135例脊髓损伤患者骨代谢标志物的回顾性分析

doi:10.3969/j.issn.1006-9771.2021.02.006

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (2): 156-163.doi: 10.3969/j.issn.1006-9771.2021.02.006

135例脊髓损伤患者骨代谢标志物的回顾性分析

康海琼^1,²,周红俊^1,²(),卫波^1,²,王一吉^1,²,刘根林^1,²,刘志忠^1,²,郑樱^1,²,郝春霞^1,²,张缨^1,²,逯晓蕾^1,²,袁媛^1,²,蒙倩茹^1,²

^1.首都医科大学康复医学院，北京市 100068
^2.中国康复研究中心北京博爱医院，北京市 100068

收稿日期:2020-04-20 修回日期:2020-12-28 出版日期:2021-02-25 发布日期:2021-02-26
通讯作者: 周红俊 E-mail:zh87569303@qq.com
作者简介:康海琼(1979-)，女，汉族，山东诸城市人，硕士，主治医师，主要研究方向：脊髓损伤康复。
基金资助:
中国康复研究中心课题(2018ZX-Q8)

Bone Metabolism Biochemical Markers for Spinal Cord Injury: A Retrospective Study of 135 Patients

Hai-qiong KANG^1,²,Hong-jun ZHOU^1,²(),Bo WEI^1,²,Yi-ji WANG^1,²,Gen-lin LIU^1,²,Zhi-zhong LIU^1,²,Ying ZHENG^1,²,Chun-xia HAO^1,²,Ying ZHANG^1,²,Xiao-lei LU^1,²,Yuan YUAN^1,²,Qian-ru MENG^1,²

^1.Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
^2.Beijing Bo'ai Hospital, China Rehabilitation Research, Beijing 100068, China

Received:2020-04-20 Revised:2020-12-28 Published:2021-02-25 Online:2021-02-26
Contact: Hong-jun ZHOU E-mail:zh87569303@qq.com
Supported by:
China Rehabilitation Research Centre Project(2018ZX-Q8)

摘要/Abstract

摘要： 目的

观察脊髓损伤患者骨代谢标志物与临床特点的关系。

方法

2018年7月至2019年12月，在本院住院康复治疗的脊髓损伤患者共135例，评定患者美国脊柱损伤协会残损分级(AIS)，检测患者空腹血清β-I型胶原羧基端肽(β-CTX)、总I型前胶原Ｎ端前肽(TP1NP)、25-OH-维生素D[25(OH)D]、甲状旁腺激素(PTH)、血清钙和血清磷水平。分析性别、年龄、病程、AIS等临床特点与TP1NP、β-CTX、25(OH)D和PTH等骨代谢标志物的关系。

结果

女性β-CTX和25(OH)D水平明显低于男性(|t| > 2.044, P < 0.01)。不同年龄组间25(OH)D水平有显著性差异(F = 3.156, P < 0.05)。所有患者β-CTX和TP1NP水平在脊髓损伤后4个月内逐渐升高，4个月后开始下降；PTH在脊髓损伤后4个月内逐渐下降，4个月后开始升高(P < 0.001)。AIS D级患者β-CTX水平低于A级和C级患者(t >2.679, P < 0.05)。截瘫患者TP1NP水平高于四肢瘫患者(Z = -2.035, P < 0.05)。有脊柱骨折或涉及脊柱手术的患者β-CTX水平高于无脊柱骨折或涉及脊柱手术的患者(t = 2.169, P < 0.05)；下肢有运动功能的患者与下肢无运动功能的患者骨代谢标志物无显著性差异(t < 0.839, Z < 1.822, P > 0.05)。所有患者中25(OH)D缺乏和不足的比例占85.19%。

结论

脊髓损伤后4个月内骨转换活跃，4个月后骨转换活跃程度逐渐下降，可能与损伤时有脊柱骨折或损伤后有涉及脊柱的手术有关。脊髓损伤对骨代谢标志物的影响尚不能明确。脊髓损伤患者普遍存在25(OH)D不足或缺乏。

关键词: 脊髓损伤, 骨代谢标志物, 临床特点

Abstract: Objective

To observe the relationship between bone metabolism biochemical markers and clinic features in patients with spinal cord injury.

Methods

From July, 2018 to December, 2019, totally 135 patients with spinal cord injury were enrolled. They were assessed with American Spinal Injury Association Impairment Scale (AIS). β-collagen type I C-terminal telopeptide (β-CTX), total N-terminal propeptide of type I precollagen (TP1NP), 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH), serum calcium and serum phosphorus were measured. The level of TP1NP, β-CTX, 25(OH)D and PTH among clinical characteristics (gender, age, disease course, AIS grade and so on) were analyzed.

