早期骨代谢改变与99 Tcm-MDP 骨显像、骨钙素、骨碱性磷酸酶的相关性分析

摘要

目的：在判断早期骨量变化时，重视核素99 Tcm-MDP骨骼显像与的骨钙素、骨碱性磷酸酶的相关性和价值。方法采用肌肉注射肾上腺糖皮质激素地塞米松磷酸钠针剂（DX）制作兔骨质疏松动物模型。设A组（正常对照组），B组（骨质疏松对照组，注射DX量2 mg/kg，每周2次）和C组（骨量减少组，注射DX量1 mg/kg，每周1次），制模时间为6周。检测指标：核素99 Tcm-MDP骨骼显像、骨密度、病理切片骨组织学、血清BALP、BGP检测。99 Tcm-MDP骨骼显像的感兴趣区（ ROI）半定量检测：第3腰椎、股骨头、膝关节、股骨中段与第4尾椎作比值。统计方法：SPSS.13软件进行方差分析和组间t检验比较。结果第7周时，B组则表现为股骨头关节表面软骨明显破坏，骨小梁稀疏、断裂等骨破坏现象。骨密度明显降低，血清BALP、BGP、99Tcm-MDP骨骼显像ROI比值均增高（P＜0.05）；而C组病理切片仅表现为轻度骨小梁稀疏，而无骨破坏，血清BGP、99 Tcm-MDP骨骼显像ROI比值均增高（P＜0.05），但骨密度和血清BALP未发生明显改变（P＞0.05），由此证实动物模型成立。B组与C组间比较，B组核素骨骼显像除股骨中段摄取99 Tcm-MDP的ROI比值增高外，腰椎、股骨头、膝关节摄取99 Tcm-MDP的比值以及血清BGP值差异不大，但骨密度、血清BALP结果存在明显差异（ P＜0.05）。结论本次动物试验结果显示：当核素99 Tcm-MDP骨骼显像提示第3腰椎、股骨头、膝关节与第4尾椎骨ROI比值增高但股骨中段ROI比值还没有升高时，可能为骨量减少期，有BGP的支持更有意义，可为临床提供早期干预防治提供参考。%Objective To investigate the correlation among early changes in bone metabolism and 99 Tcm-MDP bone nuclear image , serum BGP, and BALP, and to focus on the importance of the value .Methods Rabbit osteoporosis model was established using intramuscular injection of dexamethasone sodium phosphate ( DX ) .Three groups were set up including Group A ( normal control group) , Group B ( osteoporosis group induced with DX injection , 2 mg/kg, b.i.w) , and Group C ( bone mass loss group induced with DX injection, 1 mg/kg, q.w).The time for the model establishment lasted for 8 weeks.99Tcm-MDP bone nuclear image was taken, and histopathological examination was performed .Bone mineral density , serum BALP and BGP were detected .Semi-quantitative detection of ROI in nuclear image was calculated by the ratio of L 3/S4 , the femur head/S4 , the knee/S4 , and the femoral diaphysis/S4 .T test and variance analysis were conducted among the groups using a SPSS 13.0 software.Results At the 7th week, obvious wear and tear on the surface cartilage of the femoral head and bone destruction such as trabecular sparse and broken were observed in Group B.Bone mineral density decreased significantly , while serum BALP and BGP increased , and the ROI ratio of 99 Tcm-MDP nuclear image also elevated ( P<0.05) .In Group C, the histopathological sections demonstrated slightly sparse trabecular only without signs of bone destruction .The serum BGP and the ROI ratio of 99 Tcm-MDP nuclear image increased ( P<0.05 ) , but no significant changes of bone mineral density and serum BALP were observed ( P>0.05 ) , which proved the establishment of animal model was successful .When comparing the results of Group B and Group C , all ROI ratios and BGP remained in same range except the ratio of the femoral diaphysis/S4 increased in Group B , and significant difference of bone mineral density and serum BALP level was observed (P<0.05).Conclusion According to the results of the animal experiment , when the ratios of L3/S4, the femur head/S4, the knee/S4 in 99Tcm-MDP nuclear image increase while the ratio of the femoral diaphysis /S4 remains unchanged , it may indicate the stage of bone mass loss , which is more valuable than serum BGP .This may provide reference for clinical prevention and intervention of the early stage of osteoporosis .