血清β-CTX/PINP在多发性骨髓瘤骨病及骨转移瘤中的临床意义  

Clinical significance of the ratio of serum beta-CTX/PINP in multiple myeloma bone diseases and bone metastases

作　　者：杨世伟[1] 马荣军[1] 赵娟娟 袁晓莉[1] 姜丽[1] 杨靖[1] 雷平冲[1] 张茵[1] 张琳[2] 刘刚 王芳[3] 朱尊民[1] Yang Shiwei;Ma Rongjun;Zhao Juanjuan;Yuan Xiaoli;Jiang Li;Yang Jing;Lei Pingchong;Zhang Yin;Zhang Lin;Liu Gang;Wang Fang;Zhu Zunmin(Department of Hematology,Henan Provincial People＇s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院血液科,郑州450003 [2]河南省人民医院血液病研究所,郑州450003 [3]河南省人民医院临床单细胞生物医学中心,郑州450003 [4]郑州大学附属肿瘤医院血液科

出　　处：《中华医学杂志》2018年第32期2583-2587,共5页National Medical Journal of China

摘　　要：目的 探讨血清骨代谢物Ⅰ型胶原羧基端肽β特殊序列（β-CTX）、Ⅰ型前胶原氨基端延长肽（PINP）浓度及β-CTX/PINP比值对于多发性骨髓瘤骨病（MMBD）及骨转移瘤的临床意义.方法 纳入2016年10月至2017年10月分别于河南省人民医院血液科、肿瘤科及体检中心就诊的初诊MM 31例、骨转移瘤46例及健康对照12例.依据影像学表现将MMBD分为0～4级,骨病0～2级为A组（8例）,3～4级为B组（23例）.化疗两疗程后评价疗效,将MM分为化疗有效组（部分缓解以上,22例）和无效组（未达部分缓解,9例）;ELISA法检测血清β-CTX、PINP表达水平并计算β-CTX/PINP比值.结果 初诊MM、骨转移瘤及健康对照血清β-CTX浓度分别为（3 563±544） ng/L、（6 690 ±343） ng/L、（2 726±1 026） ng/L（x2 =22.207,P＜0.001）,PINP浓度分别为（72±14） ng/L、（112 ±62） ng/L、（171 ±62） ng/L（x2=7.418,P=0.024）及β-CTX/PINP比值分别为93±19、141±21、17 ±8（x2 =20.192,P ＜0.001）,差异均有统计学意义.初诊MM β-CTX/PINP比值高于健康对照（P=0.001）,骨转移瘤β-CTX浓度（P =0.003）及β-CTX/PINP比值（P ＜0.001）均高于健康对照.初诊MM血清β-CTX浓度低于骨转移瘤（P ＜0.001）.初诊骨髓瘤A、B两组血清β-CTX、PINP浓度差异均无统计学意义,但A组血清β-CTX/PINP比值低于B组,差异有统计学意义.化疗两疗程后,MM血清β-CTX浓度（P=0.023）及β-CTX/PINP比值（P ＜0.001）均降低;A组血清β-CTX、PINP浓度及β-CTX/PINP比值较治疗前差异均无统计学意义,B组患者血清PINP浓度较治疗前无明显变化,但血清β-CTX浓度及β-CTX/PINP比值较治疗前均降低[（4 027±647）ng/L比（2 370±460） ng/L,P=0.043;111±23比30±6,P=0.002].化疗有效组血清β-CTX/PINP比值降低,差异有统计学意义;化疗无效组血清β-CTx、PINP浓度及β-CTX/PINP比值较前差异均无统计学意义.结论 血清β-CTX在初诊MMBD与骨转移瘤中存在差异Objective To explore the clinical significance of serum bone metabolites β C-termianl telopeptide of type Ⅰ collagen（β-CTX）,Procollagen type Ⅰ N-terminal peptide（PINP） concentration and ratio of beta-CTX/PINP in multiple myeloma bone disease （MMBD） and bone metastases.Methods A total of 31 cases of MM,46 cases of bone metastases and 12 healthy controls were enrolled in the department of hematology,oncology and physical examination center of Henan Provincial People＇s Hospital respectively from October 2016 to October 2017.According to the imaging findings,MMBD was divided into 0-4 grades,group A included the patitents with grade 0-2 of osteopathy （n =8）,and group B included the grade 3-4 （n =23）.After two courses of chemotherapy,the curative effect was evaluated.MM group were divided into effective group （above partial remission,n =22） and uneffective group （unreached partial remission,n =9）.ELISA method was used to detect the concentration of serum beta-CTX and PINP,and the ratio of beta-CTX/PINP was calculated.Results The serum beta-CTX concentration in newly diagnosed MM,bone metastases and healthy control were （3 563 ± 544） ng/L,（6 690 ± 343） ng/L,（2 726 ± 1 026） ng/L （x2 =22.207,P 〈 0.001）,PINP concentration were （72 ± 14） ng/L,（112 ±62） ng/L,（171 ± 62） ng/L （x2 =7.418,P =0.024）,and beta-CTX/PINP ratio were 93 ± 19,141 ±21,17 ± 8 （x2 =20.192,P 〈 0.001）,the differences were statistically significant.The ratio of initial MM beta-CTX/PINP was higher than that of healthy control （P =0.001）.The concentration of beta-CTX （P =0.003） and the ratio of beta-CTX/PINP（P 〈 0.001） in bone metastases were higher than those in healthy controls.The serum concentration of beta-CTX in newly diagnosed MM was lower than that in bone metastases （P 〈0.001）.Before chemotherapy,the serum levels of beta-CTX and PINP in A and B groups were not statistically significant,but the ratio of serum beta-CTX/PINP in A group was lower than t

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

分 类 号：R733.3[医药卫生—肿瘤]