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目的分析40～60岁女性不同年龄段的血清中总I型前胶原氨基端肽(procollagen Ⅰ N-terminal peptide,PINP)、β-胶原降解产物(β-Crosslaps)、N端骨钙素(N-MID)及甲状旁腺素(parathyroid hormone,PTH)的变化规律,以及这几项骨转换指标与骨密度(bone mineral density,BMD)的相关性。方法①骨生化指标测定:上午8～9点空腹抽取肘静脉血4 ml,即时分离血清,采用电化学发光免疫分析法分析血清中PINP、β-Crosslaps、N-MID及PTH的含量。②骨密度测定:采用美国GE公司生产的Lunar Prodigy双能X线骨密度测定仪(dual energy X-ray absorptiometry,DEXA),检测各部位BMD。结果①40～44岁年龄段妇女血清中PINP、β-Crosslaps及N-MID相对较低,45～49岁年龄段PINP、β-Crosslaps开始明显升高(P<0.05),而50～54岁年龄段又较45～49岁年龄段有明显的上升(P<0.05),N-MID只在50～54年龄段较前一年龄段明显上升(P<0.05),随后三个指标都在55～60岁年龄段出现小幅回落;四个年龄段间妇女血中PTH有随年龄而升高的趋势,但各组间皆无显著差异(P>0.05)。②PINP与腰椎1～4(L1～L4)的BMD呈负相关(P<0.05);β-Crosslaps、N-MID与L1～L4、Ward’s以及Troch的BMD均呈显著负相关(P均<0.05);PTH与各部位的BMD无明显相关性(P>0.05)。③所测各区域,与正常骨量组比较,低骨量组及骨质疏松组妇女的PINP、β-Crosslaps均显著升高(P<0.05);低骨量组[除左侧股骨颈(femeralneck,FN)部位外]及骨质疏松组妇女的N-MID显著升高(P<0.05);低骨量组妇女L1-L4及FN区域的PTH显著升高(P<0.05),骨质疏松组妇女所测所有区域的PTH均显著上升(P<0.05)。结论高骨转换状态是围绝经期女性骨量丢失的重要原因。PINP、β-Crosslaps、N-MID及PTH在反映围绝经期女性随年龄变化的骨转换上具有较强的敏感性和特异性,监测这几个指标有助于早期防治骨质疏松症。
Objective To analyze the changes of serum total procollagen Ⅰ (PINP), β-crosslaps, N-terminal osteocalcin (N) in serum of 40-60 years old women of different ages -MID) and parathyroid hormone (PTH), as well as the correlation between these bone turnover indexes and bone mineral density (BMD). Methods ① Biochemical analysis of bone: 4 ml of elbow venous blood was drawn on 8 to 9 AM for fasting serum samples. The levels of PINP, β-Crosslaps, N-MID and PTH in serum were determined by chemiluminescence immunoassay. ② Measurement of BMD: Dual energy X-ray absorptiometry (DEXA) was used to detect the BMD of each part by GE company. Results ① The serum levels of PINP, β-Crosslaps and N-MID in women aged 40-44 years old were relatively low, and PINP and β-Crosslaps in 45-49 years old group were significantly higher than those in the age group of 50-54 years old (P <0.05). The N-MID only increased significantly in the 50-54 age group compared with the previous age group (P <0.05), and then the three indexes all ranged from 55 ~ There was a slight drop in the 60-year-old age group; PTH in the blood of the four age groups tended to increase with age, but there was no significant difference between the groups (P> 0.05). (P <0.05) .PINP was negatively correlated with BMD of lumbar spine 1-4 (L1 ~ L4) (P <0.05). There was a significant negative correlation between β-Crosslaps and N-MID with L1 ~ L4, Ward’s and Troch (all P < There was no significant correlation between PTH and BMD in different parts (P> 0.05). (3) Compared with the normal bone mass group, the PINP and β-Crosslaps in the low bone mass group and the osteoporosis group were significantly increased (P <0.05); in the low bone mass group [except the left femoral neck (P <0.05). The PTH levels of L1-L4 and FN in women with low bone mass were significantly increased (P <0.05), and the bone mass PTH in all areas measured by loose women increased significantly (P <0.05). Conclusion High bone turnover status is an important cause of bone loss in perimenopausal women. PINP, β-Crosslaps, N-MID and PTH in the perimenopausal women reflect the age-related bone turnover with strong sensitivity and specificity, the monitoring of these indicators will help early prevention and treatment of osteoporosis.