中老年人骨科围手术期有关骨代谢指标变化的研究

Changes of bone metabolic markers during orthopaedic perioperative period in people in middle-age or above

目的观察中老年骨科手术患者围手术期骨代谢变化特点,为临床治疗提供参考。方法随机抽取年龄50岁以上的中老年患者共113例作为研究对象,分别于术前、术后一周测定静脉血中骨钙素(boneγ-carboxyglutamic acid protein,BGP)及I型胶原交联C端肽(C-terminal telopeptides of type I co★agen,CTX)的水平。结果手术后CTX值较术前明显升高(P<0.001),BGP值较术前明显降低(P<0.001)。其中,骨质疏松症患者、骨折患者手术前后CTX值均变化较大;而骨折患者BGP值手术前后差异无统计学显著性(P>0.05),其余病人BGP值较术前明显降低(P<0.01)。结论中老年人在骨科手术前后存在骨代谢的变化,手术后CTX水平较术前升高,提示骨吸收过程活跃;BGP水平较术前降低,提示骨形成过程受到抑制。骨质疏松患者术后CTX升高程度较非骨质疏松患者明显。

Objective To observe the changes of bone metabolic markers of people in middle-age or above during orthopaedic perioperative period.Methods Osteocalcin(OC or BGP),C-terminal telopeptides of typeⅠcollagen (CTX) in serum were measured by ECLIA in 113 patients(23 males and 90 females,52～89 years old).Bone mineral density(BMD) were measured by dual-energy X-ray densitometer before operation.CTX and BGP were compared before and after operation.Results The CTX level was(0.37±0.28) ng/ml preoperatively and was(0.58±0.35 ) ng/ml postoperatively in all patients(P < 0.001 ).The BGP level was(15.72±10.07 ) ng/ml preoperatively and was (13.05±8.11) ng/ml postoperatively in all patients(P <0.001).The CTX level was(0.37±0.27) ng/ml preoperatively and was(0.69±0.38) ng/ml postoperatively in patients with osteoporosis(P < 0.001).The CTX level was (0.38±0.29) ng/ml preoperatively and was(0.49±0.30) ng/ml postoperatively in patients without osteoporosis(P <0.01).The postoperative CTX level changed in osteoporotic patients was more significantly than that in patients without osteoporosis.Conclusion This study shows that the postoperative serum CTX level was higher than preoperative serum CTX level,which shows bone absorption was increased after operation.Compare the BGP level in serum postoperative stage was lower than preoperative stage;the new bone formation was decreased.The postoperative CTX level changed in osteoporotic patients was more significantly than that in patients without osteoporosis.