Results

The levels of β-CTX and 25(OH)D were lower in women than in men (|t| > 2.044, P < 0.01). There was difference in the level of 25(OH)D among different ages (F = 3.156, P < 0.05). The levels of β-CTX and TP1NP increased in the first four months after spinal cord injury, and decreased then; while the level of PTH decreased in the first four months, and increased then (P < 0.001). The level of β-CTX was lower in patients of AIS D than in patients of AIS A and C (t >2.679, P < 0.05). The level of TP1NP was higher in paraplegics than in quadriplegics (Z = -2.035, P < 0.05). The level of β-CTX was higher in patients with fractures or surgeries involving bone than in patients without fractures or surgeries involving bone (t = 2.169, P < 0.05). There was no difference in all the bone metabolism markers between patients with and without lower extremity motor function (t < 0.839, Z < 1.822, P > 0.05). The ratio of 25(OH)D deficience was 85.19%.

Conclusion

Bone conversion was active in the first four months after spinal cord injury, and decreased gradually then, which may be related to fractures of spine or surgeries involving spine after injury. The effect of spinal cord injury on bone metabolism markers is not clear. Most of patients with spinal cord injury were lack of vitamin D.

Key words: spinal cord injury, bone metabolism markers, clinical characteristics

中图分类号:

R651.2

康海琼,周红俊,卫波,王一吉,刘根林,刘志忠,郑樱,郝春霞,张缨,逯晓蕾,袁媛,蒙倩茹. 135例脊髓损伤患者骨代谢标志物的回顾性分析[J]. 《中国康复理论与实践》, 2021, 27(2): 156-163.

Hai-qiong KANG,Hong-jun ZHOU,Bo WEI,Yi-ji WANG,Gen-lin LIU,Zhi-zhong LIU,Ying ZHENG,Chun-xia HAO,Ying ZHANG,Xiao-lei LU,Yuan YUAN,Qian-ru MENG. Bone Metabolism Biochemical Markers for Spinal Cord Injury: A Retrospective Study of 135 Patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(2): 156-163.

图/表 4

表1

所有患者骨代谢标志物比较"

