血清骨代谢指标与股骨颈骨量丢失的诊断价值

Significance of serum bone metabolism markers for diagnosis of femoral neck bone loss

[目的]观察骨质疏松症患者股骨颈骨质流失过程中骨代谢生化指标的变化规律及其对骨量减少的诊断价值。[方法] 2017年1月~2019年12月在本院就诊的患者172名,检测其健侧股骨颈骨密度(bone mineral density, BMD)及血清骨代谢生化指标并进行相关性分析。[结果]随着股骨颈BMD下降,25羟维生素D [25 (OH) D]显著降低(P<0.05),其余指标均显著升高(P<0.05)。其中,β胶原降解产物(β-CTX)在骨量减少期已显著升高。Pearson相关分析表明,股骨颈BMD与β-CTX、Ⅰ型原胶原N末端前肽(PINP)、骨钙素(OC)、骨特异性碱性磷酸酶(BALP)、抗酒石酸盐酸性磷酸酶-5b(TRACP-5b)均呈显著的负相关关系(P<0.05),与25 (OH) D呈显著的正相关关系(P<0.05);其中β-CTX与股骨颈BMD的相关性最强。多元线性回归分析表明,β-CTX和25 (OH) D均为股骨颈BMD的独立影响因素[β-CTX:β=-0.144,P=0.024,25 (OH) D:β=0.124,P=0.045]。[结论]骨代谢生化指标均可反映股骨颈骨质流失情况。β-CTX在骨量减少期即出现显著升高,且与股骨颈骨质流失的相关性最强。

[Objective] To observe the variation of serum bone metabolism markers in the process of femoral neck bone loss and evaluate its diagnostic value for bone loss. [Methods] A total of 172 patients who visited our hospital from January 2017 to December 2019 were enrolled into this study. All patients underwent femoral neck bone mineral density(BMD) assay and serum bone metabolism marker test.The correlation between BMD and serum bone metabolism markers was searched by Pearson correlation and multiple regression analysis.[Results] Serum levels of 25 hydroxyvitamin D [25(OH) D] significantly decreased(P<0.05), whereas other markers all significantly increased with the decreasing of femoral neck BMD(P<0.05). Among them, β-collagen degradation products(β-CTX) significantly increased in osteopenia. As results of Pearson correlation analysis, femoral neck BMD was of significantly negative correlation with β-CTX,procollagen type Ⅰ N-terminal peptide(PINP), osteocalcin(OC), bone-specific alkaline phosphatase(BALP) and tartrate resistant acid phosphatase 5 b(TRACP-5 b)(P<0.05), whereas significantly positively correlated with 25(OH) D(P<0.05). Among them, β-CTX had the strongest correlation with femoral neck BMD. In term of multiple linear regression analysis, β-CTX and 25(OH) D both proved independent influencing factors for femoral neck BMD [β-CTX: β=-0.144, P=0.024, 25(OH) D: β=0.124, P=0.045]. [Conclusion] The serum bone metabolism markers do reflect the bone loss of the femoral neck. Of them, the β-CTX increases most significantly in the process of bone loss,and has the strongest correlation with femoral neck bone loss.