血清β-CTx、25-OH-VD、磷对骨肿瘤的临床价值研究

Clinical value of serumβ-CTx,25-OH-VD and phosphorus in bone tumor

目的探讨骨肿瘤患者血清骨代谢指标的水平及其在辅助诊断中的临床价值。方法纳入2021年1-12月该院76例骨肿瘤患者(骨肿瘤组)和40例健康体检者(健康组)作为研究对象。根据病理检查结果将骨肿瘤组进一步分为良性组(29例)、中间型组(17例)和恶性组(30例)。比较不同组别之间血清钙(Ca)、磷(P)、碱性磷酸酶(ALP)、Ⅰ型胶原羧基端肽β特殊序列(β-CTx)、骨钙素N端中分子(OCN-MID)、甲状旁腺素(PTH)、25-羟基维生素D(25-OH-VD)和总Ⅰ型胶原氨基端延长肽(TP1NP)水平的差异。绘制受试者工作特征(ROC)曲线分析各指标单独及联合检测对骨肿瘤的诊断价值。采用Spearman相关分析评估指标间的相关性。结果骨肿瘤组血清β-CTx、P、ALP水平高于健康组,25-OH-VD水平低于健康组,差异均有统计学意义(P<0.01);两组血清Ca、OCN-MID、PTH、TP1NP水平比较,差异均无统计学意义(P>0.05)。ROC曲线分析结果显示,β-CTx、25-OH-VD、P、ALP诊断骨肿瘤的曲线下面积(AUC)分别为0.750、0.799、0.810、0.647;β-CTx、25-OH-VD、P联合检测时的AUC最大(0.879),优于两两联合及单项指标应用时的诊断效能,对应灵敏度为75.00%,特异度为90.00%。骨肿瘤患者血清β-CTx与P水平呈正相关(r=0.55,P<0.01),25-OH-VD与P水平呈负相关(r=-0.26,P<0.05);而良性组、中间型组、恶性组血清β-CTx、25-OH-VD和P水平比较,差异均无统计学意义(P>0.05)。结论血清β-CTx、25-OH-VD和P水平联合检测对骨肿瘤诊断具有较高价值,可为临床诊断和动态监测提供一定参考。

Objective To investigate the levels of serum bone metabolic markers in patients with bone tumor and their clinical value in auxiliary diagnosis.Methods From January to December 2021,76 patients with bone tumor(bone tumor group)and 40 healthy subjects(healthy group)in our hospital were enrolled as the study subjects.According to pathological results,the bone tumor group was further divided into benign group(29 cases),intermediate group(17 cases)and malignant group(30 cases).Serum calcium(Ca),phosphorus(P),alkaline phosphatase(ALP),specific sequence ofβcarboxyl-terminal telopeptides of typeⅠcollagen(β-CTx),N-terminal middle molecule of osteocalcin(OCN-MID),parathyroid hormone(PTH),25-hydroxyvitamin D(25-OH-VD)and total typeⅠcollagen amino-terminal elongating peptide(TP1 NP)were compared between different groups.The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of each index for bone tumor alone and in combination.Spearman correlation analysis was used to evaluate the correlations among indicators.Results The levels of serumβ-CTx,P and ALP in bone tumor group were higher than those in healthy group,while the level of 25-OH-VD was lower than that in healthy group,and the differences were statistically significant(P<0.01).There was no significant difference on serum Ca,OCN-MID,PTH and TP1 NP levels between the two groups(P>0.05).ROC curve analysis showed that the area under curve(AUC)ofβ-CTx,25-OH-VD,P and ALP were 0.750,0.799,0.810 and 0.647 respectively.The AUC ofβ-CTx,25-OH-VD and P combined detection was the the maximum(0.879),which was better than the diagnostic efficacy of pair-wise combination and single index,with the corresponding sensitivity of 75.00%and specificity of 90.00%.Serumβ-CTx was positively correlated with P level(r=0.55,P<0.01),while 25-OH-VD was negatively correlated with P level(r=-0.26,P<0.05).There was no significant difference on serumβ-CTx,25-OH-VD and P levels in benign group,intermediate group and malignant group(P>0.05).Conclusion The combined detection of serumβ-CTx,25-OH-VD and P levels has high value for the diagnosis of bone tumor,and could provide a certain reference for clinical diagnosis and dynamic monitoring.