尿Ⅰ型胶原羧基末端肽和氨基末端肽排泄率与年龄、绝经和绝经后骨丢失的关系  

Age-related and menopause-related changes of urinary excretion of C- and N-terminal cross-linked telopeptides of type I collagen and the relationships thereof with menopause-related bone loss

作　　者：刘石平[1] 廖二元[1] 伍贤平[1] 曹行之[1] 单鹏飞[1] 苏欣[1] 

机构地区：[1]中南大学湘雅二医院代谢内分泌研究所,长沙410011

出　　处：《中华医学杂志》2006年第6期371-375,共5页National Medical Journal of China

基　　金：卫生部临床学科重点基金资助项目(2001035427)

摘　　要：目的探讨健康女性随增龄尿Ⅰ型胶原羧基末端肽和氨基末端肽排泄率(uCTX/Cr和uNTX/Cr)的变化及与绝经、绝经年限和绝经后骨丢失的关系。方法用ELISA法测定659例20～80岁健康女性uCTX/Cr和uNTX/Cr,用双能X线吸收法(DXA)测定不同骨骼部位(腰椎正位和侧位、髋部和前臂)的骨密度(BMD)。根据WHO骨质疏松诊断标准,将绝经后女性(339例)分为骨质疏松、低骨量和骨量正常3组。结果(1)uCTX/Cr和uNTX/Cr分别与年龄之间以三次方回归曲线拟合优度最好,决定系数(R2)分别为0.139和0.149。35岁以后uCTX/Cr和uNTX/Cr逐渐升高。(2)uCTX/Cr和uNTX/Cr在绝经前分别为149mg/mol±80mg/mol和33nmol/mmol±17nmol/mmol;在绝经后明显升高,分别为253mg/mol±101mg/mol和63nmol/mmol±34nmol/mmol,以绝经后5年内升高最为显著,对应了BMD的显著下降。与绝经前比较,绝经后uCTX/Cr和uNTX/Cr分别升高了69.5%和93.4%,BMD下降了10.8%～27.6%。(3)在控制年龄和体重后,uCTX/Cr和uNTX/Cr仍与各骨骼部位的BMD呈明显负相关(r=-0.078～-0.283,P<0.05或0.01);uCTX/Cr和uNTX/Cr两者之间显著正相关(r=0.608,P=0.000)。(4)骨质疏松组和低骨量组较骨量正常组uCTX/Cr和uNTX/Cr均显著升高(P<0.05或0.01),如在正位腰椎,骨量正常组、低骨量组及骨质疏松组的uCTX/Cr分别为189mg/mol±87mg/mol、272mg/mol±108mg/mol和366mg/mol±135mg/mol,而uNTX/Cr分别为52nmol/mmol±22nmol/mmol、68nmol/mmol±34nmol/mmol和108nmol/mmol±41nmol/mmol。结论uCTX/Cr和uNTX/Cr能敏感地反映女性随年龄及绝经变化的骨转换状态;uCTX/Cr和uNTX/Cr与BMD间存在负相关,且在低骨量和骨质疏松的人群中明显升高,可用于预测女性年龄和绝经相关的骨丢失。Objective To study the age-related and menopause-related changes of urinary excretion of C- and N-terminal cress-linked telopeptides of type I collagen （uCTX/Cr and uNTX/Cr） and the relationships thereof with menopause state, years after menopause, bone mineral density （BMD）, and menopause-related bone loss in healthy women. Methods ELISA was used to examine the uCTX/Cr and uNTX/Cr of 659 female volunteers aged 20 -80 in Changsha. Dual energy X-ray absorptiometry （DXA） was used to measure the BMD of various skeletal sites, including the lumbar vertebrae （L1 - L4 ） at anteropusterior （AP） position, L2 -L4 at lateral （LAT） position, hip, and forearm. 339 postmenopausal women among the 659 subjects were divided into 3 groups, osteporotic, osteopenic, and normal groups according to the WHO criteria of osteoporosis diagnosis. Results ① Both the curves of uCTX/Cr and uNTX/Cr with age were fit the best by regression analysis of cubic equation. The coefficients of determination （R^2） were 0. 139 for uCTX/Cr and 0. 149 for uNTX/Cr. The levels of uCTX/Cr and uNTX/Cr of the women aged 〉 35 increased with age. ② The values of uCTX/Cr and uNTX/Cr were 253 mg/mol ＋ 101mg/mol Cr and 63 nmol ±34 nmol BCE/mmol Cr respectively in the postmenopausal women, remarkably higher than those of the premenopausal women （ 149 mg/mol 3：80 mg/mol Cr and 33 nmol ± 17 nmol BCE,/ mmol Cr respectively） , increased by 69. 5% and 93.4% respectively. The annual change rates of uCTX/Cr and uNTX/Cr were the highest within the first 5 years after menopause, and these increases were in agreement with the significant decrease of BMD at most skeletal sites by 10. 8% - 27.6%. ③After controlled for age and body weight, both uCTX/Cr and uNTX/Cr showed significant negative correlation with BMD （r = -0. 078 - -0. 283 ,P 〈0. 05 or 0. 01 ）, and there was a significant positive correlation between uCTX/Cr and uNTX/Cr.④ The elevation of the levels of uCTX/Cr and uNTX/Cr in the osteoporotic and osteopenicpostmen

关 键 词：骨密度 绝经 骨质疏松 

分 类 号：R580[医药卫生—内分泌]