骨代谢标志物对肿瘤骨转移的诊断价值  

Diagnostic value of bone metabolism markers in bone metastasis of tumors

作　　者：林敏[1] 朱柳君[1] 韩朝稳 莫春香 黄忠道[1] 李辉[1] 韦金虎 钟海芬 Lin Min;Zhu Liujun;Han Chaowen;Mo Chunxiang;Huang Zhongdao;Li Hui;Wei Jinhu;Zhong Haifen(Liuzhou Municipal Liutie Central Hospital,Liuzhou 545007,Guangxi,China)

机构地区：[1]广西柳州市柳铁中心医院,广西柳州545007

出　　处：《右江民族医学院学报》2020年第4期437-441,共5页Journal of Youjiang Medical University for Nationalities

基　　金：广西壮族自治区卫生健康委员会自筹经费课题(Z20190042)。

摘　　要：目的探讨骨代谢标志物在诊断肿瘤骨转移的应用价值。方法采用病例对照研究,选取169例肿瘤患者行SPECT全身骨扫描,并选择正常健康志愿者20例为对照组,同时采用化学发光法检测患者骨代谢6项指标:N端骨钙素(N-BGP)、总Ⅰ型胶原氨基端延长肽(TPINP)、β胶原降解产物(β-CTX)、甲状旁腺素(PTH)、降钙素(CT)及骨碱性磷酸酶(BAP)。统计比较肿瘤患者有骨转移组(包括轻度骨转移组和多发骨转移组)、无骨转移组以及对照组6项骨代谢指标的浓度。结果169例恶性肿瘤患者有骨转移组PTH、TPINP、BAP、β-CTX 4项明显高于无骨转移组,差异有统计学意义(P<0.05);而N-BGP、CT两项的差异无统计学意义(P>0.05);对4项差异有统计学意义的骨代谢指标进一步分级分析,结果提示轻度骨转移组中PTH、TPINP、BAP、β-CTX 4项明显高于无骨转移组,差异有统计学意义(P<0.05);多发骨转移组的TPINP、BAP两项明显高于轻度骨转移组,差异有统计学意义(P<0.05),而PTH、β-CTX两项组间比较,差异无统计学意义(P>0.05)。通过ROC曲线分析骨代谢指标在监测肿瘤骨转移时发现:BAP、TPINP、β-CTX 3项曲线下面积分别为0.954、0.726、0.774,3项诊断价值较高,且灵敏度、特异性都较佳。结论在肿瘤有骨转移患者中骨代谢指标PTH、TPINP、BAP、β-CTX可用于肿瘤骨转移监测。而TPINP和BAP指标诊断价值较高且灵敏度、特异性佳,可用于对肿瘤骨转移患者随访,动态评判骨转移的发生及进程。Objective To investigate the application value of bone metabolism markers in the diagnosis of bone metastasis of tumors.Methods A case-control study was conducted,in which 169 cases of tumor patients were chosen for SPECT whole-body bone scanning and 20 healthy volunteers were selected as the control group.Six indicators on bone metabolism including N-terminal bone glad protein(N-BGP),TPINP,β-collagen degradation products(β-CTX),parathyroid hormone(PTH),calcitonin(CT)and bone alkaline phosphatase(BAP)were measured by chemiluminescence.The concentrations of the 6 indicators among the patient group with bone metastasis(including the patients with mild bone metastasis and those with multiple bone metastasis),the patient group without bone metastasis and the control group were collected and compared.Results The PTH,TPINP,BAP andβ-CTX of the patient group with bone metastasis were significantly higher than those of the group without bone metastasis,which showed significant differences(P<0.05),however,there was no significant difference in N-BGP and CT between these two groups(P>0.05).Further grading analysis of the four bone metabolism indicators with significant differences suggested that PTH,TPINP,BAP andβ-CTX in the group with mild bone metastasis were significantly higher than those in the group without bone metastasis,which showed significant differences(P<0.05).The levels of TPINP and BAP in the group with multiple bone metastases were significantly higher than those in the group with mild bone metastasis,showing significant differences(P<0.05).while there was no significant difference in the levels of PTH andβ-CTX between these two groups(P>0.05).Analysis of the bone metabolism markers by ROC curve in monitoring bone metastasis revealed that the areas under the curve of BAP,TPINP,andβ-CTX were respectively 0.954,0.726,0.774,which indicated that the three indicators had high diagnostic value with good sensitivity and specificity.Conclusion PTH,TPINP,BAP andβ-CTX as indicators of bone metabolism can be use

关 键 词：肿瘤 骨转移 骨代谢标志物 全身骨扫描 

分 类 号：R730.4[医药卫生—肿瘤]