骨代谢指标结合全身骨显像在肿瘤骨转移早期诊断中的临床价值

摘要

Objective To investigate the clinical value of bone metabolism biochemical marker N-MID,TP1NP and beta-CTx combined with whole body bone scintigraphy in early diagnosis of bone metastasis of tumor.Methods The concentration of the 3 markers were measured by the electrochemical luminescence analysis method in 30 cases of healthy control group and 210 cases of patients with malignant tumor,which were divided into non bone metastasis group(45 cases) and bone metastasis group(165 cases).The bone metastasis group were divided into 4 grades(0-grade Ⅲ) by Soloway classification according to whole body bone imaging.Results The levels of serum N-MID,TP1NP and beta-CTx in 165 malignant tumor patients with bone metastasis were significantly higher than in 45 malignant tumor patients with bone metastasis and in 30 healthy control group,the difference was statistically significant(P<0.05).With the increase of the number of metastatic lesions in the bone metastasis group,the serum levels of N-MID,TP1NP,and beta-CTx were increased gradually,and they were positively correlated with the progression of the disease.According to the analysis of ROC curve,the cut-off value,sensitivity and specificity in the diagnosis of tumor bone metastasis were 17.59 ng/mL,70.3％,88.9％ for serum N-MID,43.04 ng/mL,78.2％,95.6％ for TP1NP,and 0.48 ng/mL,73.9％,93.3％ for beta-CTx.Under the ROC curve(AUC) was 0.831 for serum N-MID,0.890 for TP1NP,and 0.869 for beta-CTx.The sensitivity and specificity of three bone metabolic markers in the diagnosis of bone metastasis of malignant tumor were significantly higher.Conclusion Bone metabolism biochemical markers:Serum N-MID,TP1NP and beta-CTx for diagnosis of bone metastasis of malignant tumor are sensitive,accurate and simple,which can significantly improve the efficiency of diagnosis of bone metastasis,and can be combined with whole-body bone scintigraphy in early diagnosis of bone metastasis with malignant tumor.%目的 探讨骨代谢指标N端骨钙素(N-MID)、总Ⅰ型前胶原氨基末端肽(TP1NP)和Ⅰ型胶原羧基端肽β特殊序列(β-CTx)结合全身骨显像在肿瘤骨转移早期诊断中的临床价值.方法 根据全身骨显像将210例恶性肿瘤患者分为无骨转移组(45例)和骨转移组(165例),采用Soloway分级将骨转移组病例分为4级(0～Ⅲ级),用电化学发光法检测血清N-MID、TP1NP和β-CTx水平,并与30例健康对照组比较分析.结果 恶性肿瘤骨转移组血清N-MID、TP1NP和β-CTx水平明显高于无骨转移组及健康对照组,差异有统计学意义(P<0.05);恶性肿瘤骨转移组中随着转移病灶数目的增加,血清N-MID、TP1NP、β-CTx水平逐步增高且与病情进展呈正相关.ROC曲线分析显示,血清N-MID诊断肿瘤骨转移截断值为17.59 ng/mL,灵敏度70.3％,特异度88.9％,ROC曲线下面积0.831;血清TP1NP诊断肿瘤骨转移截断值为43.04 ng/mL,灵敏度78.2％,特异度95.6％,ROC曲线下面积0.890;血清β-CTx诊断肿瘤骨转移的截断值为0.48 ng/mL,灵敏度73.9％和特异度93.3％,ROC曲线下面积0.869.结论 血清N-MID、TP1NP及β-CTx是反映恶性肿瘤骨转移骨代谢敏感、准确、简便的生化指标,检测其水平能明显提高恶性肿瘤骨转移的诊断效率,可结合全身骨显像检查早期诊断肿瘤骨转移.