青海省饮茶型地方性氟中毒病区成人氟骨症患者血清CTX-1及P1NP含量变化

Changes of serum CTX-1 and P1NP in patients with skeletal fluorosis in tea-drinking-borne endemic fluorosis area in Qinghai Province

目的观察青海省饮茶型地方性氟中毒病区成人氟骨症患者血清Ⅰ型胶原C端肽(CTX-1)及Ⅰ型胶原氨基端延长肽(P1NP)含量变化规律,为氟骨症诊断寻找敏感指标。方法2019年4-8月,采用病例对照研究,在青海省玉树藏族自治州治多县及海北藏族自治州刚察县的饮茶型地方性氟中毒病区,根据《地方性氟骨症诊断标准》(WS/T 192-2008),对病区内≥25岁且居住10年以上的常住人口进行氟骨症临床诊断和X线检查,结合对既往疾病史、生活方式、临床表现的面对面询问调查,分别选择氟骨症患者和健康人群作为氟骨症组和对照组。采集两组人群中段随机尿样和空腹静脉血,采用离子选择电极法检测尿氟含量,酶联免疫吸附试验(ELISA)法检测血清CTX-1和P1NP含量。结果共调查病区人群127例,其中氟骨症组63例、对照组64例,两组间年龄、性别比例比较差异均无统计学意义(t=0.42,χ^(2)=0.07,均P>0.05)。X线检查结果显示,氟骨症患者病情分度以轻度为主,占71.43%(45/63);X线改变以骨间膜骨化、肌腱骨化为主。对照组和氟骨症组人群尿氟分别为1.62(1.12,1.95)、3.22(2.38,4.89)mg/L,二者比较差异有统计学意义(Z=7.07,P<0.001);两组间血清CTX-1、P1NP含量比较,差异均有统计学意义(Z=2.00、4.89,均P<0.05)。结论氟骨症患者血清CTX-1、P1NP含量均高于健康人群,血清CTX-1、P1NP可能成为氟骨症诊断的敏感指标。

Objective To observe the changes of serum C-terminal peptide of typeⅠcollagen(CTX-1)and N-terminal lengthening peptide of typeⅠcollagen(P1NP)in adult patients with skeletal fluorosis in the tea-drinking-borne endemic fluorosis area in Qinghai Province,and to find sensitive indicators for diagnosis of skeletal fluorosis.Methods From April to August 2019,a case-control study was carried out in tea-drinking-borne endemic fluorosis area in Zhiduo County,Yushu Tibetan Autonomous Prefecture,and Gangcha County,Haibei Tibetan Autonomous Prefecture of Qinghai Province.According to the Diagnostic Standard for Endemic Skeletal Fluorosis(WS/T 192-2008),the clinical diagnosis and X-ray examination of skeletal fluorosis were carried out for permanent residents≥25 years old and living for more than 10 years in the area,combined with face-to-face inquiry and investigation of past disease history,lifestyle and clinical manifestations.The patients with skeletal fluorosis and healthy people were selected as skeletal fluorosis group and control group,respectively.Randomized urine samples and fasting venous blood from the two groups were collected.The content of fluoride in urine was determined by ion selective electrode method,and the contents of CTX-1 and P1NP in serum were determined by enzyme-linked immunosorbent assay(ELISA).Results A total of 127 people in the disease area were investigated,including 63 cases in skeletal fluorosis group and 64 cases in control group.There was no statistically significant difference in age and sex ratio between the two groups(t=0.42,χ^(2)=0.07,P>0.05).The X-ray examination results showed that the patients with skeletal fluorosis were mainly mild,accounting for 71.43%(45/63);X-ray changes were mainly ossification of interosseous membrane and tendon.The urinary fluoride in control group and skeletal fluorosis group was 1.62(1.12,1.95)and 3.22(2.38,4.89)mg/L,respectively,with statistically significant difference between the two groups(Z=7.07,P<0.001).The difference of serum CTX-1 and P1NP contents between the two groups was statistically significant(Z=2.00,4.89,P<0.05).Conclusions The levels of serum CTX-1 and P1NP in patients with skeletal fluorosis are higher than those in healthy people.Serum CTX-1 and P1NP may be used as sensitive indicators for diagnosis of skeletal fluorosis.