP、β-CTX、25(OH)D和PTH等骨代谢标志物的关系。结果女性β-CTX和25(OH)D水平明显低于男性(|t|>2.044,P<0.01)。不同年龄组间25(OH)D水平有显著性差异(F=3.156,P<0.05)。所有患者β-CTX和TP1NP水平在脊髓损伤后4个月内逐渐升高,4个月后开始下降;PTH在脊髓损伤后4个月内逐渐下降,4个月后开始升高(P<0.001)。AIS D级患者β-CTX水平低于A级和C级患者(t>2.679,P<0.05)。截瘫患者TP1NP水平高于四肢瘫患者(Z=-2.035,P<0.05)。有脊柱骨折或涉及脊柱手术的患者β-CTX水平高于无脊柱骨折或涉及脊柱手术的患者(t=2.169,P<0.05);下肢有运动功能的患者与下肢无运动功能的患者骨代谢标志物无显著性差异(t<0.839,Z<1.822,P>0.05)。所有患者中25(OH)D缺乏和不足的比例占85.19%。结论脊髓损伤后4个月内骨转换活跃,4个月后骨转换活跃程度逐渐下降,可能与损伤时有脊柱骨折或损伤后有涉及脊柱的手术有关。脊髓损伤对骨代谢标志物的影响尚不能明确。脊髓损伤患者普遍存在25(OH)D不足或缺乏。

Objective To observe the relationship between bone metabolism biochemical markers and clinic features in patients with spinal cord injury.Methods From July,2018 to December,2019,totally 135 patients with spinal cord injury were enrolled.They were assessed with American Spinal Injury Association Impairment Scale(AIS).β-collagen type I C-terminal telopeptide(β-CTX),total N-terminal propeptide of type I precollagen(TP1NP),25-hydroxyvitamin D[25(OH)D]and parathyroid hormone(PTH),serum calcium and serum phosphorus were measured.The level of TP1NP,β-CTX,25(OH)D and PTH among clinical characteristics(gender,age,disease course,AIS grade and so on)were analyzed.Results The levels ofβ-CTX and 25(OH)D were lower in women than in men(|t|>2.044,P<0.01).There was difference in the level of 25(OH)D among different ages(F=3.156,P<0.05).The levels ofβ-CTX and TP1NP increased in the first four months after spinal cord injury,and decreased then;while the level of PTH decreased in the first four months,and increased then(P<0.001).The level ofβ-CTX was lower in patients of AIS D than in patients of AIS A and C(t>2.679,P<0.05).The level of TP1NP was higher in paraplegics than in quadriplegics(Z=-2.035,P<0.05).The level ofβ-CTX was higher in patients with fractures or surgeries involving bone than in patients without fractures or surgeries involving bone(t=2.169,P<0.05).There was no difference in all the bone metabolism markers between patients with and without lower extremity motor function(t<0.839,Z<1.822,P>0.05).The ratio of 25(OH)D deficience was 85.19%.Conclusion Bone conversion was active in the first four months after spinal cord injury,and decreased gradually then,which may be related to fractures of spine or surgeries involving spine after injury.The effect of spinal cord injury on bone metabolism markers is not clear.Most of patients with spinal cord injury were lack of vitamin D.