占允中　叶舟　占蓓蕾

[摘要] 目的 探討绝经后骨质疏松性腰椎骨折患者血清Ⅰ型胶原羧基端肽β特殊序列（Type Ⅰ collagen carboxy- terminal peptide β-specific sequence，β-CTx）、Ⅰ型前胶原氨基端前肽（Type Ⅰ procollagen N-terminal propeptide，PINP）水平及意义。 方法 选择衢州市人民医院骨科2013年3月～2016年7月绝经后骨质疏松性腰椎骨折患者60例作为腰椎骨折组，绝经后骨质疏松无骨折患者60例作为对照组。测量髋部骨密度、腰椎骨密度和血清β-CTx、PINP水平。 结果 腰椎骨折组和对照组髋部骨密度和腰椎骨密度比较差异无显著性（P>0.05）。腰椎骨折组血清β-CTx、PINP水平高于对照组（P<0.05）。绝经后骨质疏松性腰椎骨折与血清β-CTx和PINP呈正相关（P<0.05）。β-CTx阈值为467.68 pg/mL时，诊断绝经后骨质疏松性腰椎骨折的ROC曲线下面积、敏感性、特异性分别为0.823、0.86、0.67；PINP阈值为29.34 ng/mL时，诊断绝经后骨质疏松性腰椎骨折的ROC曲线下面积、敏感性、特异性分别为0.651、0.89、0.43；β-CTx和PINP联合检测诊断绝经后骨质疏松性腰椎骨折的ROC曲线下面积、敏感性、特异性分别为0.891、0.94、0.83。 结论 绝经后骨质疏松性腰椎骨折患者血清β-CTx、PINP水平升高，β-CTx对绝经后骨质疏松性腰椎骨折的诊断价值高于PINP，两者联合检测对绝经后骨质疏松性腰椎骨折的诊断价值高于两者单独检测。

[关键词] 绝经后；骨质疏松；腰椎骨折；Ⅰ型胶原羧基端肽β特殊序列；Ⅰ型前胶原氨基端前肽

[中图分类号] R580；R683 [文献标识码] A [文章编号] 1673-9701（2018）20-0009-04

Serum levels of β-CTx and PINP in postmenopausal osteoporotic lumbar fractures and their significance

ZHAN Yunzhong YE Zhou ZHAN Beilei ZHANG Junchao

Department of Orthopedics， Quzhou People's Hospital in Zhejiang Province， Quzhou 324000， China

[Abstract] Objective To investigate the serum levels of Type Ⅰ collagen carboxy-terminal peptide β-specific sequence（β-CTx） and Type Ⅰ procollagen amino terminal propeptide（PINP） in postmenopausal osteoporotic lumbar fractures and their significance. Methods 60 patients of postmenopausal osteoporotic lumbar fractures were selected as lumbar fracture group， and 60 cases of postmenopausal osteoporotic patients without fracture were selected as control group in the Quzhou City People's Hospital orthopedics from March 2013 to July 2016.The bone mineral density， lumbar vertebrae bone mineral density and serum β-CTx and PINP levels were measured. Results There was no significant difference in hip bone mineral density and lumbar vertebrae bone mineral density between the lumbar vertebrae fracture group and the control group（P>0.05）. The levels of serum β-CTx and PINP in the lumbar fracture group were higher than those in the control group（P<0.05）. The postmenopausal osteoporotic lumbar fractures were positively correlated with serum β-CTx and serum PINP（P<0.05）. When the β-CTx threshold was 467.68 pg/mL， the area under the ROC curve， sensitivity， specificity of β-CTx diagnosis the postmenopausal osteoporotic lumbar fracture postmenopausal osteoporotic lumbar fractures were 0.823， 0.86 and 0.67 respectively. When the P1NP threshold was 29.34ng/mL， the area under the ROC curve， sensitivity， specificity of PINP diagnosis the postmenopausal osteoporotic lumbar fracture postmenopausal osteoporotic lumbar fractures were 0.651， 0.89， 0.43 respectively. The area under the ROC curve， sensitivity， specificity of β-CTx and PINP diagnosis the postmenopausal osteoporotic lumbar fracture postmenopausal osteoporotic lumbar fractures were 0.891， 0.94 and 0.83， respectively. Conclusion The serum β-CTx， PINP levels in patients with postmenopausal osteoporotic lumbar fractures increase. The diagnostic value of β-CTx on postmenopausal osteoporotic lumbar fractures is higher than PINP. The diagnostic value of the combined detection of β-CTx and PINP on menopausal osteoporotic lumbar fracture is higher than the two separate tests.

[Key words] Postmenopausal； Osteoporosis； Lumbar fracture； Type Ⅰ collagen carboxy terminal peptide β special sequence； Type Ⅰ procollagen amino terminal propeptide

骨质疏松症是一种慢性疾病，其特征为骨代谢物增加、骨密度下降、骨微结构破坏，随着人口的老年化的加剧和生活方式的改变，骨质疏松症的发生率明显增加[1-3]；骨质疏松症在绝经后老年妇女中的发病率比较高，成为影响绝经后妇女健康的严重问题，绝经后骨质疏松在绝经后10年左右好发，发病年龄在50～70岁女性中多见[4]。绝经后骨质疏松性骨折是绝经后骨质疏松常见的并发症之一，常见的骨折部位为髋部骨折、椎体骨折和前臂骨折等[5]。β-CTx为细胞外基质中的胶原纤维降解产物，可反映骨基质降解速率[6]；PINP可反映Ⅰ型胶原合成速率和成骨活性[7]。本文对绝经后骨质疏松性腰椎骨折患者血清β-CTx、PINP水平进行检测，探讨其在绝经后骨质疏松性腰椎骨折诊断中的价值。

1 资料与方法

1.1 临床资料

选择衢州市人民医院骨科2013年3月～2016年7月绝经后骨质疏松性腰椎骨折患者60例作为腰椎骨折组，年龄58～74岁，平均（66.43±7.68）岁；绝……