Ⅰ型神经纤维瘤病伴脊柱侧凸患者骨密度与血清骨钙素和骨代谢生化指标的相关性

The relationship of bone mineral density with osteocalcin and bone metabolism index in scoliosis patients secondary to neurofibromatosis type 1

中文关键词:  Ⅰ型神经纤维瘤病  脊柱侧凸  骨密度  骨钙素  骨代谢指标

英文关键词:Neurofibromatosis type 1  Scoliosis  Bone mineral density  Osteocalcin  Bone metabolism index

中文摘要:

  【摘要】 目的：探讨Ⅰ型神经纤维瘤病（neurofibromatosis type 1，NF1） 伴脊柱侧凸患者骨密度（BMD）与血清骨钙素（BGP）及骨代谢生化指标的相关性。方法：选取2012年2月~2013年3月我院脊柱外科收治的17例NF1伴脊柱侧凸（NF1-S）患者为观察对象（病例组），年龄8~18岁，Cobb角40°~143°；17例正常儿童及青少年作为对照组，年龄7~19岁。两组均采用双能X线骨密度吸收仪测量非优势侧的股骨近端和腰椎（L2~L4）的BMD，同时采用免疫分析仪检测BGP水平，血生化分析仪检测碱性磷酸酶（ALP）、血钙（血Ca）、血磷（血P）、尿钙/肌酐比值（尿Ca/Cr）和尿磷/肌酐比值（尿P/Cr）。应用SPSS 16.0软件进行统计分析，采用独立样本t检验分析两组BMD及各项骨代谢生化指标之间的差异；Pearson相关分析病例组患者腰椎BMD与对应各项骨代谢生化指标的相关关系。结果：两组受试者年龄、性别构成比无统计学差异（P>0.05）。病例组所测各部位BMD均明显低于正常对照组，差异有显著性（P<0.05）；BGP（135.6ng/ml）、血Ca（2.59mmol/L）、血P（1.75mmol/L）、尿Ca/Cr（0.10mg/mg）均高于正常对照组（79ng/ml、2.45mmol/l、1.47mmol/l、0.06mg/mg），差异均具有显著性（P<0.05），而ALP（141.6u/L vs 141.8u/l，t=3.611，P=0.991）和尿P/Cr（0.47mg/mg vs 0.46mg/mg，t=0.054，P=0.957）则无显著性差异（P>0.05）。NF1-S患者腰椎BMD与BGP（r=-0.916，P=0.000）、尿Ca/Cr（r=-0.968，P=0.000）存在显著性负相关。结论：NF1-S患者BMD明显低于正常人；BGP、血Ca、血P和尿Ca/Cr均高于正常人，测定BGP、尿Ca/Cr水平是监测NF1-S患者BMD变化较为敏感的方法之一。

英文摘要:

  【Abstract】 Objectives: To investigate the relationship of bone mineral density(BMD) with osteocalcin(BGP) and serum levels of bone metabolism indexes in scoliosis patients secondary to neurofibromatosis type 1(NF1-S). Methods: From February 2012 to March 2013, 17 NF1-S patients aged 8-18 years old and with the Cobb angle ranging from 40° to 143° were recruited as the case group, while 17 healthy peers ranged 7-19 years old were recruited as the control group. Dual-energy X-ray absorptiometry was used to measure the BMD of two groups. The bone metabolism indexes including BGP, serum alkaline phosphatase(ALP), serum calcium, serum phosphorus, urinary calcium, urinary phosphorus, and urinary creatinine were measured by using electro-chemilumin escence immunoassay and an automatic biochemical analyzer. SPSS 16.0 software was used for data analysis. Independent-sample t test was used to analyze the differences of BMD and bone metabolism indexes between two groups, the relationship between lumbar BMD and bone metabolism was accessed by using Pearson correlation analysis. Results: No difference in terms of age and sex was noted in two groups(P>0.05). The BMD of the lumbar spine and the proximal femur in case group was significantly lower than that of the control group(P<0.05). The levels of BGP(135.6ng/ml), serum calcium(2.59mmol/L), serum phosphorus(1.75mmol/L) and urinary calcium/creatinine(U Ca/Cr, 0.10mg/mg) were significantly higher than those of control group(79ng/ml, 2.45mmol/L, 1.47mmol/l, 0.06mg/mg)(P<0.05). The levels of serum ALP(141.6u/L vs 141.8u/L, t=3.611, P=0.991) and urinary phosphorus/creatinine ration(U P/Cr, 0.47mg/mg vs 0.46mg/mg, t=0.054, P=0.957) showed no significance between two groups(P>0.05). The factors, including BGP(r=-0.916, P=0.000) and U Ca/Cr(r=-0.968, P=0.000), were both negatively related with lumbar BMD. Conclusions: The BMD in NF1-S patients is significantly lower than those of the normal control. The levels of BGP, serum calcium, serum phosphorus and U Ca/Cr in NF1-S patients are higher than that of the normal control. The level of BGP and U Ca/Cr is a more sensitive index to monitor the situation of BMD in NF1-S patients.