摘要目的 探讨尿Ⅰ型胶原氨基末端肽(uNTX)、血清骨特异性碱性磷酸酶(sBAP)水平在多发性骨髓瘤(MM)骨病中的临床意义,并了解双膦酸盐对MM溶骨性骨病的治疗作用.方法 53例MM患者(初治33例、复发难治10例、平台期10例)分为两组:氯膦酸盐联合化疗组(简称治疗组)33例,单纯化疗组(简称对照组)20例.应用酶联免疫吸附试验(ELISA法)检测uNTX浓度,应用化学发光法检测sBAP浓度.结果 ①治疗组和对照组治疗前uNTX水平分别为(173.74±14.55)μg/L和(129.79±12.13)μg/L,差异无统计学意义(P＞0.05).治疗6个月后,治疗组为(85.71±8.23)μg/L,明显低于对照组[(121.59±12.43)μg/L](P＜0.05).同时治疗组中治疗前与治疗后3个月(P=0.045)、治疗后6个月(P＜0.01)相比,差异均有统计学意义.②治疗组和对照组治疗前血清sBAP水平分别为(4.78±0.55)μg/L和(8.42±1.32)μg/L,差异无统计学意义(P＞0.05)；治疗6个月后,治疗组为(16.01±0.52)μg,/L,明显高于对照组[(9.62±1.29)μg/L](P＜0.01).同时治疗组中治疗前与治疗后3个月相比,差异无统计学意义(P＞0.05)；治疗前与治疗后6个月相比,差异有统计学意义(P＜0.01).结论 骨代谢标志物uNTX、sBAP是临床了解MM患者溶骨性骨病的早期敏感指标.同时,双膦酸盐可以减轻MM患者骨质的降解代谢,促进其合成代谢,对MM溶骨性骨病有一定的治疗价值.

abstractsObjective To explore the clinical value of urine N-telopeptides of type Ⅰ collagen(uNTX)and serum bone specificalkaline phosphatase(sBAP)in myeloma bone disease,and to understand the role of bisphosphonates therapy for multiple myeloma(MM)osteolytic bone lesion.Methods Thirty-three MM cases were treated with bisphosphonates combined with chemotherapy(considered as treatment group),and 20 untreated MM cases with chemotherapy alone considered as control group.uNTX was detected by ELISA,and sBAP by chemiluminescence analysis.Results ①There was no significant differences in uNTX between treatment[(173.74 ± 14.55)μg/L]and control groups[(129.79 ± 12.13)μg/L]before bisphosphonates treatment(P ＞ 0.05).After six-month treatment,there was significant differences between two groups[(85.71 ± 8.23)μg/L and(121.59 ± 12.43)μg/L,respectively](P ＜ 0.05); Meanwhile,there were significant differences in uNTX between before and after three-month treatment(P =0.045)and between before and after six-month treatment(P ＜0.01)in treatment group.②There was no significant differences in sBAP concentration between treatment and control groups[(4.78 ± 0.55)μg/L and(8.42 ±1.32)μg/L,respectively]before treatment(P ＞ 0.05).After six-month treatment,there were significant differences between them[(16.01 ±0.52)μg/L and(9.62 ± 1.29)μg/L,respectively](P ＜0.01).Meanwhile,in treatment group,there was no significant differences between before and after three-month treatment(P ＞0.05),but being significant difference between before and after six-month treatment(P ＜0.01).Conclusion uNTX,sBAP are important early sensitive index to measure the osteolytic bone lesion in MM patients.Bisphosphonates can significantly improve the osteopathy in MM cases.