女性致密性骨炎血清骨转换生化标志物水平变化研究

Characteristic of Biochemical Markers of Bone Turnover in Female Patients with Osteitis Condensans Ilii

背景致密性骨炎(OCI)和其他疾病有时难以鉴别,探讨血清骨转换生化标志物可为OCI的鉴别诊断提供依据。目的探索女性OCI患者的血清骨转换生化标志物的水平变化及临床意义。方法回顾性选取2013年6月至2022年2月在北京积水潭医院门诊及住院诊断为OCI的61例女性患者作为观察组,年龄15~50岁,平均(33.8±6.6)岁,病程2周~15年。选择同期61例女性体检健康者作为对照组,年龄15~48岁,平均(35.6±7.6)岁。比较两组一般临床资料和血清骨转换生化标志物水平,并对血清骨转换生化标志物与病情相关指标进行相关性分析。结果观察组血清白蛋白(45.4±2.9)g/L低于对照组(46.5±2.8)g/L(t=2.190,P<0.05)。血清骨转换生化标志物比较结果显示,观察组血清1型胶原羧基末端肽β特殊序列(β-CTX)〔0.28(0.23,0.37)μg/L〕、N-端骨钙素(OC)〔13.1(11.2,16.2)μg/L〕、25-羟维生素D_(3)〔25-(OH)VD_(3)〕〔(14.1±5.1)μg/L〕低于对照组〔0.36(0.29,0.48)μg/L,15.6(13.7,17.3)μg/L,(17.5±6.6)μg/L〕(Z=-2.983、-3.255,t=3.081,P<0.05)。长病程亚组OC水平〔14.6(12.4,18.5)μg/L〕高于短病程亚组〔11.7(10.2,14.0)μg/L〕(Z=-2.407,P<0.05)。多孕亚组β-CTX〔0.25(0.22,0.32)μg/L〕、OC水平〔12.2(10.3,15.0)μg/L〕低于非多孕亚组〔0.33(0.26,0.44)μg/L、13.4(12.0,18.8)μg/L〕(Z=-2.486、-1.897,P<0.05)。相关性分析显示,观察组血清1型前胶原氨基端延长肽(tP1NP)与妊娠次数、生产次数均呈负相关(r_(s)=-0.276、-0.298,P<0.05),OC与体质指数(BMI)、视觉模拟评分法(VAS)评分、妊娠次数均呈负相关(r_(s)=-0.284、-0.374、-0.360,P<0.05),25-(OH)VD_(3)水平与BMI呈正相关(r_(s)=0.275,P<0.05)。结论女性OCI患者血清OC、β-CTX水平明显降低,可为鉴别其他疾病提供依据;血清OC水平可以反映OCI患者的严重程度,同时OC水平与患者妊娠次数相关;tP1NP与妊娠次数、生产次数相关。

Background It is sometimes difficult to distinguish osteitis condensans ilii(OCI)from other diseases,and exploring biochemical markers of bone turnover may contribute to the differential diagnosis.Objective To evaluate the characteristic and significance of biochemical markers of bone turnover in patients with OCI.Methods Participants were retrospectively selected from Beijing Jishuitan Hospital from June 2013 to February 2022,including 61 female outpatients and inpatients with OCI{observation group:15-50 years old〔mean age of(33.8±6.6)years〕,duration of OCI of two weeks to 15 years},and 61 healthy female physical examinees{control group:15-48 years old〔mean age of(35.6±7.6)years〕}.The clinical data and biochemical markers of bone turnover were compared between the two groups.The correlations of biochemical markers of bone turnover with OCI-related indices were analyzed.Results The serum albumin of the observation group was significantly lower than that of the control group〔(45.4±2.9)g/L vs(46.5±2.8)g/L〕(t=2.190,P<0.05).In term of biochemical markers of bone turnover,the observation group had significantly lower serumβ-isomerised carboxy-terminal cross-linking telopeptide of type 1 collagen(β-CTX)〔0.28(0.23,0.37)μg/L vs 0.36(0.29,0.48)μg/L〕,N-terminal osteocalcin(OC)〔13.1(11.2,16.2)μg/L vs 15.6(13.7,17.3)μg/L〕,and 25-(OH)VD_(3)〔(14.1±5.1)μg/L vs(17.5±6.6)μg/L〕than the control group(Z=-2.983,-3.255,t=3.081,P<0.05).OCI patients with a longer disease duration had significantly higher serum OC〔14.6(12.4,18.5)μg/L vs 11.7(10.2,14.0)μg/L〕than those with a shorter duration(Z=-2.407,P<0.05).OCI patients with two or more pregnancies had significantly lower serumβ-CTX〔0.25(0.22,0.32)μg/L vs 0.33(0.26,0.44)μg/L〕and OC〔12.2(10.3,15.0)μg/L vs 13.4(12.0,18.8)μg/L〕than those with no or one pregnancy(Z=-2.486,-1.897,P<0.05).Correlation analysis showed that,in OCI patients,the procollagen type 1 N-terminal propeptide(tP1NP)was negatively correlated with the number of pregnancies and deliveries(r_(s)=-0.276,-0.298,P<0.05).Serum OC level was negatively correlated with BMI,VAS score and the number of pregnancies(r_(s)=-0.284,-0.374,-0.360,P<0.05).The serum 25-(OH)VD_(3) level was positively correlated with BMI(r_(s)=0.275,P<0.05).Conclusion The serum levels of OC andβ-CTX in female patients with OCI were significantly lowered,which could be used for distinguishing OCI and other diseases.The serum level of OC may be a predictor of the severity of OCI,which was related to the number of pregnancies.The level of tP1NP was related to the number of pregnancies and deliveries.