免疫性血小板减少性紫癜患者糖皮质激素治疗前后血清P1NP、β-CTX水平的变化
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摘要
目的观察糖皮质激素(GC)治疗对免疫性血小板减少性紫癜(ITP)患者骨代谢指标的影响。方法检测30例健康体检者(对照组)、52例ITP患者(观察组)糖皮质激素治疗前及治疗24周内的血清总I型前胶原氨基端延长肽(P1NP)、I型胶原羧基端肽β特殊序列(β-CTX)水平及骨密度(BMD)指标,比较ITP患者治疗期间P1NP、β-CTX及骨密度水平的变化。结果观察组治疗前血清P1NP、β-CTX、骨密度与对照组比较差异无统计学意义(P>0.05);治疗24周后ITP患者血清P1NP、β-CTX与治疗前比较,差异有统计学意义(P<0.05);治疗24周后患者髋部骨密度明显低于治疗前,差异有统计学意义(P<0.05);ITP患者P1NP、髋部BMD水平与GC的使用时间呈负相关(P<0.01),β-CTX与GC使用时间呈正相关(P<0.01)。结论经GC治疗后ITP患者的BMD下降,骨代谢处于高分解低成骨转换状态,存在骨质疏松风险,需要提高对ITP患者糖皮质激素性骨质疏松的认识和防治。
Objective To observe the effect of glucocorticoid(GC) treatment on bone metabolism in patients with immune thrombocytopenic purpura(ITP). Methods Serum total type I procollagen amino-terminal extension peptide(P1 NP), type I collagen carboxylase and bone mineral density(BMD) were measured in 30 healthy subjects(control group) and 52 ITP patients(observation group) before and after treatment with glucocorticoid hormone. The levels of P1 NP, β-CTX and BMD were compared in patients with ITP during treatment. Results There was no statistical significance on the difference in serum P1 NP, β-CTX, and bone mineral density between the observation group before treatment and the control group(P>0.05). There was statistical significance on the difference of serum P1 NP and β-CTX in patients with ITP after treatment for 24 weeks, compared with that before treatment(P<0.05). After 24 weeks of treatment, the hip bone density of patients was significantly lower than before treatment(P<0.05); P1 NP and hip BMD levels were negatively correlated with Glucocorticoid use time in patients with ITP(P<0.01), and β-CTX is positively correlated with GC use time(P<0.01). Conclu￣sion The BMD of patients with ITP decreased after GC treatment, and the bone metabolism was in a state of high decomposition and low osteogenesis, and there was a risk of osteoporosis. It was necessary to improve the understanding and prevention of glucocorticoid-induced osteoporosis in patients with ITP.
Objective To observe the effect of glucocorticoid(GC) treatment on bone metabolism in patients with immune thrombocytopenic purpura(ITP). Methods Serum total type I procollagen amino-terminal extension peptide(P1 NP), type I collagen carboxylase and bone mineral density(BMD) were measured in 30 healthy subjects(control group) and 52 ITP patients(observation group) before and after treatment with glucocorticoid hormone. The levels of P1 NP, β-CTX and BMD were compared in patients with ITP during treatment. Results There was no statistical significance on the difference in serum P1 NP, β-CTX, and bone mineral density between the observation group before treatment and the control group(P>0.05). There was statistical significance on the difference of serum P1 NP and β-CTX in patients with ITP after treatment for 24 weeks, compared with that before treatment(P<0.05). After 24 weeks of treatment, the hip bone density of patients was significantly lower than before treatment(P<0.05); P1 NP and hip BMD levels were negatively correlated with Glucocorticoid use time in patients with ITP(P<0.01), and β-CTX is positively correlated with GC use time(P<0.01). Conclu￣sion The BMD of patients with ITP decreased after GC treatment, and the bone metabolism was in a state of high decomposition and low osteogenesis, and there was a risk of osteoporosis. It was necessary to improve the understanding and prevention of glucocorticoid-induced osteoporosis in patients with ITP.
引文
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[16] 石磊,刘驰,闵楠,等.老年骨质疏松症患者应用唑来膦酸治疗后骨代谢标志物与骨密度变化相关性研究[J].中华骨与关节外科杂志,2016,9(3):246-250.
[2] Weinstein RS.Glucocorticoid-induced osteoporosis and osteonecrosis[J].Endocrinol Metab Clin North Am,2012,41(3):595-611.
[3] Rizzoli R,Adachi JD,Cooper C,et al.Management of glucocorticoid-induced osteoporosis[J].Calcif Tissue Int,2012,91(4):225-243.
[4] Seibel MJ,Cooper MS,Zhou H.Glucocorticoid-induced osteoporosis:mechanisms,management,and future perspectives[J].Lancet Diabetes Endocrinol,2013,1(1):59-70.
[5] Garnero P.New developments in biological markers of bone metabolism in osteoporosis[J].Bone,2014,66:46-55.
[6] Stolina M,Dwyer D,Niu QT,et al.Temporal changes in systemic and local expression of bone turnover markers during six months of sclerostin antibody administration to ovariectomized rats[J].Bone,2014,67:305-313.
[7] Nishizawa Y,Ohta H,Miura M,et al.Guidelines for the use of bone metabolic markers in the diagnosis and treatment of osteoporosis (2012 edition)[J].J Bone Miner Metab,2013,31(1):1-15.
[8] 张萌萌,毛未贤,马倩倩,等.骨代谢标志物在骨质疏松诊疗中的应用指南(2012年版)[J].中国骨质疏松杂志,2013,19(7):645-657.
[9] 李梅,章振林,李艳,等.健康汉族男女性血清骨转换生化指标P1NP和β-CTX浓度范围再分析[J].中华骨质疏松和骨矿盐疾病杂志,2016,9(1):7-12.
[10] Lee J,Vasikaran S.Current recommendations for laboratory testing and use of bone turnover markers in management of osteoporosis[J].Ann Lab Med,2012,32(2):105-112.
[11] Glendenning P.Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment:a need for international reference standards[J].Clin Biochem Rev,2011,32(1):45-47.
[12] 王福斌,陈剑明.β-CTX、P1NP在绝经后女性骨质疏松性骨折风险中的评价作用[J].中国卫生检验杂志,2017,27(9):1266-1268.
[13] Ma C,Shuai B,Shen L,et al.Serum carcinoembryonic antigen-related cell adhesion molecule 1 level in postmenopausal women:correlation with β-catenin and bone mineral density[J].Osteoporos Int,2016,27(4):1529-1535.
[14] 黄象维,丁陈颖,徐霞,等.骨代谢标志物与糖尿病患者骨质疏松症的关系[J].中国卫生检验杂志,2018,28(2):206-208.
[15] Li M,Lv F,Zhang Z,et al.Establishment of a normal reference value of parathyroid hormone in a large healthy Chinese population and evaluation of its relation to bone turnover and bone mineral density[J].Osteoporos Int,2016,27(5):1907-1916.
[16] 石磊,刘驰,闵楠,等.老年骨质疏松症患者应用唑来膦酸治疗后骨代谢标志物与骨密度变化相关性研究[J].中华骨与关节外科杂志,2016,9(3):246-250.