骨质疏松症骨代谢生化指标与骨密度测量分析  

Relationship between bone metabolic biochemical markers of osteoporosis and bone mineral density

作　　者：李平生[1] 韦兴[1] 殷亚昕[1] 唐志雄[1] 彭朝津[1] 张瑾[1] 刘加昌[1] 候晓霞 蔺静[1] 黄志红[1] 欧阳巧洪[1] 

机构地区：[1]解放军总医院第304临床部,北京100037

出　　处：《中国骨质疏松杂志》2005年第1期22-24,33,共4页Chinese Journal of Osteoporosis

摘　　要：目的　为使骨质疏松症的治疗更加个体化 ,更具针对性。希望在骨代谢水平上对骨质疏松症患者进行深一步的分型 ,并能指导临床用药。方法　观察住院和门诊骨质疏松症患者 6 5例 ,空腹采血测骨钙素 (BGP)、骨碱磷酶 (B- ALP)、Ⅰ 型胶原C 末端 (CTX)。骨密度 (BMD)用美国NOLAND双能X线骨密度仪测定 ;应用积水潭医院软件分析 ,BMD≤ 2 0SD诊断为骨质疏松症 ,排除继发性骨质疏松症。正常对照组选用健康体检者 2 7例 ,检查项目同骨质疏松疗组。结果　骨质疏松症患者各部位BMD明显低于正常组 ,血BGP明显比正常对照组升高 ,CTX ,B -ALP与正常组无明显差别。而骨质疏松症患者血生化指标中 ,仅B ALP与股骨颈和Ward三角区的BMD密切相关 ,CTX、BGP与各部位BMD无明显相关性。 70岁以上患者B- ALP与股骨颈和Ward三角区BMD呈负相关 ;其中男患者CTX与股骨颈和大转子BMD呈正相关 ,B- ALP与Ward三角区BMD呈正相关 ;女性BMDB ALP与Ward三角区BMD呈负相关。CTX仅在正常组与Ward三角区BMD相关。结论　虽然骨代谢生化指标是用于评估骨转换率有效的方法 ,与BMD测定相结合能全面合理评价骨转换 ,有利于骨质疏松症的个体化治疗 ;但在骨质疏松症BMD和正常人之间血清中各项骨代谢生化指标有很多重叠 ,无法用这些指标来做骨质疏松?Objective To study the relationship between bone density and change of bone metabolism biochemical markers of osteoporosis, thereky differentiating osteoporotic patients with different bone metabolic levels and guiding clinical medication. Methods Sixty-five osteoporosis patients (27 men, 38 women) Blood tests for BGP, ALP-B and CTX, and bone density measurement by dual energy X-ray absorptiometry (Norland, USA), using the special software developed by Beijing Ji Shui Tan Hospital; the diagnosis of osteoporosis ectablished when BMD≤-2.0 SD, and secondary Osteoporosis was excluded. Twenty-seven healthy subjects as normal controls underwent the same tests. Results The bone density of osteoporoic patients in various parts of the body was significomtly lower than that of the confrols. Blood BGP level was significanfly higher than that in the control group but the ALP-B and CTX did not show much differece. Among the biochemical markers of the osteoporotic patients, only ALP-B was closely relatied to the bone density of femoral neck and Ward's triangle. BGP and CTX did not show much connection with the bone density in other parts of the body. CTX had some relationship to Ward's triangle bone desity only in the healthy untrol group. Conclusions Bone metabolism biochemical markers is an effective means for evaluating bone Turn-over; combined with bone density measurement, it can properly and fully evaluate bone furn-over, rete, facilitating individualized treatment of osteoporosis. Sine there are no diffesenus in a number of bone metabolic biochemical markers between osteoporotic patients and healthy confrals these indices are not useful for diagnosis and differentiation of osteoporosis except for evahcation of therapeutic results.

关 键 词：BMD 骨质疏松症 患者 正常 CTX 骨代谢生化指标 ALP 诊断 股骨颈 对照组 

分 类 号：R681[医药卫生—骨科学] R683[医药卫生—外科学]