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目的:观察鼻咽癌放疗患者血、尿中骨代谢生化指标的改变,探讨放疗对颌骨代谢的影响及这些指标改变的意义。方法:采集22例鼻咽癌初诊患者在单纯放疗前、放疗30Gy后、放疗50Gy 3个时段的血、尿标本,检测标本中骨代谢生化指标:用酶联免疫吸附法测定血清BAP、TRACP-5b水平,用偶氮胂三法测定尿Ca水平,同时为减少尿液浓度对尿Ca水平的影响,用苦味酸不除蛋白法测定尿Cr,用尿Ca/Cr表示尿Ca水平的变化。采用SPSS17.0软件包,以配对t检验分析3个时段血清BAP、TRACP-5b水平差异,以Mann-Whitney检验分析3个时段尿Ca/Cr水平差异。结果:患者血清BAP水平随放疗剂量增加呈下降趋势,在50Gy时较放疗前有统计学差异(P<0.05);血清TRACP-5b水平变化在放疗前后无统计学差异(P>0.05);尿Ca/Cr水平随着放疗剂量增加呈明显下降趋势,在30Gy及50Gy时较放疗前均有统计学差异(P<0.05)。结论:放疗抑制鼻咽癌患者颌骨的正常代谢,骨代谢生化指标血清BAP、尿Ca/Cr能够敏感反映颌骨早期的放射性改变。
OBJECTIVE: To observe the changes of biochemical markers of bone metabolism in blood and urine of patients with nasopharyngeal carcinoma (NPC) treated by radiotherapy and to explore the effects of radiotherapy on the metabolism of the jaw and the significance of the changes of these indicators. Methods: Blood samples and urine samples from 22 newly diagnosed nasopharyngeal carcinoma patients before radiotherapy, 30 Gy radiotherapy and 50 Gy of radiotherapy were collected to detect the biochemical markers of bone metabolism. The levels of serum BAP and TRACP-1 were measured by enzyme-linked immunosorbent assay (ELISA) 5b level. The urinary Ca level was measured by arsenazo three-method. At the same time, in order to reduce the effect of urine concentration on urinary calcium level, urine Cr level was measured by picric acid non-removing protein method. SPSS17.0 software package was used to analyze the differences of serum BAP and TRACP-5b levels in three periods by paired t-test. Urinary Ca / Cr levels in three periods were analyzed by Mann-Whitney test. Results: Serum BAP level decreased with the increase of radiotherapy dose, and there was a significant difference at 50 Gy before radiotherapy (P <0.05); serum TRACP-5b level had no significant difference before and after radiotherapy (P> 0.05) The level of Ca / Cr decreased significantly with the increase of radiotherapy dose, and there was a significant difference at 30Gy and 50Gy before radiotherapy (P <0.05). Conclusion: Radiotherapy can inhibit the normal metabolism of the jaw bone in patients with nasopharyngeal carcinoma. The serum BAP and urinary Ca / Cr, biochemical markers of bone metabolism, can reflect the early radioactive changes of the jaw.