脊髓损伤患者不同临床特点与骨代谢生化标志物、骨密度的相关性研究  

Correlation of different clinical characteristics with bone mineral density and biochemical markers of bone metabolism in patients with spinal cord injury

作　　者：林乐[1] 黄倩倩 林心心 郑余银[1] 蒋松鹤[1] LIN Le;HUANG Qianqian;LIN Xinxin;ZHENG Yuyin;JIANG Songhe(Department of Rehabilitation Medicine,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 32500,Zhejiang,China)

机构地区：[1]温州医科大学附属第二医院康复医学科,浙江温州325000

出　　处：《中国现代医生》2023年第14期33-36,41,共5页China Modern Doctor

基　　金：温州市科技局项目(Y20190041)。

摘　　要：目的分析脊髓损伤(spinal cord injury,SCI)患者不同临床特点与骨代谢生化标志物及骨密度(bone mineral density,BMD)的相关性。方法回顾性分析2019年6月至2022年6月于温州医科大学附属第二医院住院的SCI患者76例,根据不同临床特征分别进行分组。根据损伤病程分为损伤<3个月组(n=55)、损伤3~6个月组(n=9)、损伤7~24个月组(n=12);根据瘫痪类型分为四肢瘫组(n=13)和截瘫组(n=63);根据损伤程度分为完全性损伤组(n=22)和不完全性损伤组(n=54);根据损伤原因分为创伤组(n=67)和非创伤组(n=9)。收集所有患者临床资料、β-Ⅰ型胶原羧基端肽(β-C-terminal peptide of typeⅠcollagen,β-CTX)、总Ⅰ型胶原氨基端前肽(total procollagen type 1 intact N-terminal propeptide,T-PINP)、人N端中段骨钙素(human N-terminal middle osteocalcin,N-MID)、血清骨特异性碱性磷酸酶(bone alkaline phosphatase,BALP)、25-羟维生素D[25-hydroxyvitamin D,25-(OH)D)]及不同部位BMD,分析其特点及与BMD和骨代谢指标的相关性。结果与损伤<3个月组比较,其他两组的β-CTX水平均显著降低(P<0.05),T-PINP、N-MID水平均显著升高(P<0.05)。BALP和25-(OH)D水平均随着损伤时间的增加而降低,但差异无统计学意义(P>0.05)。25-(OH)D正常者(≥30ng/ml)仅2例(2.6%),不足者(<30ng/ml)15例(19.7%),缺乏者(<20ng/ml)59例(76.6%)。截瘫组腰椎(L_(1~4))的BMD显著高于四肢瘫组(P<0.05),两组的股骨颈、股骨干和全身骨密度比较,差异无统计学意义(P>0.05)。创伤组的β-CTX水平显著高于非创伤组(P<0.05),两组T-PINP、N-MID、BALP水平比较,差异无统计学意义(P>0.05)。Spearman相关性分析结果显示,腰椎(L_(1~4))BMD、股骨干BMD、全身BMD与年龄呈负相关(P<0.05);腰椎(L_(1~4))与股骨颈BMD、β-CTX、BALP与病程呈负相关(P<0.05);T-PINPβ-CTX升高明显,应重视抗骨吸收治疗。结论SCI患者25-(OH)D不足和缺乏的比例极高,建议临床上常规予以补充。早期及创伤�Objective To analyze the correlation between different clinical characteristics and biochemical markers of bone metabolism and bone mineral density(BMD)in patients with spinal cord injury.Methods Seventy-six patients with SCI who were hospitalized at the Second Affiliated Hospital of Wenzhou Medical University from June 2019 to June 2022 were retrospectively analyzed and grouped separately according to different clinical characteristics.According to the duration of injury,they were divided into injury<3 months group(n=55),injury 3-6 months group(n=9),injury 7-24 months group(n=12);according to the type of paralysis,they were divided into quadriplegia group(n=13),paraplegia group(n=63);according to the degree of injury,they were divided into complete injury group(n=22),incomplete injury group(n=54);according to the cause of injury,they were divided into trauma group(n=67),and non-trauma group(n=9).The clinical data,β-C-terminal peptide of typeⅠcollagen(β-CTX),total procollagen type 1 intact N-terminal propeptide(T-PINP),and human N-terminal mid-bone calcium peptide were collected from all patients.The results were analyzed by using the following methods:human N-terminal middle osteocalcin(N-MID),serum bone-specific alkaline phosphatase(BALP),25-hydroxyvitamin D[25-(OH)D]and BMD at different sites,to analyse their characteristics and correlation with BMD and bone metabolism indexes.Results Compared to the group with<3 months of injury,β-CTX levels were significantly lower(P<0.05),and T-PINP and N-MID levels were significantly higher(P<0.05)in the other two groups.BALP and 25-(OH)D levels both decreased with increasing duration of injury,but the differences were not statistically significant(P>0.05).Among them,25-(OH)D was normal(≥30ng/ml)in only 2 cases(2.6%),insufficient(<30ng/ml)in 15 cases(19.7%)and deficient(<20ng/ml)in 59 cases(76.6%).The BMD of the lumbar spine(L_(1-4))was significantly higher in the paraplegic group than in the tetraplegic group(P<0.05);there was no statistically significant differenc

关 键 词：脊髓损伤 骨代谢标志物 骨密度 相关性分析 

分 类 号：R493[医药卫生—康复医学]