老年髋部骨折患者骨转换生化标志物的早期变化

摘要

目的 了解老年骨质疏松患者髋部骨折后骨转换生化标志物早期的变化规律,并初步比较股骨颈骨折和股骨粗隆间骨折的异同.方法 收集在北京积水潭医院老年髋部骨折病房住院的患者216例,其中女性151例,男性65例;股骨粗隆间骨折135例,股骨颈骨折81例;明确骨折日期,检测血清P1NP、CTX、25(OH)D等水平以及骨密度和QCT检查.结果 (1)股骨粗隆间骨折后P1NP在第7天可达到初始值的两倍,股骨颈骨折后1 w内P1NP的上升未见统计学意义.股骨粗隆间骨折后CTX在1 w内的上升未见统计学意义,股骨颈骨折后CTX在第7天可达到初始值近2倍水平;(2)股骨粗隆间骨折患者P1NP和CTX的上升均与25(OH)D成负相关(r=-0.2),而股骨颈骨折患者P1NP和CTX的上升与25(OH)D均不相关;(3)在平衡了年龄、体重、体重指数、骨折后天数的情况下,骨代谢标记物和骨密度的相关分析提示仅有ALP与骨密度相关,P1NP和CTX均不与骨密度相关.结论 老年髋部骨折后骨代谢标记物的变化有一定规律,不同类型的骨折似有不同.%Objective To understand the early changes in Bone Specific Turnover Markers during the hip fracture healing process in elderly patients.Methods Two hundred and sixteen cases of elderly hip fracture patients were selected,with 151 females and 65 males,135 cases of intertrochanteric fracture and 85 cases of femoral neck fracture.Serum N-propeptide of type 1 collagen (P1NP),C-terminal crosslinking telopeptides of type 1 collagen (CTX),and 25 (OH) D were assessed.DXA bone mineral density and Hip Quantitative CT were also measured.Results (1) P1NP peaked on the seventh day after Intertrochanteric fracture,twice the value of baseline,whereas the rise was not statistically significant in femoral neck fracture patients.CTX peaked on the seventh day after femoral neck fracture,twice the value of baseline,whereas the rise in intertrochanteric fracture patients was not statically significant.(2) Within the first week of intertrochanteric fracture,P1NP and CTX had negative linear correlation with 25 (OH) D (r =-0.2),whereas there were no significant relationships between P1NP or CTX and 25 (OH) D in femoral neck fracture patients.(3) Accounting for age,weight,BMI,number of days after fracture,ALP but not P1NP and CTX had significant correlation with bone mineral density.Conclusion The changes of bone turnover markers follow certain pattern after hip fractures in elderly patients,and there were differences between intertrochanteric fracture and femoral neck fracture.