项目		n	β-CTX (ng/ml)	TP1NP (ng/ml)	25(OH)D (ng/ml)	PTH (ng/ml)
性别	男	110	0.99±0.46	98.76(62.96, 144.08)	15.35±6.49	21.91(16.53, 32.39)
	女	25	0.79±0.29	103.33±65.87	9.88±2.64	25.30±8.94
年龄(岁)	< 30	39	1.01±0.42	136.20±91.22	13.50±5.41^a	23.18±12.14
	30~50	66	0.95±0.45	125.76±117.99	13.52±6.01^b	27.31±13.37
	> 50	30	0.88±0.44	98.00±77.42	16.86±7.56	26.32±13.18
病程(d)	< 30	31	1.01±0.50	74.48(48.14, 101.82)	12.97±5.94	25.86(19.77, 30.30)
	30~59	32	1.08±0.36	113(73.22, 142.2)	14.36(10.18, 20.41)	20.67±7.36
	60~119	23	1.18±0.44	137.2(111.1, 242.15)	14(9.39, 17.39)	17.71(15.41, 22.09)
	120~365	16	0.97±0.41	155.21±109.68	13.56±5.02	17.85(15.07, 21.96)
	366~1000	16	0.72±0.24	83.5(62.19, 109.65)	14.00±4.54	34.06±13.71
	> 1000	17	0.51±0.21	77.51±35.64	14.05±5.55	43.34±13.85
AIS分级	A	70	0.99±0.41^c	121.28±14.50	13.74±5.63	25.37±13.77
	B	15	0.99±0.41	117.15±58.48	14.49±8.16	22.43±10.42
	C	17	1.15±0.55^d	131.93±102.05	14.73±5.63	26.85±14.36
	D	33	0.76±0.39	81.55±58.76	15.35±7.23	29.84±12.11
截瘫/四肢瘫	截瘫	89	0.96±0.40	109.7(74.82, 139.3)	14.33±6.41	22.58(16.99, 31.06)
截瘫/四肢瘫	四肢瘫	46	0.95±0.50	66.71(50.2, 143.35)	14.37±6.23	27.50±14.14
有/无下肢运动功能(全体)	无	77	0.98±0.44	109.7(67.46,140.5)	14.15±6.19	20.65(15.59,32.71)
有/无下肢运动功能(全体)	有	58	0.92±0.43	107.11±79.16	14.60±6.55	27.92±12.49
有/无下肢运动功能(受伤120 d以内)	无	44	1.16±0.42	79.33(52.26,141.33)	14.52±6.75	19.75±7.83
有/无下肢运动功能(受伤120 d以内)	有	42	1.00±0.44	110.78±86.57	14.71±7.33	25.45±10.58
有/无脊柱骨折或涉及脊柱的手术	有	128	0.97±0.44	102.55(63.76, 140.88)	14.25±6.25	22.83(16.81, 32.06)
有/无脊柱骨折或涉及脊柱的手术	无	7	0.61±0.24	86.15±68.12	16.02±7.95	25.29±12.90
有/无骨质疏松	有	7	0.54±0.24	102.27±62.71	12.54±4.83	41.15±16.08
	无	128	0.98±0.44	100.35(62.12, 140.88)	14.44±6.39	21.91(16.63, 30.87)
性别	Z/t值		-2.044^g	-0.776^h	4.136^g	-0.207^h
	P值		0.009	0.438	< 0.001	0.836
年龄	F值		0.780^e	1.232^e	3.156^e	1.625^e
年龄	P值		0.461	0.295	0.046	0.201
病程	F/χ²值		36.230^f	26.050^f	0.790^e	44.160^f
病程	P值		< 0.001	< 0.001	0.558	< 0.001
AIS分级	F值		3.761^e	2.636^e	0.512^e	1.362^e
AIS分级	P值		0.014	0.052	0.674	0.257
截瘫/四肢瘫	Z/t值		-0.120^g	-2.305^h	0.042^g	-0.543^h
截瘫/四肢瘫	P值		0.904	0.021	0.967	0.587
有/无下肢运动功能	Z/t值		0.839^g	-1.709^h	-0.407^g	-1.822^h
有/无下肢运动功能	P值		0.403	0.087	0.684	0.068
有/无下肢运动功能(病程<120 d)	Z/t值		1.720^g	-2.000^h	-0.126^g	-2.850^g
有/无下肢运动功能(病程<120 d)	P值		0.088	0.045	0.900	0.005
有/无脊柱骨折或涉及脊柱的手术	Z/t值		2.169^g	-1.379^h	-0.718^g	-0.298^h
有/无脊柱骨折或涉及脊柱的手术	P值		0.032	0.168	0.474	0.766
有/无骨质疏松	Z/t值		2.650^g	-0.337^h	0.772^g	-2.610^h
有/无骨质疏松	P值		0.009	0.736	0.441	0.009

