多发性骨髓瘤骨病临床特点及监测骨代谢标志物的临床意义  

Clinical characteristics of bone disease in multiple myeloma and clinical significance of monitoring bone metabolic markers

作　　者：褚彬[1] 陆敏秋[1] 吴梦青[1] 石磊[1] 付丽娜[1] 高珊[1] 房立娟[1] 项秋晴 鲍立[1] 

机构地区：[1]北京积水潭医院血液内科,100096

出　　处：《中华医学杂志》2016年第18期1424-1429,共6页National Medical Journal of China

基　　金：基金项目：北京市自然科学基金（7162080）

摘　　要：目的观察多发性骨髓瘤（MM）患者骨病的临床特点以及监测骨代谢标志物的临床意义。方法回顾性分析2009年1月至2014年6月北京积水潭医院178例初治的MM患者的临床资料，分析骨病类型和骨病分级，比较不同分级骨病患者的临床特点。66例患者接受了骨代谢标志物的连续动态监测，观察治疗后2年内骨代谢标志物总I型前胶原氨基端延长肽（tPINP）和I型胶原羧基端肽β特殊序列（β—CTX）的变化。结果（1）178例初治的MM患者首诊时表现为骨痛者167例，合并高钙血症者35例，骨质疏松者83例，有溶骨性破坏者154例，有病理性骨折的73例。最常见的溶骨病变发生部位及骨折部位均是脊柱。（2）根据骨病分级将178例患者分为骨病较轻的A组（0～2级，51例）和骨病较重的B组（3～4级，127例），A组与B组患者性别、中位年龄、化疗有效／无效、中位总生存时间、中位疾病无进展生存时间、血清乳酸脱氢酶、血清白蛋白、尿轻链以及血肌酐水平差异均无统计学意义（均P〉0．05），但B组患者较A组患者血红蛋白水平更低[（99．78±29．93）比（108．84±29．30）∥L]，血钙水平更高[（2．47±0．40）比（2．30±0．29）mmol／L]、B2微球蛋白水平更高[（6．04±4．84）比（4．12±3．97）mg／L]，骨髓浆细胞比例更高（33．30％±24．87％比23．51％±22．67％）（均P〈0．05）。（3）治疗前，B组患者（47例）β—CTX、tPINP的表达水平及β-CTX／tPINP比值均明显高于A组患者（19例）（中位数0．78比0．42μg/L，60．95比43．47μg/L，0．017比0．012，均P〈0．05）。在治疗3个月后，A组和B组患者tPINP的表达水平与治疗前比较差异均无统计学意义，两组β-CTX的表达水平及B—CTX／tPINP比值均较治疗前有明显下降（中位数0．16比0．42μg／L，0．26比0．78μg／L；0．008比0．012，0．011比0．017；均P〈0．05）。Objective To observe the clinical characteristics of bone disease in patients with multiple myeloma （MM） and the clinical significance of monitoring bone metabolic markers. Methods The data of 178 MM cases newly diagnosed in Beijing Ji Shui Tan Hospital from January 2009 to June 2014 were reviewed to analysis the types and classification of bone disease and to observe the clinical characteristics of patients with different grades of bone disease. The levels of bone metabolic markers total procollagen type I N-terminal peptide （tPINP） and β C-terminal telopeptide of type I collagen （β-CTX） were monitored regularly in the two years following treatment in 66 cases. Results （ 1 ） Among the 178 newly diagnosed MM cases, 167 cases complained of pain in bones on first visit, 35 cases combined with hypercalcemia, 83 cases combined with osteoporosis, 154 cases combined with osteolytic bone destruction, and 73 cases combined with pathologic fracture. The most common osteolytic location was the spine. The most common fracture sites was the spine. （2） According to bone disease grading, the 178 cases were divided into group A （bone grade0-2, n=51） and group B（bone grade 3 -4, n= 127）. There were no significant differences between group A and group B in gender, median age, therapeutic effect/ineffec, median overall survival, median progress-free survival, mean serum lactic dehydrogenase, mean albumin, urine light chains and serum creatinine（ all P 〉0. 05）. Compared with group A, group B had lower hemoglobin level[ （99. 78 ± 29. 93）vs （ 108.84 ± 29. 30） g/L], and higher blood calcium level[ （2. 47 ± 0. 40） vs （2. 30 ± 0. 29） mmol/L], serum 132-microglobuin level[ （6. 04 ±4. 84）vs （4. 12 ±3.97） mg/L], and bone marrow plasma cells percentage（33. 30% ± 24. 87% vs 23.51% ± 22. 67% ） （ all P 〈 0. 05 ）. （3） Before treatment, the levels of β-CTX and tPINP in patients of group B （ n = 47 ） were higher than those in group A （ n = 19） （ median 0.

关 键 词：多发性骨髓瘤 骨疾病 I型前胶原氨基端延长肽 I型胶原羧基端肽β特殊 序列 

分 类 号：R733.3[医药卫生—肿瘤]