CAJ | 학술논문

目的：探讨Ⅰ型神经纤维瘤病（neurofibromatosis type 1，NF1）伴脊柱侧凸患者骨密度（BMD）与血清骨钙素（BGP）及骨代谢生化指标的相关性。方法：选取2012年2月~2013年3月我院脊柱外科收治的17例NF1伴脊柱侧凸（NF1-S）患者为观察对象（病例组），年龄8~18岁，Cobb角40°~143°；17例正常儿童及青少年作为对照组，年龄7~19岁。两组均采用双能X线骨密度吸收仪测量非优势侧的股骨近端和腰椎（L2~L4）的BMD，同时采用免疫分析仪检测BGP水平，血生化分析仪检测碱性磷酸酶（ALP）、血钙（血Ca）、血磷（血P）、尿钙/肌酐比值（尿Ca/Cr）和尿磷/肌酐比值（尿P/Cr）。应用SPSS 16.0软件进行统计分析，采用独立样本t检验分析两组BMD及各项骨代谢生化指标之间的差异；Pearson相关分析病例组患者腰椎BMD与对应各项骨代谢生化指标的相关关系。结果：两组受试者年龄、性别构成比无统计学差异（P>0.05）。病例组所测各部位BMD均明显低于正常对照组，差异有显著性（P<0.05）；BGP （135.6ng/ml）、血 Ca （2.59mmol/L）、血 P （1.75mmol/L）、尿 Ca/Cr （0.10mg/mg）均高于正常对照组（79ng/ml、2.45mmol/l、1.47mmol/l、0.06mg/mg），差异均具有显著性（P<0.05），而ALP（141.6u/L vs 141.8u/l，t=3.611，P=0.991）和尿P/Cr（0.47mg/mg vs 0.46mg/mg，t=0.054，P=0.957）则无显著性差异（P>0.05）。NF1-S患者腰椎BMD与BGP（r=-0.916，P=0.000）、尿Ca/Cr（r=-0.968，P=0.000）存在显著性负相关。结论：NF1-S患者BMD明显低于正常人；BGP、血Ca、血P和尿Ca/Cr均高于正常人，测定BGP、尿Ca/Cr水平是监测NF1-S患者BMD变化较为敏感的方法之一。
목적：탐토Ⅰ형신경섬유류병（neurofibromatosis type 1，NF1）반척주측철환자골밀도（BMD）여혈청골개소（BGP）급골대사생화지표적상관성。방법：선취2012년2월~2013년3월아원척주외과수치적17례NF1반척주측철（NF1-S）환자위관찰대상（병례조），년령8~18세，Cobb각40°~143°；17례정상인동급청소년작위대조조，년령7~19세。량조균채용쌍능X선골밀도흡수의측량비우세측적고골근단화요추（L2~L4）적BMD，동시채용면역분석의검측BGP수평，혈생화분석의검측감성린산매（ALP）、혈개（혈Ca）、혈린（혈P）、뇨개/기항비치（뇨Ca/Cr）화뇨린/기항비치（뇨P/Cr）。응용SPSS 16.0연건진행통계분석，채용독립양본t검험분석량조BMD급각항골대사생화지표지간적차이；Pearson상관분석병례조환자요추BMD여대응각항골대사생화지표적상관관계。결과：량조수시자년령、성별구성비무통계학차이（P>0.05）。병례조소측각부위BMD균명현저우정상대조조，차이유현저성（P<0.05）；BGP （135.6ng/ml）、혈 Ca （2.59mmol/L）、혈 P （1.75mmol/L）、뇨 Ca/Cr （0.10mg/mg）균고우정상대조조（79ng/ml、2.45mmol/l、1.47mmol/l、0.06mg/mg），차이균구유현저성（P<0.05），이ALP（141.6u/L vs 141.8u/l，t=3.611，P=0.991）화뇨P/Cr（0.47mg/mg vs 0.46mg/mg，t=0.054，P=0.957）칙무현저성차이（P>0.05）。NF1-S환자요추BMD여BGP（r=-0.916，P=0.000）、뇨Ca/Cr（r=-0.968，P=0.000）존재현저성부상관。결론：NF1-S환자BMD명현저우정상인；BGP、혈Ca、혈P화뇨Ca/Cr균고우정상인，측정BGP、뇨Ca/Cr수평시감측NF1-S환자BMD변화교위민감적방법지일。
Objectives: To investigate the relationship of bone mineral density (BMD) with osteocalcin (BGP) and serum levels of bone metabolism indexes in scoliosis patients secondary to neurofibromatosis type 1(NF1-S). Methods: From February 2012 to March 2013, 17 NF1-S patients aged 8-18 years old and with the Cobb angle ranging from 40° to 143° were recruited as the case group, while 17 healthy peers ranged 7-19 years old were recruited as the control group. Dual-energy X-ray absorptiometry was used to measure the BMD of two groups. The bone metabolism indexes including BGP, serum alkaline phosphatase (ALP), serum calcium, serum phosphorus, urinary calcium, urinary phosphorus, and urinary creatinine were measured by us-ing electro-chemilumin escence immunoassay and an automatic biochemical analyzer. SPSS 16.0 software was used for data analysis. Independent-sample t test was used to analyze the differences of BMD and bone metabolism indexes between two groups, the relationship between lumbar BMD and bone metabolism was ac-cessed by using Pearson correlation analysis. Results: No difference in terms of age and sex was noted in two groups (P>0.05). The BMD of the lumbar spine and the proximal femur in case group was significantly lower than that of the control group (P<0.05). The levels of BGP (135.6ng/ml), serum calcium (2.59mmol/L), <br> serum phosphorus (1.75mmol/L) and urinary calcium/creatinine (U Ca/Cr, 0.10mg/mg) were significantly higher than those of control group(79ng/ml, 2.45mmol/L, 1.47mmol/l, 0.06mg/mg)(P<0.05). The levels of serum ALP (141.6u/L vs 141.8u/L, t=3.611, P=0.991) and urinary phosphorus/creatinine ration (U P/Cr, 0.47mg/mg vs 0.46mg/mg, t=0.054, P=0.957) showed no significance between two groups(P>0.05). The factors, including BGP (r=-0.916, P=0.000) and U Ca/Cr (r=-0.968, P=0.000), were both negatively related with lumbar BMD. Conclusions: The BMD in NF1-S patients is significantly lower than those of the normal control. The levels of BGP, serum calcium, serum phosphorus and U Ca/Cr in NF1-S patients are higher than that of the normal control. The level of BGP and U Ca/Cr is a more sensitive index to monitor the situation of BMD in NF1-S patients.