骨碱性磷酸酶、N-端骨钙素在重组人甲状旁腺素(1-34)治疗原发性骨质疏松症疗效观察中的应用  

Bone alkaline phosphatase and N-MID osteocalcin in monitoring of osteoporosis treatment with recombinant human parathyroid hormone1-34

作　　者：翁秀妹[1,2] 潘建平[3] 

机构地区：[1]浙江大学医学院基础医学系,浙江杭州310058 [2]浙江医院检验科,浙江杭州310013 [3]浙江大学城市学院医学院临床医学系,浙江杭州310015

出　　处：《浙江大学学报（医学版）》2013年第5期578-582,共5页Journal of Zhejiang University(Medical Sciences)

摘　　要：目的：探讨血清骨转换指标骨碱性磷酸酶（BALP）和N-端骨钙素（N-MID）水平监测在重组人甲状旁腺素（1-34）治疗原发性骨质疏松症疗效观察中的作用.方法：采用双能X-线骨密度仪测定患者治疗前、治疗后6个月及12月时腰椎L2～L4和股骨颈骨密度;同时采用化学发光仪及电化学发光仪检测血清BALP及N-MID水平.结果：与用药前相比,患者在用药6个月后股骨颈骨密度无变化,腰椎L2～L4骨密度均值由治疗前0.753g/cm^2上升到0.781 g/cm^2,上升了3.7％（P＜0.05）;而血清N-MID水平由15.46 ng/ml上升到27.07 ng/ml,BALP水平均值由14.05 μg/ml上升到24.31 μg/m,分别上升了75.1％和73.0％（均P＜0.01）.用药12个月后,患者股骨颈骨密度与用药前比较仍无明显变化（P＞0.05）,腰椎L2～L4骨密度由0.753 g/cm^2上升到0.807 g/cm^2,上升了7.2％（P＜0.01）;而血清N-MID和BALP水平由用药前15.46 ng/ml、14.05 μg/ml上升到49.38 ng/ml、33.99 μg/ml,与治疗前相比分别上升了219.4％和141.9％（均P＜0.01）.结论：在促进骨合成的骨质疏松治疗中,血清N-MID及BALP水平较骨密度测量更敏感.因此,骨密度测量联合血液骨转化标志指标检测,可以对骨质疏松疗效进行有效监测.Objective：To evaluate the application of bone turnover markers bone alkaline phosphatase （BALP） and N-MID osteocalcin （N-MID） in monitoring of osteoporosis treatment with recombined parathyroid hormone 1-34 （rhPTH1-34）.Methods：The bone mineral density （BMD） of the lumbar spine L2-L4 and the proximal femur were examined by dual energy X-ray absorptiometry （DXA） before and 6 and 12 months after rhPTH 1-34 treatment.Meanwhile,serum levels of BALP and N-MID were detected by electro-chemiluminescence assay.Results：Six months after rhPTH 1-34 treatment,the BMD of proximal femur remained unchanged,and the BMD of the lumbar L2-L4 spine increased from 0.753 g/cm^2 to 0.781 g/cm^2 （P 〈0.05） ; while serum levels of N-MID increased from 15.46 ng/ml to 27.07 ng/ml（P 〈 0.01）,BALP from 14.05 μg/ml to 24.31 μg/ml （P 〈 0.01）.Twelve months after drug administration,no significant changes were observed in BMD of proximal femur,and the BMD of the lumbar spine L2-L4 increased from 0.753 g/cm^2 to 0.807 g/cm^2 （P 〈 0.01） while serum levels of N-MID and BALP increased from 15.46 ng/ml and 14.05μg/ml to 49.38 ng/ml and 33.99 μg/ml,respectively （both P 〈 0.01）.Conclusion：Serum levels of BALP and N-MID are more sensitive than BMD.Combination of two methods may provide better indicators for monitoring of osteoporosis treatment.

关 键 词：骨质疏松 碱性磷酸酶 骨钙素 甲状旁腺素 骨密度 治疗结果 病例对照研究 

分 类 号：R580[医药卫生—内分泌]