中国西部地区健康绝经前女性骨转换标志物参考范围研究  

Reference Range for Bone Turnover Markers in Healthy Premenopausal Women in Western China

作　　者：范翩翩 王覃[1] 卢春燕[1] 李静[1] 徐勇 曹洪义[3] 谢小华[4] 吴雪艳[5] 郭彦宏[6] 刘婷[7] 陈燕[8] 黄媛媛[1] 张琪[1] 许慎[1] 陈雯[1] 陈德才[1] 

机构地区：[1]四川大学华西医院内分泌与代谢病科,四川省成都市610041 [2]西南医科大学附属医院内分泌科,四川省泸州市646000 [3]四川省成都市第五人民医院内分泌科,611130 [4]四川省凉山州第一人民医院内分泌科,615000 [5]四川省广元市中心医院内分泌科,628099 [6]四川大学华西医院西藏成办分院内分泌科,四川省成都市610041 [7]北京市房山区良乡医院内分泌科,102402 [8]四川省内江市第一人民医院内分泌科,641000

出　　处：《中国全科医学》2017年第8期896-902,共7页Chinese General Practice

基　　金：MERCK&MSD Investigator Initiated Studies Program(IISP-40407);四川省科技厅支撑计划项目(2015SZ0109)

摘　　要：背景骨转换标志物(BTMs)是评估抗骨质疏松症疗效、预测骨量丢失和骨折风险的重要指标,而我国目前尚缺乏西部地区绝经前女性BTMs参考范围的研究。目的建立中国西部地区健康绝经前女性Ⅰ型前胶原氨基端肽(P1NP)、Ⅰ型胶原交联羧基端肽(CTX)的参考范围,并探究绝经后女性在不同骨密度、骨折状态下P1NP、CTX水平。方法 2012年12月—2013年3月,于四川省成都市、广元市、西昌市、泸州市各随机选取一个城市社区和一个农村社区,以年龄≥30岁的女性为调查对象。检测血钙、血磷、血肌酐、甲状旁腺激素(PTH)、25羟维生素D〔25(OH)D〕、1,25二羟维生素D〔1,25(OH)_2D〕、P1NP、CTX水平;采用双能X线骨密度吸收仪检测L1~4、股骨颈、全髋骨密度;问卷调查受试者骨折史、绝经状态。结果本研究纳入1 060例女性,其中绝经前女性319例,绝经后女性741例。绝经后女性L1~4、股骨颈、全髋骨密度低于绝经前女性,体质指数(BMI)、血钙、血磷、血肌酐、P1NP、CTX水平及骨折史比例高于绝经前女性(P<0.05)。不同年龄女性P1NP、CTX水平及L1~4、股骨颈、全髋骨密度比较,差异均有统计学意义(P<0.05);其中,≥70岁女性P1NP水平高于30~44岁,≥45岁女性CTX水平高于30~44岁,≥55岁女性CTX水平高于45~49岁;≥45岁女性L1~4、股骨颈骨密度低于30~44岁,≥55岁女性全髋骨密度低于30~54岁(P<0.05)。30~44岁人群可用于建立绝经前女性的BMTs参考范围,P1NP参考范围为178.36~887.73μg/L,CTX参考范围为0.04~0.67μg/L。绝经后女性不同骨密度者CTX水平比较,差异无统计学意义(P>0.05)。绝经后女性不同骨密度者P1NP水平比较,差异有统计学意义(P<0.05);其中,骨量低下、骨质疏松症者P1NP水平高于骨量正常者(P<0.05)。有无骨折史的绝经后女性P1NP水平比较,差异无统计学意义(P>0.05);有骨折史的绝经后女性CTX水平高于无骨折史者(P<0.05)。结论本研究Background Bone turnover markers（ BTMs） are vital indexes in evaluating antiosteoporosis efficacy,predicting bone loss and fracture risk. However,until recently,few researches about premenopausal reference intervals of BTMs are available in western China. Objective To establish the premenopausal reference intervals of serum N- terminal propeptide of type Ⅰ procollagen（ P1NP） and type Ⅰ collagen cross- linked C- telopeptide（ CTX） in western China,and investigate the status of P1NP and CTX under different conditions of bone mineral density（ BMD） and fractures in postmenopausal women.Methods This cross- sectional population- based survey was conducted in 4 cities in Sichuan Province from December 2012 to March 2013,which were Chengdu,Guangyuan,Xichang and Luzhou that located in eastern,southern,western and northern Sichuan,respectively. Subjects were females who aged over 30 years old and where voluntarily recruited from 2 communities in each city（ one in an urban district and another in a rural area） by using the block- randomization method. Over- night fasting venous blood samples were collected to measure calcium, phosphate, creatinine, parathyroid hormone（ PTH）, 25-hydroxyvitamin D 〔25（ OH） D〕,1,25- dihydroxyvitamin D 〔1,25（ OH）2D〕,P1NP and CTX. BMD in lumbar vertebra（ L（1-4））,femoral neck（ FN） and total hip（ TH） were measured by dual energy X- ray absorptiometry. All women completed a questionnaire concerning history of fractures and status of menopause. Results This study population comprised 1060 women,including 319 pre- and 741 postmenopausal subjects. The BMD in L（1-4）,FN and TH in postmenopausal women were significantly lower than those in premenopausal group（ P〈0.05）, whereas the BMI, serum levels of calcium, phosphate, creatinine,P1NP and CTX,and the ratio of women who experienced fractures were significantly higher than those of premenopausal women（ P〈0.05）. Significant differences were observed in P1NP,CTX and BMD in L（1-4）

关 键 词：骨质疏松 绝经后 骨转换标志物 参考值 中国西部 骨密度 

分 类 号：R681[医药卫生—骨科学]