伴轻微颈椎外伤的脊髓型颈椎病患者骨代谢标志物及骨密度特点研究

Research on the characteristics of bone turnover marker and bone mineral density in cervical spondylotic myelopathy patients with mild cervical trauma

目的探讨伴轻微颈椎外伤的脊髓型颈椎病(CSM)患者脊髓信号强度和病程等临床特点与骨质疏松(OP)的相关性。方法纳入2015年8月至2021年12月郑州大学第一附属医院收治的72例伴轻微颈椎外伤的CSM患者。患者在入院后均接受颈椎核磁共振成像(MRI)检查,依据Yukawa分级法进行颈髓信号强度分级,使用改良日本整形外科协会(JOA)评分评价患者的神经功能障碍程度。通过电化学发光法检测Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、Ⅰ型前胶原氨基端前肽(P1NP)和骨钙素(OC),通过双能X线骨密度仪测量骨密度(BMD)。采用R统计分析法评估CSM患者脊髓信号强度和病程与OP的相关性。结果Yukawa分级越高,β-CTX升高越明显;Yukawa 0级和1级患者P1NP低于正常值,而Yukawa 2级患者P1NP仍在正常范围内;各组患者OC值为(17.31±9.76)ng/ml,与Yukawa分级无相关(t=-0.32,P>0.05)。CSM病程≥24个月患者髋部和腰椎Z值较CSM病程<24个月患者更低,差异有统计学意义(髋部:W=1100.5,P<0.01;腰椎:W=1090.0,P<0.01);CSM病程≥24个月患者与CSM病程<24个月患者比较,髋部较腰椎Z值变化更明显。结论CSM患者相对于健康人群BMD更低,且髋部较腰椎BMD下降更加明显,CSM患者颈椎在受到轻微外伤后容易导致脊髓再损伤,β-CTX可在短期内升高,需重视此类患者OP的预防和治疗。

Objective To investigate the correlation of spinal cord signal intensity and course of disease with osteoporosis(OP)in patients with cervical spondylotic myelopathy(CSM)with mild cervical spine trauma.Methods 72 CSM patients with mild cervical spine trauma admitted to the First Affiliated Hospital of Zhengzhou University from August 2015 to December 2021 were included.All patients received cervical magnetic resonance imaging(MRI)after admission,and the cervical spinal cord signal intensity was graded according to the Yukawa grading method.The degree of neurological dysfunction was evaluated by the modified Japanese Orthopaedic Association(JOA)score.Detection of typeⅠcollagen carboxy-terminal peptideβspecial sequence(β-CTX),typeⅠprocollagen amino-terminal propeptide(P1NP),osteocalcin(OC)levels by electrochemiluminescence method,and BMD was measured by dual-energy X-ray absorptiometry.The R statistical analysis method was used to evaluate the correlation of signal intensity and disease duration in the spinal cord of CSM patients with OP.Results The higher the Yukawa grade,the more obvious the elevation ofβ-CTX;the P1NP of the Yukawa grade 0 and 1 patients was lower than the normal value,while the P1NP of the Yukawa grade 2 patient was still within the normal range;OC of patients in each group were(17.31±9.76)ng/ml,with no significant correlation with Yukawa grade(t=-0.32,P>0.05).The Z-scores of the hip and lumbar spine were lower in patients with CSM disease duration≥24 months than those with CSM duration<24 months,and the difference was statistically significant(hip:W=1100.5,P<0.01;lumbar spine:W=1090.0,P<0.01);patients with CSM disease duration≥24 months had more significant changes in the Z value of the hip than the lumbar spine compared with patients with CSM disease duration<24 months.Conclusion Compared with healthy people,CSM patients have lower BMD,and the BMD of the hip is more significantly lower than that of the lumbar spine.CSM patients are prone to re-injury of the spinal cord after minor trauma to the cervical spine,β-CTX can be increased in a short period of time.Attention should be paid to the prevention and treatment of OP in such patients.