绝经后女性骨代谢生化指标与骨质疏松性腰椎骨折之间的相关性

摘要

目的 探讨骨代谢标志物对预测绝经后骨质疏松患者合并腰椎骨折风险的诊断价值.方法 采用双能X线骨密度仪、酶联免疫检测法(ELISA)和速率法对70例绝经后骨质疏松症腰椎无骨折患者和70例绝经后骨质疏松症腰椎骨折患者的髋部及腰椎骨密度、各项骨代谢生化指标进行检测,并分析骨代谢生化指标的变化与骨质疏松症、骨质疏松性腰椎骨折之间的相关性.结果 绝经后骨质疏松性腰椎骨折的发生风险与年龄、体重、身高、体重指数、骨密度等一般指标和骨钙素N端中分子片段(N-MID osteocalcin,N-MID)、骨碱性磷酸酶(bone alkaline phospha,BAP)、钙离子(calcium ionic,Ca2+)、骨吸收标志物B-Ⅰ型胶原羧基端肽(3-C-terminal telopeptide of type Ⅰ collagen,β-CTx)等生化指标之间无关联,而与血清Ⅰ型原胶原氨基端延长肽(propeptide of type Ⅰ procollagen,PINP)、抗酒石酸酸性磷酸酶5b(TRAP-5b)和25-羟维生素D(25-hydroxy vitamin,25-(0H)D)之间存在显著相关性(P=0.002、0.007、0.001),其中与PINP、TRAP-5b呈正相关,与25-(OH)D呈负相关.结论 绝经后女性血清PINP、TRAP-5b和25-(OH)D与骨质疏松性骨折的发生存在显著的相关性,骨代谢标志物与骨密度的联合检测对预测绝经后骨质疏松腰椎骨折具有一定的临床意义.%Objective To investigate the correlation between biochemical markers of bone metabolism and osteoporotic lumbar vertebrae fractures in postmenopausal women.Methods Bone mineral density (BMD) and biochemical indicators of bone metabolism were measured using dual energy X-ray absorptiometry,ELISA,and ratemethod in 70 postmenopausal osteoporotic patients with lumbar vertebral fractures and in 70 patients without fractures.The correlation between biochemical markers of bone metabolism and osteoporosis and osteoporotic lumbar fractures were analyzed.Results The risk of postmenopausal osteoporotic lumbar fractures was not associated with general indices (such as age,weight,height,body mass index,and BMD,etc.) and certain biochemical parameters (such as N-MID,BAP,Ca2+,and β-CTX).There was a positive correlation between the occurrence of osteoporotic fracture and the serum levels of PINP and TRAP-5b (P =0.002,0.007,respectively).There was a negative correlation between the occurrence of osteoporotic fracture and 25-(OH) D (P =0.001).Conclusion The serum PINP,TRAP-5b,and 25-(OH)D have significant correlation with the occurrence of osteoporotic fracture in postmenopausal women.The combined detection of bone metabolic markers and BMD is of clinical significance in the prediction of lumbar fractures in postmenopausal osteoporosis.