血清Ⅰ型胶原吡啶交联终肽、骨钙素在肿瘤骨转移中的应用

摘要

目的 探讨骨胶原吸收指标血清Ⅰ型胶原吡啶交联终肽(ICTP)和骨形成指标血清骨钙素(OC)二者在肿瘤骨转移的应用价值.方法 收集我院肿瘤科经病理确诊的肺癌患者血清65例,乳腺癌患者血清36例,通过影像学诊断,将其分为骨未转移组和骨转移组两组.并征集我院健康体检人群41例作为健康对照组,分别定量测定血清ICTP、OC和碱性磷酸酶(ALP)浓度.结果 血清ICTP在肺癌和乳腺癌骨转移组[(27.80±11.14)μg/L和(122.33±34.92)μg/L]均显著高于骨未转移组[(8.95±3.81)μg/L和(8.40±4.59)μg/L],差异有统计学意义(P<0 01),骨未转移组较健康对照组[(5.16±1.76)μg/L]亦有极显著性差异(P<0.01),血清OC值在乳腺癌骨转移组[(69.31±36.17)ng/mL]亦显著高于骨未转移组[(15.54±6.09)ng/mL],差异有统计学意义(P<0.01),而肺癌骨未转移组血清OC值较健康对照组以及肺癌骨转移组较肺癌骨未转移组差异均无统计学意义(P>0.05).血清ICTP在诊断肺癌和乳腺癌骨转移中是特异性高、敏感度较好的指标,血清OC在诊断肺癌骨转移中单独使用敏感度不够,意义不大,但在诊断乳腺癌骨转移时特异度和敏感度均较好.两者联合诊断乳腺癌骨转移的敏感度为96.3%,特异度为96.7%,联合诊断肺癌骨转移的敏感度为80.3%,特异度为84.2%.结论 可根据需要单独或联合应用血清ICTP和OC,作为除影像学外诊断肿瘤骨转移有用的实验室诊断指标.%Objective To investigate the clinical application of serum marker of bone resorption pyridinoline cross-linked carboxy-terminal telopeptide of type Ⅰ collagen (ICTP) and bone formation marker osteocalcin (OC) in osseous metastasis in tumor patients.Methods Based on pathological and radiological findings, all patients were divided into 3 groups: osseous metastasis group, including 9 lung cancer and 6 breast cancer patients with osseous metastasis;non-osseous metastasis group, including 56 lung cancer and 30 breast cancer patients without osseous metastasis;and control group, including 41 normal individuals. Serum levels of ICTP, OC and alkaline phosphatase (ALP) were quantitatively determined.Results Serum ICTP level was significantly higher in osseous metastasis group than that of non-osseous metastasis group [lung cancer patients: (27.80±11.14) vs (8.95±3.81)μg/L;breast cancer patients: (122.33±34.92) vs (8.40±4.59)μg/L] (P<0.01).There was significant difference between non-osseous metastasis group and control group in serum ICTP level (P<0 01). Serum OC level was also significantly higher in breast cancer with osseous metastasis group than that of breast cancer non-osseous metastasis group [(69.31±36.17) vs (15.54±6.09) ng/mL] (P<0.01),and while there wasn′t statistical difference in serum OC level among lung cancer with osseous metastasis group,non-osseous metastasis group and control group (P>0.05).Serum ICTP was specifici and sensitive in the diagnosis of osseous metastasis in patients with lung cancer or breast cancer.The sensitivity of serum OC was poor in diagnosis of lung cancer with osseous metastasis, but its sensitivity and specificity were both ideal in diagnosis of breast cancer with osseous metastasis.The sensitivity and specificity of combined detection of ICTP and OC was 96.3% and 96.7% for breast cancer with osseous metastasis,80.3% and 84.2% for lung cancer with osseous metastasis,respectively.Conclusion Taken singly or jointly, serum ICTP and OC may be employed as useful laboratory diadynamic criteria in diagnosis of osseous metastasis in tumor patients besides radiological findings.