老年骨质疏松性椎体压缩性骨折病人骨转换标志物的早期变化

doi:10.3969/j.issn.1003-9198.2022.09.009

摘要/Abstract

摘要： 目的探究老年骨质疏松性椎体压缩性骨折(OVCF)病人骨转换标志物水平的早期变化情况。方法选取我院35例老年OVCF病人作为研究组,另选择同期35例老年健康体检者作为对照组,比较2组临床资料、血清Ⅰ型前胶原氨基末端前肽(PINP)、Ⅰ型胶原交联羧基末端肽(CTX)、25羟维生素D[25(OH)D]水平以及双能X线骨密度,并比较研究组不同性别、年龄、椎体骨折数量病人骨折后第1、2、3、6、8、12周血清PINP、CTX、25(OH)D水平,骨折后第1、12周骨密度的差异,分析骨折后第1周各指标与病人性别、年龄、椎体骨折数量的相关性。结果研究组入院时血清PINP、CTX、25(OH)D水平及骨密度均低于对照组(P＜0.05)。研究组中,不同性别病人第2、3、6、8、12周血清PINP、CTX、25(OH)D水平均较骨折后第1周明显升高(P＜0.05);女性病人骨折后第1周血清PINP、CTX、25(OH)D水平及骨密度,骨折后第12周骨密度均低于男性(P＜0.05)。＞80岁、70~80岁病人第2、3、6、8、12周血清PINP、CTX、25(OH)D水平均较骨折后第1周明显升高(P＜0.05);年龄＞80岁病人骨折后第1周血清PINP、CTX、25(OH)D水平及骨密度,骨折后第12周骨密度均低于70~80岁病人(P＜0.05)。研究组椎体骨折数量＞2个以及1~2个病人第2、3、6、8、12周血清PINP、CTX、25(OH)D水平均较骨折后第1周明显升高(P＜0.05);且椎体骨折数量＞2个病人骨折后第1周血清PINP、CTX、25(OH)D水平及骨密度,骨折后第12周骨密度均低于椎体骨折数量1~2个病人(P＜0.05)。骨折后第1周血清PINP、CTX、25(OH)D水平及骨密度与老年OVCF病人的性别、年龄、椎体骨折数量显著相关(P＜0.01)。结论老年OVCF病人骨折后早期血清PINP、CTX、25(OH)D水平及骨密度明显异常,其相关因素包括病人性别、年龄及椎体骨折数量。

关键词: 骨质疏松性椎体压缩性骨折, Ⅰ型前胶原氨基末端前肽, Ⅰ型胶原交联羧基末端肽, 25羟维生素D, 骨密度

Abstract: Objective To explore the early changes of bone turnover markers in the elderly patients with osteoporotic vertebral compression fractures (OVCF). Methods A total of 35 elderly OVCF patients in our hospital were selected as the research group, and 35 healthy elderly were selected as the control group. The clinical data, serum levels of typeⅠprocollagen amino terminal propeptide (PINP), type Ⅰ collagen cross-linked carboxyl terminal peptide (CTX), 25-hydroxy vitamin D [25(OH)D] 1, 2, 3, 6, 8 and 12 weeks after fracture and dual-energy X-ray bone mineral density 1 and 12 weeks after fracture were detected and compared in the patients with different genders, ages, and the number of vertebral fractures. And the correlation between each index at the first week after fracture and gender, age, the number of vertebral fractures was analyzed. Results The serum levels of PINP, CTX, 25(OH)D and bone mineral density in the research group were lower than those in the control group at admission (P<0.05). The serum levels of PINP, CTX and 25(OH)D at the 2nd, 3rd, 6th, 8th and 12th weeks in the research group were significantly higher than those in the first week after fracture (P<0.05). The serum levels of PINP, CTX, 25(OH)D, the bone mineral density in the first week after fracture, and the bone mineral density 12 weeks after fracture showed significant differences in the patients with different gender, age and the number of vertebral fractures, respectively (P＜0.05). The serum levels of PINP, CTX, 25(OH)D and bone mineral density in the first week after fracture were significantly correlated with gender, age, and the number of vertebral fractures in the elderly patients with OVCF (P<0.01). Conclusions The serum levels of PINP, CTX, 25(OH)D and bone mineral density of the elderly patients with OVCF are significantly abnormal in the early stage after fracture, and the related factors include gender, age and the number of vertebral fractures.

