脊髓损伤患者中骨代谢生化标志物变化的回顾性研究

摘要

Objective:To investigate the relationship between bone metabolism biochemical markers and clinic features (course,AIS,etc.)in spinal cord injury patients.Method:Totally 73 patients aged from 13 to 89 years with SCI were enrolled.The injury time was recorded,and patients' AIS was assessed.25-hydroxyvitamin D [25(OH)D],collagen type Ⅰ C-terminal telopeptide (CTX)and N-terminal propeptide of type 1 precollagen(P1NP) were measured.Result:In our observation of patients with spinal cord injury,the ratio of 25(OH)D deficience was 98.6％.Correlation between 25(OH)D and clinic features was not found.P1NP showed positive correlation with course (R=-0.235,P＜0.05)and negative correlation with AIS (R=0.442,P＜0.01).CTX showed negative correlation with AIS and age(R was-0.232 and-0.296,P＜0.05).There is no difference between tetraplegia and paraplegia (AIS C and D) in 25(OH)D、P1NP and CTX.CTX is higher in traumatic spinal cord injury patients,(Z=-.2.086,P ＜ 0.05)Conclusion:In patients with spinal cord injury,a lack of vitamin D has a high proportion.The lower AIS was,the higher P1NP and CTX was,which meant severe bone loss.Bone loss may be faster in younger SCI patients and traumatic spinal cord injury patients.%目的:观察脊髓损伤患者骨代谢生化标志物的变化与病程及美国脊髓损伤学会残损分级(American spinal injury association impairment scale,AIS)等临床特点的相关性.方法:脊髓损伤后l周-20个月患者共73例,年龄13-89岁,评定患者AIS,检测患者血25-OH维生素D(25-hydroxy vitamin D,25(OH)D)、Ⅰ型前胶原N端前肽(N-terminal propeptide of type 1 precollagen,P1NP)和羧基端肽(collagen type Ⅰ C-terminal telopeptide,CTX).进行年龄、病程、AIS与25(OH)D、P1NP和CTX的相关性分析.结果:在我们观察的脊髓损伤患者中,VitD缺乏和不足的比例占98.6％.未发现维生素D与年龄、病程、AIS的相关性.P1NP与AIS负相关(R=-0.235,P＜0.05),与病程正相关(R=0.442,P＜0.01).CTX与AIS、年龄负相关(R为-0.232和-0.296,P＜ 0.05).在AIS C、D的四肢瘫与截瘫患者中,25(OH)D、P1NP和CTX无差异(P＞0.05).创伤性脊髓损伤患者的CTX明显高于非创伤性脊髓损伤的患者(Z为-2.086,P＜0.05).结论:脊髓损伤患者中,VitD缺乏有着极高的比例.AIS越低的患者骨转化指标中的P1NP和CTX升高越明显,即骨丢失越严重.年轻脊髓损伤患者和创伤性脊髓损伤患者骨丢失速度更快.