血清BALP、NTX在糖尿病足骨髓炎患者中的表达及意义

Expressions and significance of serum BALP and NTX in patients with diabetic foot osteomyelitis

目的探讨骨碱性磷酸酶(BALP)、Ⅰ型胶原交联氨基末端肽(NTX)在糖尿病足骨髓炎(DFO)患者血清中的水平及意义。方法前瞻性选取2017年10月至2020年6月诊治的糖尿病足(DF)患者139例为研究对象,根据DF患者是否并发骨髓炎将其分为非骨髓炎组(n=59)、骨髓炎组(n=80)。比较两组患者的临床资料;采用酶联免疫吸附法(ELISA)检测血清BALP、NTX水平;采用受试者工作特征曲线(ROC)评价血清BALP、NTX对DFO的诊断价值;采用多因素Logistic回归分析糖化血红蛋白、WBC计数、血清BALP、NTX(对DFO发生的独立危险因素。结果骨髓炎组患者糖化血红蛋白、WBC计数、血清BALP、NTX水平均显著高于非骨髓炎组(P<0.05),年龄、男/女比例、糖尿病病程、糖尿病肾病比例、溃疡史比例、冠心病比例、高血压比例与非骨髓炎组无明显差异(P>0.05);血清BALP、NTX诊断DFO的曲线下面积(AUC)分别为0.836、0.863,截断值分别为99.98 mmol/L、9.45 nmol BCE/μM Cr,相应灵敏度分别为78.8%、75.0%,特异度分别为84.3%、88.1%;两者联合诊断DFO的AUC为0.908,其灵敏度、特异度分别为91.3%、83.1%;WBC计数(OR=1.847)、BALP(OR=1.278)、NTX(OR=1.243)均是影响DFO发生的危险因素(P<0.05)。结论DFO患者血清BALP、NTX水平均显著升高,两者均可能在DFO发病进展中具有重要作用,BALP、NTX联合可提高对DFO的诊断价值,有助于临床筛查DFO患者。

Objective To investigate the levels and significance of bone alkaline phosphatase(BALP) and cross-linked N-telopeptides of type Ⅰ collagen(NTX) in patients with diabetic foot osteomyelitis(DFO). Methods From October 2017 to June 2020, 139 patients with diabetic foot(DF) who were diagnosed and treated were selected as research objects. According to whether DF patients complicated with osteomyelitis, they were divided into non osteomyelitis group(n=59) and osteomyelitis group(n=80). The clinical data of the two groups were compared. The levels of serum BALP and NTX were detected by enzymelinked immunosorbent assay(ELISA), receiver operating characteristic curve(ROC) was used to evaluate the diagnostic value of serum BALP and NTX for DFO, and Multivariate Logistic regression analysis was used to analyze the influencing factors of DFO. Results The glycosylated hemoglobin, WBC count, serum BALP and NTX levels in osteomyelitis group were significantly higher than those in non osteomyelitis group(P<0.05). There were no significant differences in age, male/female ratio, course of diabetes, proportions of diabetic nephropathy, proportions of ulcer history, proportions of coronary heart disease and proportions of hypertension(P>0.05);the area under the curve(AUC) of serum BALP and NTX in the diagnosis of DFO was 0.836 and 0.863, the cut-off value was 99.98 mmol/L and 9.45 nmol BCE/μ M Cr, respectively, the corresponding sensitivity was 78.8%, 75.0% and the specificity was 84.3% and 88.1%, respectively. The AUC of combined diagnosis was 0.908, and the sensitivity and specificity were 91.3% and 83.1% respectively;WBC count, BALP and NTX were risk factors of DFO(P<0.05). Conclusions The levels of serum BALP and NTX in patients with DFO are significantly increased, and both of them may play an important role in the pathogenesis of DFO. BALP combined with NTX can improve the diagnostic value of DFO, which is helpful for clinical screening of DFO patients.