血清Ⅰ型前胶原氨基端前肽与Ⅰ型胶原羧基端肽β特殊序列在恶性肿瘤骨转移诊断和病情评估及疗效评价中的应用价值
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摘要
目的:探讨血清Ⅰ型前胶原氨基端前肽(N-terminal propeptide of typeⅠprecollagen,PⅠNP)与Ⅰ型胶原羧基端肽β特殊序列(βcross-linked C-telopeptide of typeⅠcollagen,β-CTX)在恶性肿瘤骨转移诊断、病情评估及疗效评价中的应用价值。方法:回顾性分析2015年3月至2017年3月收治的115例恶性肿瘤患者的临床资料。根据肿瘤是否出现骨转移分为骨转移组和无骨转移组,根据骨转移数目将骨转移组分为骨转移数目<3个组和骨转移数目≥3个组,根据世界卫生组织实体瘤近期疗效评价标准中的骨转移评价标准将骨转移组分为治疗有效组和治疗无效组。比较治疗前骨转移组和无骨转移组,骨转移数目<3个组和骨转移数目≥3个组的血清PⅠNP和β-CTX含量,以及骨转移组治疗前后的血清PⅠNP和β-CTX含量。结果:骨转移组48例,无骨转移组67例,骨转移组的血清PⅠNP和β-CTX含量均高于无骨转移组[(110.31±15.67)ng·m L~(-1),(45.56±8.65)ng·m L~(-1),t=3.146,P=0.002;(0.58±0.02)ng·m L~(-1),(0.36±0.01)ng·m L~(-1),t=2.858,P=0.005]。骨转移数目<3个组21例,骨转移数目≥3个组27例,骨转移数目<3个组的血清PⅠNP和β-CTX含量均低于骨转移数目≥3个组[(102.41±12.34)ng·m L~(-1),(116.45±17.48)ng·m L~(-1),t=3.121,P=0.003;(0.56±0.01)ng·m L~(-1),(0.58±0.04)ng·m L~(-1),t=2.058,P=0.045]。48例骨转移患者中,42例针对原发肿瘤进行了化疗和放疗,并应用了双磷酸盐药物治疗;其余6例均采用镇痛药物进行姑息治疗。治疗2个月后,治疗有效34例、无效14例,治疗有效组的血清PⅠNP和β-CTX含量均较治疗前下降[(97.14±17.32)ng·m L~(-1),(105.77±15.04)ng·m L~(-1),t=9.890,P=0.000;(0.52±0.03)ng·m L~(-1),(0.57±0.02)ng·m L~(-1),t=11.655,P=0.000],治疗无效组的血清PⅠNP和β-CTX含量与治疗前相比差异均无统计学意义[(118.24±20.42)ng·m L~(-1),(121.31±16.30)ng·m L~(-1),t=1.815,P=0.093;(0.59±0.04)ng·m L~(-1),(0.60±0.03)ng·m L~(-1),t=0.780,P=0.450]。结论:对恶性肿瘤患者进行血清PⅠNP和β-CTX含量测定,有助于早期发现骨转移、评估骨转移程度和评价骨转移治疗效果。
Objective: To explore the applied values of serum N-terminal propeptide of type Ⅰ precollagen( P Ⅰ NP) and β cross-linked C-telopeptide of typeⅠcollagen( β-CTX) in diagnosis,severity assessment and therapeutic efficacy evaluation of bone metastasis of malignant tumors. Methods: The medical records of 115 patients with malignant tumors recruited from March 2015 to March 2017 were analyzed retrospectively. The patients were divided into bone metastasis group and non-bone metastasis group according to whether bone metastases of malignant tumor were found. The patients in bone metastasis group were divided into < 3 subgroup and≥3 subgroup according to the number of bone metastases and effective treatment group and ineffective treatment group according to the evaluation criteria for bone metastasis which was extracted from short-term efficacy evaluation criteria for solid tumors issued by World Health Organization( WHO).The serum contents of PⅠNP and β-CTX were compared between bone metastasis group and non-bone metastasis group and between bone metastasis number of < 3 subgroup and bone metastasis number of≥3 subgroup before the treatment,moreover,the serum contents of PⅠNP and β-CTX were compared between pre-treatment and post-treatment in bone metastasis group. Results: The serum contents of PⅠNP and β-CTX were higher in bone metastasis group( 48 cases) compared to non-bone metastasis group( 67 cases)( 110. 31 +/-15. 67 vs 45. 56 +/-8. 65 ng/m L,t = 3. 146,P = 0. 