表1

图1

图2

图3

参考文献 40

1	Frotzler A, Krebs J, Göhring A, et al. Osteoporosis in the lower extremities in chronic spinal cord injury [J]. Spinal Cord, 2020, 58(4): 441-448.
2	Maïmoun L, Fattal C, Sultan C. Bone remodeling and calcium homeostasis in patients with spinal cord injury: a review [J]. Metabolism, 2011, 60(12): 1655-1663.
3	谷莉,周谋望. 脊髓损伤患者中骨代谢生化标志物变化的回顾性研究[J]. 中国康复医学杂志, 2017, 32(12): 1356-1360.
	Gu L, Zhou M W. A retrospective study on bone metabolism biochemical markers change in patients with spinal cord injury [J]. Chin J Rehabil Med, 2017, 32(12): 1356-1360.
4	赵国权,罗春山,陆廷盛,等. 颈脊髓损伤后患者P1NP和β-CTX的研究分析[J]. 中国骨质疏松杂志, 2017, 23(12): 1617-1620.
	Zhao G Q, Luo C S, Lu T S, et al. Analysis of P1NP and β-CTX in patients after cervical spinal injury [J]. Chin J Osteopor, 2017, 23(12): 1617-1620.
5	美国脊髓损伤协会,国际脊髓损伤学会.脊髓损伤神经学分类国际标准(2011年修订)[J]. 李建军,王方永,译. 中国康复理论与实践, 2011, 17(10): 963-972.
	American Spinal Injury Association, International Spinal Cord Society. International Standards for Neurological Classification of Spinal Cord Injury [J]. Li J J, Wang F Y, trans. Chin J Rehabil Theory Pract, 2011, 17(10): 963-972.
6	陈德才,廖二元,徐苓,等. 骨代谢生化标志物临床应用指南[J]. 中华骨质疏松和骨矿盐疾病杂志, 2015, 8(4): 283-293.
	Chen D C, Liao E Y, Xu L, et al. Guidelines for clinical application of biochemical markers of bone metabolism [J]. Chin J Osteop Bone Mineral Res, 2015, 8(4): 283-293.
7	Johansson H, Odén A, Kanis J A, et al. A meta-analysis of reference markers of bone turnover for prediction of fracture [J]. Calcif Tissue Int, 2014, 94(5): 560-567.
8	Garnero P, Cloos P, Sornay-Rendu E, et al. Type I collagen racemization and isomerization and the risk of fracture in postmenopausal women: the OFELY prospective study [J]. J Bone Miner Res, 2002, 17(5): 826-833.
9	Johnell O, Scheele W H, Lu Y, et al. Additive effects of raloxifene and alendronate on bone density and biochemical markers of bone remodeling in postmenopausal women with osteoporosis [J]. J Clin Endocrinol Metab, 2002, 87(3): 985-992.
10	Ross P D, Kress B C, Parson R E, et al. Serum bone alkaline phosphatase and calcaneus bone density predict fractures: a prospective study [J]. Osteoporos Int, 2000, 11(1): 76-82.
11	Reiter A L, Volk A, Vollmar J, et al. Changes of basic bone turnover parameters in short-term and long-term patients with spinal cord injury [J]. Eur Spine J, 2007, 16(6): 771-776.
12	Zehnder Y, Lüthi M, Michel D, et al. Long-term changes in bone metabolism, bone mineral density, quantitative ultrasound parameters, and fracture incidence after spinal cord injury: a cross-sectional observational study in 100 paraplegic men [J]. Osteoporos Int, 2004, 15(3): 180-189.
13	Maïmoun L, Couret I, Mariano-Goulart D, et al. Changes in osteoprotegerin/RANKL system, bone mineral density, and bone biochemicals markers in patients with recent spinal cord injury [J]. Calcif Tissue Int, 2005, 76(6): 404-411.
14	Thakkar P, Prakash N B, Tharion G, et al. Evaluating bone loss with bone turnover markers following acute spinal cord injury [J]. Asian Spine J, 2020, 14(1): 97‐105.
15	Paker N, Bugdayci D, Ersoy S, et al. Bone loss and bone turnover in acute and chronic spinal cord injured patients [J]. Neurosciences (Riyadh), 2007, 12(3): 232-235.
16	Gaspar A P, Brandão C M, Lazaretti-Castro M. Bone mass and hormone analysis in patients with spinal cord injury:evidence for a gonadal axis disruption [J]. J Clin Endocrinol Metab, 2014, 99(12): 4649-4655.
17	Maïmoun L, Ben Bouallègue F, Gelis A, et al. Periostin and sclerostin levels in individuals with spinal cord injury and their relationship with bone mass, bone turnover, fracture and osteoporosis status [J]. Bone, 2019, 127: 612-619.
18	Jørgensen V, Slettahjell H B, Skavberg Roaldsen K, et al. Carboxy terminal collagen crosslinks as a prognostic risk factor for fall-related fractures in individuals with established spinal cord injury [J]. Spinal Cord, 2019, 57(11): 985-991.
19	Goenka S, Sethi S, Pandey N, et al. Effect of early treatment with zoledronic acid on prevention of bone loss in patients with acute spinal cord injury: a randomized controlled trial [J]. Spinal Cord, 2018, 56(12): 1207-1211.
20	Liu D, Zhao C Q, Li H, et al. Effects of spinal cord injury and hindlimb immobilization on sublesional and supralesional bones in young growing rats [J]. Bone, 2008, 43(1): 119-125.
