骨代谢标志物在前列腺癌骨转移患者血清中的表达水平及其诊断价值

Expression levels and diagnostic value of serum bone metabolism markers in patients with bone metastasis of prostate cancer

目的探讨骨代谢标志物在前列腺癌骨转移患者血清中的表达水平及其诊断价值。方法根据全身骨扫描结果将88例前列腺癌患者分为骨转移组64例和无骨转移组24例,骨转移组进一步分为轻微骨转移组14例与多发骨转移组50例。检测患者血清中Ⅰ型胶原交联C端肽(CTX)、Ⅰ型前胶原N端前肽(PⅠNP)、N端骨钙素、降钙素、骨碱性磷酸酶(BALP)、甲状旁腺素(PTH)的表达水平,采用受试者工作特征(ROC)曲线分析各指标对前列腺癌骨转移的诊断价值。结果骨转移组与无骨转移组的血清PTH、N端骨钙素、降钙素水平比较,差异均无统计学意义(均P>0.05),而骨转移组的血清BALP、PⅠNP、CTX水平均高于无骨转移组(均P<0.05);轻微骨转移组与多发骨转移组的血清PTH、N端骨钙素、降钙素、PⅠNP、CTX水平比较,差异均无统计学意义(均P>0.05),而多发骨转移组的BALP水平高于轻微骨转移组(P<0.05)。ROC曲线分析结果显示:血清BALP、PⅠNP、CTX水平及3者联合检测诊断前列腺癌骨转移的曲线下面积分别为0.957、0.762、0.747、0.974(均P<0.05),灵敏度分别为84.32%、56.21%、68.72%、78.12%,特异性分别98.10%、91.63%、83.33%、98.31%。结论前列腺癌骨转移患者血清BALP、PⅠNP、CTX水平明显升高,或可作为诊断前列腺癌患者发生骨转移的血清学指标,且BALP、PⅠNP、CTX联合检测诊断前列腺癌骨转移的诊断效能高于各标志物单独应用。前列腺癌多发骨转移患者血清BALP水平明显增加,或可用于监测前列腺癌骨转移患者的病情发展。

Objective To investigate the expression levels and diagnostic value of serum bone metabolism markers in patients with bone metastasis of prostate cancer.Methods Eighty-eight prostate canceRpatients were divided into bone metastasis group(n=64)and non bone metastasis group(n=24)according to the results of whole-body bone scan.The bone metastasis group was furtheRdivided into mild bone metastasis group(n=14)and multiple bone metastasis group(n=50).The expression levels of serum C-terminal cross-linked telopeptide of typeⅠcollagen(CTX),N-terminal propeptide of typeⅠprocollagen(PⅠNP),N-terminal osteocalcin,calcitonin,bone-specific alkaline phosphatase(BALP)and parathyroid hormone(PTH)were detected in the patients.The diagnostic value of each index foRbone metastasis of prostate canceRwas analyzed using receiveRoperating characteristic(ROC)curve.Results There were no statistically significant differences in serum PTH,N-terminal osteocalcin oRcalcitonin level between the bone metastasis group and the non bone metastasis group(all P>0.05),whereas the bone metastasis group exhibited higheRserum BALP,PⅠNP and CTX levels than the non bone metastasis group(all P<0.05);there were no statistically significant differences in serum PTH,N-terminal osteocalcin,calcitonin,PⅠNP oRCTX level between the mild bone metastasis group and the multiple bone metastasis group(all P>0.05),whereas the level of BALP in the multiple bone metastasis group was higheRthan that in the mild bone metastasis group(P<0.05).The results of ROC curve analysis showed that the areas undeR the curve of serum BALP,PⅠNP,CTX levels and theiRcombined detection in the diagnosis of bone metastasis of prostate canceRwere 0.957,0.762,0.747 and 0.974(all P<0.05),the sensitivities were 84.32%,56.21%,68.72%and 78.12%,and the specificities were 98.10%,91.63%,83.33%and 98.31%,respectively.Conclusion Serum BALP,PⅠNP and CTX levels are significantly increased in patients with bone metastasis of prostate cancer,which may serve as serological indicators foRthe diagnosis of bone metastasis in patients with prostate cancer.Furthermore,the combined detection of BALP,PⅠNP and CTX exhibits a higheRdiagnostic efficiency than single markeRdetection foRdiagnosing bone metastasis of prostate cancer.Serum BALP level is elevated remarkably in patients with multiple bone metastasis of prostate cancer,which may be used foRmonitoring disease progression in patients with bone metastasis of prostate cancer.