002; 0. 58 +/-0. 02 vs 0. 36 +/-0. 01 ng/m L,t = 2. 858,P = 0. 005). The serum contents of PⅠNP and β-CTX were lower in bone metastasis number of < 3 subgroup( 21 cases) compared to bone metastasis number of≥3 subgroup( 27 cases)( 102. 41 +/-12. 34 vs 116. 45 +/-17. 48 ng/m L,t = 3. 121,P = 0. 003; 0. 56 +/-0. 01 vs 0. 58 +/-0. 04 ng/m L,t =2. 058,P = 0. 045). Forty-two out of 48 patients with bone metastases were treated with chemotherapy and radiotherapy aiming at primary tumor and were treated with bisphosphonates,while the others were treated with palliative therapy by using analgesic drugs. After 2-month treatment,34 patients got a good therapeutic result and 14 patients got a bad therapeutic result. The serum contents of PⅠNP and β-CTX decreased in effective treatment group( 97. 14 +/-17. 32 vs 105. 77 +/-15. 04 ng/m L,t = 9. 890,P = 0. 000; 0. 52 +/-0. 03 vs 0. 57 +/-0. 02 ng/m L,t = 11. 655,P = 0. 000),and there was no statistical differences in the serum contents of PⅠNP and β-CTX between pre-treatment and post-treatment in ineffective treatment group( 118. 24 +/-20. 42 vs 121. 31 +/-16. 30 ng/m L,t = 1. 815,P = 0. 093;0. 59 +/-0. 04 vs 0. 60 +/-0. 03 ng/m L,t = 0. 780,P = 0. 450). Conclusion: Determining the serum contents of PⅠNP and β-CTX is helpful to early detection,severity assessment and therapeutic efficacy evaluation of bone metastasis for patients with malignant tumor.
Objective: To explore the applied values of serum N-terminal propeptide of type Ⅰ precollagen( P Ⅰ NP) and β cross-linked C-telopeptide of typeⅠcollagen( β-CTX) in diagnosis,severity assessment and therapeutic efficacy evaluation of bone metastasis of malignant tumors. Methods: The medical records of 115 patients with malignant tumors recruited from March 2015 to March 2017 were analyzed retrospectively. The patients were divided into bone metastasis group and non-bone metastasis group according to whether bone metastases of malignant tumor were found. The patients in bone metastasis group were divided into < 3 subgroup and≥3 subgroup according to the number of bone metastases and effective treatment group and ineffective treatment group according to the evaluation criteria for bone metastasis which was extracted from short-term efficacy evaluation criteria for solid tumors issued by World Health Organization( WHO).The serum contents of PⅠNP and β-CTX were compared between bone metastasis group and non-bone metastasis group and between bone metastasis number of < 3 subgroup and bone metastasis number of≥3 subgroup before the treatment,moreover,the serum contents of PⅠNP and β-CTX were compared between pre-treatment and post-treatment in bone metastasis group. Results: The serum contents of PⅠNP and β-CTX were higher in bone metastasis group( 48 cases) compared to non-bone metastasis group( 67 cases)( 110. 