Key words: osteoporotic vertebral compression fracture, type Ⅰ procollagen amino terminal propeptide, type Ⅰ collagen cross-linked carboxy terminal peptide, 25-hydroxy vitamin D, bone mineral density

中图分类号:

R683.2

魏翾娣, 岳建彪, 苟静. 老年骨质疏松性椎体压缩性骨折病人骨转换标志物的早期变化[J]. 实用老年医学, 2022, 36(9): 902-906.

WEI Xuan-di, YUE Jian-biao, GOU Jing. Early changes of bone turnover markers in elderly patients with osteoporotic vertebral compression fractures[J]. Practical Geriatrics, 2022, 36(9): 902-906.

参考文献

[1] 中华医学会,中华医学会杂志社,中华医学会全科医学分会,等.原发性骨质疏松症基层诊疗指南(实践版·2019)[J].中华全科医师杂志,2020,19(4):316-323.
[2] JACOBS E, SENDEN R, MCCRUM C, et al. Effect of a semirigid thoracolumbar orthosis on gait and sagittal alignment in patients with an osteoporotic vertebral compression fracture[J]. Clin Interv Aging, 2019, 14:671-680.
[3] 马远征,王以朋,刘强,等.中国老年骨质疏松症诊疗指南(2018)[J].中国骨质疏松杂志,2018,24(12):1541-1567.
[4] QI H, XUE J, GAO J, et al. Changes of bone turnover markers and bone tissue content after severe osteoporotic vertebral compression fracture[J].Med Sci Monit,2020,26:e923713.
[5] 中华医学会放射学分会骨关节学组,中国医师协会放射医师分会肌骨学组,中华医学会骨科学分会骨质疏松学组,等.骨质疏松的影像学与骨密度诊断专家共识[J].中国骨质疏松杂志,2020,26(9):1249-1256.
[6] 杨帅,张红新,古雪建.老年骨质疏松性骨折患者血清B-ALP、PTH、s-PINP和s-CTX表达[J].分子诊断与治疗杂志,2021,13(2):276-279.
[7] 张恬,吕珊,殷泉忠,等.维生素D缺乏与老年2型糖尿病患者发生骨质疏松、骨骼肌质量减少的相关性研究[J].中国骨质疏松杂志,2019,25(8):1110-1115.
[8] 中华医学会骨质疏松和骨矿盐疾病分会.骨质疏松性椎体压缩性骨折诊疗与管理专家共识[J].中华骨质疏松和骨矿盐疾病杂志,2018,11(5):425-437.
[9] 佟静,季志民,高翔.双能X线骨密度仪椎体骨密度测定骨质疏松症临床价值分析[J].影像研究与医学应用,2020,4(6):68-69.
[10] QU X L,ZHENG B,CHEN T Y, et al. Bone turnover markers and bone mineral density to predict osteoporotic fractures in older women: a retrospective comparative study[J].Orthop Surg, 2020, 12(1):116-123.
[11] ELENI A, PANAGIOTIS P.A systematic review and meta-analysis of vitamin D and calcium in preventing osteoporotic fractures[J].Clin Rheumatol, 2020, 39(12):3571-3579.
[12] 董飞,王玲.绝经后女性骨转换生化标志物水平与骨密度的相关性分析[J].检验医学与临床,2021,18(9):1323-1325.
[13] 李春阳,赵洪涛,张康.血清PINP、β-CTX水平与骨质疏松性椎体压缩骨折术后再发伤椎塌陷的相关性分析[J].中国骨与关节损伤杂志,2020,35(9):951-953.
[14] ZHANG L, CHUN C, YANG Y, et al. Vitamin D deficiency/insufficiency is associated with risk of osteoporotic thoracolumbar junction vertebral fractures[J]. Med Sci Monit, 2019, 25:8260-8268.
[15] 王春生.骨质疏松患者发生椎体压缩性骨折后早期的骨代谢标志物变化规律探讨[J].颈腰痛杂志,2017,38(6):521-524.
[16] 曹成红.血清FGF23、PINP、IGF-1联合检测对绝经期妇女骨质疏松的辅助诊断价值[J].标记免疫分析与临床,2019,26(11):1858-1862.
[17] 陈婵.维生素D、维生素B12和同型半胱氨酸水平与绝经后女性骨密度的相关性研究[J].中国骨质疏松杂志,2019,25(2):189-192.