骨代谢生化指标测定在中老年人骨质疏松症诊断中的价值

摘要

[Objective] To discuss the characters of bone metabolic markers of middle-aged and old people along with the change of age and the value in clinical application with bone metabolic markers. [Methods] Bone mineral density (BMD) of anterior-posterior lumbar spines and fasting serum bone gla protein(BGP), serum alkaline phosphatase (ALP) and urinary pyridinoline(PYD) were tested in 410 patients. Then statistic biochemical criterion value was used in each age stage and different BMD groups with man and woman respectively. [Results] Middle-aged and senile men's BGP lowered down and the PYD/Cr rised with growth of age. Middle-aged and senile women's BGP and PYD/Cr significantly rised from 50 years old to 69 years old, but they showed the lowering trend after 70 years old, which approached to BGB and PYD/Cr of the senile men with the same age. Regardless of serum ALP of men or women in the normal range, there was no obvious difference in each age stage. BGP of middle-aged and senile men osteoporosis group and osteopenia group was lower than that of normal group while the PYD/Cr was higher than that of normal group, BGP and PYD/Cr of middle-aged and senile women osteoporosis group and osteopenia group were significantly higher than that of normal group without obvious difference for BGP and PYD/Cr of osteoporosis group and less bone mass group. There was no significant difference with serum ALP in each group.[Conclusions] The serum BGP and PYD/Cr are specific and sensitive markers for giving expression to bone formation and bone resorption, prior to the change of BMD. Therefore, to test serum BGP and PYD/Cr contributes to the early diagnosis of primary osteoporosis.%目的 了解中老年人骨代谢生化指标随年龄变化的特点,分析骨代谢生化指标在临床应用中的价值.方法 测定410例中老年患者腰椎正位骨密度,同时检测所有患者空腹血清骨钙素、血清碱性磷酸酶及晨尿吡啶啉,尿吡啶啉用肌酐校正.按年龄段和不同骨密度组对男性和女性的骨代谢生化指标值分别进行统计分析.结果 按年龄分析,中老年男性骨钙素随年龄增长下降,尿吡啶啉/肌酐随年龄增长上升,中老年女性骨钙素和尿吡啶啉/肌酐在50～69岁时明显升高.70岁以后又趋于下降,并与同年龄的老年男性的骨钙素、尿吡啶啉/肌酐值相近.而血清碱性磷酸酶不论男性或女性均在正常范围,各年龄段差异无显著性.按骨密度分析,中老年男性骨质疏松组和骨量减低组的骨钙素低于正常组,而尿吡啶啉/肌酐高于正常组,中老年女性骨质疏松组和骨量减低组的骨钙素和尿吡啶啉/肌酐均明显高于正常组.而同性别骨质疏松组和骨量减低组的骨钙素和尿吡啶啉/肌酐值差异无显著性.各骨密度组的血清碱性磷酸酶差异无显著性.结论 血清骨钙素、尿吡啶啉/肌酐分别是反映骨形成和骨吸收特异性和敏感性较高的指标,有助于原发性骨质疏松症的早期诊断.