31 +/-15. 67 vs 45. 56 +/-8. 65 ng/m L,t = 3. 146,P = 0. 002; 0. 58 +/-0. 02 vs 0. 36 +/-0. 01 ng/m L,t = 2. 858,P = 0. 005). The serum contents of PⅠNP and β-CTX were lower in bone metastasis number of < 3 subgroup( 21 cases) compared to bone metastasis number of≥3 subgroup( 27 cases)( 102. 41 +/-12. 34 vs 116. 45 +/-17. 48 ng/m L,t = 3. 121,P = 0. 003; 0. 56 +/-0. 01 vs 0. 58 +/-0. 04 ng/m L,t =2. 058,P = 0. 045). Forty-two out of 48 patients with bone metastases were treated with chemotherapy and radiotherapy aiming at primary tumor and were treated with bisphosphonates,while the others were treated with palliative therapy by using analgesic drugs. After 2-month treatment,34 patients got a good therapeutic result and 14 patients got a bad therapeutic result. The serum contents of PⅠNP and β-CTX decreased in effective treatment group( 97. 14 +/-17. 32 vs 105. 77 +/-15. 04 ng/m L,t = 9. 890,P = 0. 000; 0. 52 +/-0. 03 vs 0. 57 +/-0. 02 ng/m L,t = 11. 655,P = 0. 000),and there was no statistical differences in the serum contents of PⅠNP and β-CTX between pre-treatment and post-treatment in ineffective treatment group( 118. 24 +/-20. 42 vs 121. 31 +/-16. 30 ng/m L,t = 1. 815,P = 0. 093;0. 59 +/-0. 04 vs 0. 60 +/-0. 03 ng/m L,t = 0. 780,P = 0. 450). Conclusion: Determining the serum contents of PⅠNP and β-CTX is helpful to early detection,severity assessment and therapeutic efficacy evaluation of bone metastasis for patients with malignant tumor.
引文
[1]周际昌.实用肿瘤内科学[M].2版.北京:人民卫生出版社,2005:45-48.
[2]张萌萌.中国老年学学会骨质疏松委员会骨代谢生化指标临床应用专家共识[J].中国骨质疏松杂志,2014,20(11):1263-1272.
[3]TANKLB,KARSDAL MA,CHRISTIANSEN C,et al.Biochemical approach to the detection and monitoring of metastatic bone disease:what do we know and what questions need answers?[J].Cancer Metastasis Rev,2006,25(4):659-668.
[4]唐琼,赵辉,贾锐,等.BAP和β-CTX与肺癌骨转移进展程度的相关性[J].中国肺癌杂志,2013,16(3):144-147.
[5]FERREIRA A,ALHO I,CASIMIRO S,et al.Bone remodeling markers and bone metastases:From cancer research to clinical implications[J].Bonekey Rep,2015,4:668.
[6]于世英.恶性肿瘤骨转移的诊断与治疗[M].2版.北京:中国协和医科大学出版社,2012:5.
[7]吴晓徽,陆汉魁.骨代谢指标在肿瘤骨转移诊治中的应用[J].肿瘤,2007,27(6):505-507.
[8]HERRMANN M,SEIBEL MJ.The amino-and carboxyterminal cross-linked telopeptides of collagen type I,NTX-I and CTX-I:a comparative review[J].Clin Chim Acta,2008,393(2):57-75.
[9]LUMACHI F,SANTEUFEMIA DA,DEL CONTE A,et al.Carboxy-terminal telopeptide(CTX)and amino-terminal propeptide(PINP)of type I collagen as markers of bone metastases in patients with non-small cell lung cancer[J].Anticancer Res,2013,33(6):2593-2596.
[10]彭东,刘学芬,刘徽婷,等.骨代谢指标结合全身骨显像在肿瘤骨转移早期诊断中的临床价值[J].国际检验医学杂志,2017,38(17):2395-2398.
[11]吴春娇,马丽霞,朱晶,等.联合检测乳腺癌骨转移患者中尿Ⅰ型胶原氨基末端肽和Ⅰ型胶原羧基末端肽的临床意义[J].中华肿瘤杂志,2016,38(9):693-697.
[12]潘兴喜,杨文,杨画,等.血清β-CTX、PINP在肺癌骨转移诊断中的意义[J].中华临床医师杂志(电子版),2015,9(9):1735-1736.
