CAJ | 학술논문

目的探讨血清中骨代谢物检测在多发性骨髓瘤骨病(MBD)诊断和病情监测中的意义和价值.方法选取2013年1月至2014年12月天津医科大学总医院血液科收治的36例初治多发性骨髓瘤(MM)患者,根据全身X线影像学检查结果将骨病的发生分为两期,骨病A期:无溶骨性病变或仅有骨质疏松;骨病B期:出现溶骨性病变和(或)病理性骨折.36例初治MM患者中骨病A期12例,骨病B期24例.所有患者应用硼替佐米、地塞米松和唑来膦酸方案治疗均达到部分缓解以上.以性别、年龄相近的25名健康志愿者作为对照.应用ELISA方法检测血清抗酒石酸盐酸性磷酸酶-5b(TRACP-5b)水平,电化学发光免疫分析试验(ECLIA)方法测定血清Ⅰ型胶原蛋白交联羧基末端肽(CTX)、骨钙素(OCN)和总Ⅰ型前胶原氨基端前肽(PINP)水平,观察这些骨代谢物水平在治疗前、后及骨病不同阶段的差异.结果 MM患者治疗前TRACP-5b水平明显高于健康对照及治疗后(中位数:4.16比2.63 U/L,P=0.014;4.16比2.61 U/L,P=0.037);治疗前CTX水平明显高于治疗后(中位数:1.05比0.26 μg,/L,P=0.003);治疗后CTX/OCN和CTX/PINP比值低于治疗前,但差异无统计学意义(均P＞0.05).治疗前,骨病B期患者TRACP-5b水平高于健康对照(中位数:4.20比2.63 U/L,P=0.015);骨病A期和B期患者CTX水平均高于健康对照(中位数:1.16比0.48 μg/L,P =0.002;0.88比0.48 μg/L,P=0.040);骨病A期患者血清OCN和PINP水平绝对值高于骨病B期患者,但差异无统计学意义(均P＞0.05);骨病A期及B期MM患者CTX/OCN和CTX/PINP比值均高于健康志愿者,但差异无统计学意义(均P＞0.05).结论治疗有效的MM患者骨破坏指标有所改善,但仍存在骨质失衡,提示MBD的治疗是一长期过程.骨质吸收代谢物(TRACP-5b和CTX)异常早于X线影像学异常,提示其可作为MBD早期诊断指标.
목적 탐토혈청중골대사물검측재다발성골수류골병(MBD)진단화병정감측중적의의화개치.방법 선취2013년1월지2014년12월천진의과대학총의원혈액과수치적36례초치다발성골수류(MM)환자,근거전신X선영상학검사결과장골병적발생분위량기,골병A기:무용골성병변혹부유골질소송;골병B기:출현용골성병변화(혹)병이성골절.36례초치MM환자중골병A기12례,골병B기24례.소유환자응용붕체좌미、지새미송화서래련산방안치료균체도부분완해이상.이성별、년령상근적25명건강지원자작위대조.응용ELISA방법검측혈청항주석산염산성린산매-5b(TRACP-5b)수평,전화학발광면역분석시험(ECLIA)방법측정혈청Ⅰ형효원단백교련최기말단태(CTX)、골개소(OCN)화총Ⅰ형전효원안기단전태(PINP)수평,관찰저사골대사물수평재치료전、후급골병불동계단적차이.결과 MM환자치료전TRACP-5b수평명현고우건강대조급치료후(중위수:4.16비2.63 U/L,P=0.014;4.16비2.61 U/L,P=0.037);치료전CTX수평명현고우치료후(중위수:1.05비0.26 μg,/L,P=0.003);치료후CTX/OCN화CTX/PINP비치저우치료전,단차이무통계학의의(균P＞0.05).치료전,골병B기환자TRACP-5b수평고우건강대조(중위수:4.20비2.63 U/L,P=0.015);골병A기화B기환자CTX수평균고우건강대조(중위수:1.16비0.48 μg/L,P =0.002;0.88비0.48 μg/L,P=0.040);골병A기환자혈청OCN화PINP수평절대치고우골병B기환자,단차이무통계학의의(균P＞0.05);골병A기급B기MM환자CTX/OCN화CTX/PINP비치균고우건강지원자,단차이무통계학의의(균P＞0.05).결론 치료유효적MM환자골파배지표유소개선,단잉존재골질실형,제시MBD적치료시일장기과정.골질흡수대사물(TRACP-5b화CTX)이상조우X선영상학이상,제시기가작위MBD조기진단지표.
Objective To explore the significance of serum bone metabolic markers in the diagnosis and monitoring of multiple myeloma bone disease (MBD).Methods Thirty-six newly diagnosed multiple myeloma (MM) patients who were treated in Department of Hematology,Tianjin Medical University General Hospital from January 2013 to December 2014 were collected.Bone morbidity was graded into two stages according to the radiographic evaluation of the skeleton:stage A (n =12) included patients with no lytic lesions or with osteoporosis alone;stage B (n =24) included patients with osteolytic lesions and/or a pathological fracture.All the patients achieved partial or complete remission after treated with bortezomib + dexamethasone + zoledronic acid regimen.A total of 25 aged-and gender-matched healthy individuals were enrolled in this study as controls.The levels of serum tartrate-resistant acid phosphatase isoform 5b (TRACP-5b),carboxy-terminal cross-linking telopeptide of type Ⅰ collagen (CTX),osteocalcin (OCN),and procollagen Ⅰ amino-terminal propeptide (PINP) were investigated by ELISA and electrochemiluminescence immunoassay (ECLIA).The differences of these bone metabolic markers before and after treatment,and at different stages of bone disease were observed.Results The value of TRACP-5b in the newly diagnosed MM was significantly higher than that in the healthy controls and after treatment (median 4.16 vs 2.63 U/L,P =0.014;4.16 vs 2.61 U/L,P =0.037).Serum level of CTX in the newly diagnosed MM patients was significantly decreased after treatment (median:0.26 vs 1.05 μg/L,P =0.003).The ratio of CTX/OCN and CTX/PINP decreased after treatment,but there were no significant differences (both P ＞ 0.05).The pretreatment level of serum TRACP-5b in stage B patients was higher than that of the healthy controls (median:4.20 vs 2.63 U/L,P =0.015).The levels of serum CTX in stage A and stage B patients were both higher than that of the healthy controls (median:1.16 vs 0.48 μg/L,P =0.002;0.88 vs 0.48 μg/L,P =0.040).The levels of serum OCN and PINP were higher in stage A patients compared with stage B patients,but there were no significant differences (both P ＞ 0.05).The ratio of CTX/OCN and CTX/PINP of stage A and stage B patients all increased compared with those of the healthy controls,but there were no significant differences (all P ＞ 0.05).Conclusions Bone damage of MM patients is improved after effective treatment,but bone imbalance still exists,indicating that the treatment of MBD is a long process.Abnormal serum levels of TRACP-5b and CTX are found before positive X-ray findings in MBD,suggesting that these biochemical markers could be used as indices for early diagnosis of MBD.