21	Roberts D, Lee W, Cuneo R C, et al. Longitudinal study of bone turnover after acute spinal cord injury [J]. J Clin Endocrinol Metab, 1998, 83(2): 415-422.
22	Kostovski E, Hjeltnes N, Eriksen E F, et al. Differences in bone mineral density, markers of bone turnover and extracellular matrix and daily life muscular activity among patients with recent motor-incomplete versus motor-complete spinal cord injury [J]. Calcif Tissue Int, 2015, 96(2): 145-154.
23	Veitch S W, Findlay S C, Hamer A J, et al. Changes in bone mass and bone turnover following tibial shaft fracture [J]. Osteoporos Int, 2006, 17(3): 364-372.
24	Akesson K, Käkönen S M, Josefsson P O, et al. Fracture-induced changes in bone turnover: a potential confounder in the use of biochemical markers in osteoporosis [J]. J Bone Miner Metab, 2005, 23(1): 30-35.
25	Zhao J, Xia W, Nie M, et al. The levels of bone turnover markers in Chinese postmenopausal women: Peking vertebral fracture study [J]. Menopause, 2011, 18(11): 1237-1243.
26	王福斌. β-CTx、P1NP在绝经后女性骨质疏松性骨折诊疗中的临床应用[D]. 杭州:浙江大学, 2016.
	Wang F B. The clinical value of β-CTx and P1NP detection in evaluation risks of fragile fracture in postmenopausal women with osteoporosis [D]. Hangzhou: Zhejiang University, 2016.
27	Wölfl C, Schweppenhäuser D, Gühring T, et al. Characteristics of bone turnover in the long bone metaphysis fractured patients with normal or low bone mineral density (BMD) [J]. PLoS One, 2014, 9(5): e96058.
28	Stoffel K, Engler H, Kuster M, et al. Changes in biochemical markers after lower limb fractures [J]. Clin Chem, 2007, 53(1): 131-134.
29	Kurdy N M, Bowles S, Marsh D R, et al. Serology of collagen types I and III in normal healing of tibial shaft fractures [J]. J Orthop Trauma, 1998, 12(2): 122-126.
30	Qi H, Xue J, Gao J, et al. Changes of bone turnover markers and bone tissue content after severe osteoporotic vertebral compression fracture [J]. Med Sci Monit, 2020, 26: e923713.
31	李晓峰. 骨转换标志物对骨质疏松症药物治疗的临床意义研究[D]. 济南:山东大学, 2017.
	Li X F. The research of clinical significance of bone turnover markers in the treatment of osteoporosis [D]. Jinan: Shandong University, 2017.
32	Gueye Y, Marqueste T, Maurel F, et al. Cholecalciferol (vitamin D₃) improves functional recovery when delivered during the acute phase after a spinal cord trauma [J]. J Steroid Biochem Mol Biol, 2015, 154: 23-31.
33	Koutrakis N E, Goldstein R L, Walia P, et al. Vitamin D, diet, and lifestyle in a chronic SCI population [J]. Spinal Cord, 2019, 57(2): 117-127.
34	廖祥鹏,张增利,张红红,等. 维生素D与成年人骨骼健康应用指南(2014年简化版)[J]. 中国骨质疏松杂志, 2014, 20(6): 718-722.
	Liao X P, Zhang Z L, Zhang H H, et al. Application guideline for vitamin D and bone health in adult Chinese (2014 Starter Edition) [J]. Chin J Osteopor, 2014, 20(6): 718-722.
35	魏秋实,陈镇秋,谭新,等. 中国男性和女性血清25羟维生素D水平与年龄、性别和骨密度之间的关系[J]. 实用骨科杂志, 2016, 22(5): 480.
	Wei Q S, Chen Z Q, Tan X, et al. Relation of age, sex and bone mineral density to serum 25-hydroxyvitamin D levels in Chinese women and men [J]. J Prac Orthop, 2016, 22(5): 480.
36	Hummel K, Craven B C, Giangregorio L. Serum 25(OH)D, PTH and correlates of suboptimal 25(OH)D levels in persons with chronic spinal cord injury [J]. Spinal Cord, 2012, 50(11): 812‐816.
37	Canalis E, Giustina A, Bilezikian J P. Mechanisms of anabolic therapies for osteoporosis [J]. N Engl J Med, 2007, 357(9): 905-916.
38	Harlow L, Sahbani K, Nyman J S, et al. Daily parathyroid hormone administration enhances bone turnover and preserves bone structure after severe immobilization-induced bone loss [J]. Physiol Rep, 2017, 5(18): e13446.
39	Linstow M V, Biering-Sørensen F. Immobilisation-induced hypercalcemia following spinal cord injury affecting the kidney function in two young native Greenlanders [J]. Spinal Cord Ser Cases, 2017, 3: 17010.
40	Massagli T L, Cardenas D D. Immobilization hypercalcemia treatment with pamidronate disodium after spinal cord injury [J]. Arch Phys Med Rehabil, 1999, 80(9): 998-1000.

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135例脊髓损伤患者骨代谢标志物的回顾性分析

Bone Metabolism Biochemical Markers for Spinal Cord Injury: A Retrospective Study of 135 Patients

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