[13]韩丽敏,魏丽荣,杜玉珍.骨代谢标志物t P1NP和β-CTx及BAP在肺癌骨转移中的临床应用[J].中华检验医学杂志,2017,40(11):860-864.
[14]朱礼.肺癌骨转移血清肿瘤标志物水平及放疗对血清PINP和β-CTX水平的影响分析[J].河北医学,2017,23(3):394-398.
[15]张秋华,王静,李静,等.PICP和β-CTX在乳腺癌骨转移诊断和随访中的价值[J].湖南师范大学学报(医学版),2017,14(1):150-153.
[16]潘兴喜,杨文,杨画,等.肺癌骨转移患者放疗前后血清β-CTX和PINP水平变化及其与疗效的关系[J].山东医药,2015,55(8):31-33.
[2]张萌萌.中国老年学学会骨质疏松委员会骨代谢生化指标临床应用专家共识[J].中国骨质疏松杂志,2014,20(11):1263-1272.
[3]TANKLB,KARSDAL MA,CHRISTIANSEN C,et al.Biochemical approach to the detection and monitoring of metastatic bone disease:what do we know and what questions need answers?[J].Cancer Metastasis Rev,2006,25(4):659-668.
[4]唐琼,赵辉,贾锐,等.BAP和β-CTX与肺癌骨转移进展程度的相关性[J].中国肺癌杂志,2013,16(3):144-147.
[5]FERREIRA A,ALHO I,CASIMIRO S,et al.Bone remodeling markers and bone metastases:From cancer research to clinical implications[J].Bonekey Rep,2015,4:668.
[6]于世英.恶性肿瘤骨转移的诊断与治疗[M].2版.北京:中国协和医科大学出版社,2012:5.
[7]吴晓徽,陆汉魁.骨代谢指标在肿瘤骨转移诊治中的应用[J].肿瘤,2007,27(6):505-507.
[8]HERRMANN M,SEIBEL MJ.The amino-and carboxyterminal cross-linked telopeptides of collagen type I,NTX-I and CTX-I:a comparative review[J].Clin Chim Acta,2008,393(2):57-75.
[9]LUMACHI F,SANTEUFEMIA DA,DEL CONTE A,et al.Carboxy-terminal telopeptide(CTX)and amino-terminal propeptide(PINP)of type I collagen as markers of bone metastases in patients with non-small cell lung cancer[J].Anticancer Res,2013,33(6):2593-2596.
[10]彭东,刘学芬,刘徽婷,等.骨代谢指标结合全身骨显像在肿瘤骨转移早期诊断中的临床价值[J].国际检验医学杂志,2017,38(17):2395-2398.
[11]吴春娇,马丽霞,朱晶,等.联合检测乳腺癌骨转移患者中尿Ⅰ型胶原氨基末端肽和Ⅰ型胶原羧基末端肽的临床意义[J].中华肿瘤杂志,2016,38(9):693-697.
[12]潘兴喜,杨文,杨画,等.血清β-CTX、PINP在肺癌骨转移诊断中的意义[J].中华临床医师杂志(电子版),2015,9(9):1735-1736.
[13]韩丽敏,魏丽荣,杜玉珍.骨代谢标志物t P1NP和β-CTx及BAP在肺癌骨转移中的临床应用[J].中华检验医学杂志,2017,40(11):860-864.
[14]朱礼.肺癌骨转移血清肿瘤标志物水平及放疗对血清PINP和β-CTX水平的影响分析[J].河北医学,2017,23(3):394-398.
[15]张秋华,王静,李静,等.PICP和β-CTX在乳腺癌骨转移诊断和随访中的价值[J].湖南师范大学学报(医学版),2017,14(1):150-153.
[16]潘兴喜,杨文,杨画,等.肺癌骨转移患者放疗前后血清β-CTX和PINP水平变化及其与疗效的关系[J].山东医药,2015,55(8):31-33.