骨代謝指標物在骨質疏松癥診療中的應用進展_West China Medical Journal

Authors：

 朱傳美

四川大學華西醫院門診部（成都 610041）;

Corresponding?author：

Keywords：

骨代謝指標物; 骨質疏松癥; 骨密度; 骨強度

DOI：

10.7507/1002-0179.20150450

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骨質疏松癥（OP）屬于全球重要健康問題，主要以骨量減低、骨微結構損壞、以致骨脆性增加，骨折風險增高為特點。依照世界衛生組織標準，通過雙能X線檢測骨密度仍是目前診斷OP及判斷其嚴重程度的金標準。然而，由于骨密度并非影響骨強度的唯一因素，且具有結果相對恒定，對干預療效的反應不夠靈敏等不足之處，體現骨重建水平的骨代謝標志物則在一定程度上起到了與骨密度相輔相成的作用，對OP的輔助診斷、療效監測以及治療方案的選擇方面起到了良好的作用。不僅如此，由于骨密度不適宜頻繁檢測而缺乏對患者給予相應的正向療效反饋，導致OP患者依從性較低。而定期檢查骨代謝標志物，可行性好，通過其動態變化情況可提高依從性，使患者堅持治療。現就臨床上較為常用的幾種骨代謝指標作一綜述。

Citation： 朱傳美. 骨代謝指標物在骨質疏松癥診療中的應用進展. West China Medical Journal, 2015, 30(8): 1567-1570. doi: 10.7507/1002-0179.20150450 Copy

1.	Genant HK, Cooper C, Poor G, et al. Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis[J]. Osteoporos Int, 1999, 10(4):259-264.
2.	中華醫學會骨質疏松和骨礦鹽疾病分會. 原發性骨質疏松癥診治指南(2011年)[J]. 柳州醫學, 2012, 04(3):188-199.
3.	李寧華, 朱漢民, 區品中, 等. 中國部分地區中老年人群原發性骨質疏松癥患病率研究[J]. 中華骨科雜志, 2001, 21(5):18-21.
4.	Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis:synopsis of a WHO report. WHO Study Group[J]. Osteoporos Int, 1994, 4(6):368-381.
5.	肖恩, 孟萍. 骨質疏松骨代謝生化指標的研究進展[J]. 中國骨質疏松雜志, 2008, 14(3):212-216, 147.
6.	張紅, 羅湘杭, 謝輝, 等. 基質金屬蛋白酶-1、-2與女性年齡、骨轉換生化指標及骨密度的關系[J]. 中華內科雜志, 2006, 45(4):306-309.
7.	張新菊, 李融. 骨代謝標志物相關研究進展[J]. 山東醫藥, 2014(16):93-95.
8.	Pedersen BJ, Schlemmer A, Rosenquist C, et al. Circadian rhythm in typeⅠcollagen formation in postmenopausal women with and without osteopenia[J]. Osteoporos Int, 1995, 5(6):472-477.
9.	Hernández MV, Gua?abens N, Alvarez L, et al. Immunocytochemical evidence on the effects of glucocorticoids on typeⅠcollagen synthesis in human osteoblastic cells[J]. Calcif Tissue Int, 2004, 74(3):284-293.
10.	DeFranco DJ, Glowacki J, Cox KA, et al. Normal bone particles are preferentially resorbed in the presence of osteocalcin-deficient bone particles in vivo[J]. Calcif Tissue Int, 1991, 49(1):43-50.
11.	王琳, 牛愛軍. 骨代謝標志物在多發性骨髓瘤診治中的應用現狀[J]. 實用醫藥雜志, 2011, 28(9):844-846.
12.	闕文君, 馮正平. 骨轉換生化標志物的研究進展[J]. 中國骨質疏松雜志, 2014(5):575-579.
13.	L?fman O, Magnusson P, Toss G, et al. Common biochemical markers of bone turnover predict future bone loss:a 5-year follow-up study[J]. Clin Chim Acta, 2005, 356(1/2):67-75.
14.	楊國君, 呂龍. 骨轉換標志物與骨質疏松癥的研究進展[J]. 內蒙古醫科大學學報, 2012, 34(增刊1):105-110.
15.	O'brien CA. Control of RANKL gene expression[J]. Bone, 2010, 46(4):911-919.
16.	Jabbar S, Drury J, Fordham JN, et al. Osteoprotegerin, RANKL and bone turnover in postmenopausal osteoporosis[J]. J Clin Pathol, 2011, 64(4):354-357.
17.	Chen YH, Wu YW, Yang WS, et al. Relationship between bone mineral density and serum osteoprotegerin in patients with chronic heart failure[J]. PLoS One, 2012, 7(8):e44242.
18.	Qin YJ, Zhang ZL, Zhang H, et al. Age-related changes of serum tartrate-resistant acid phosphatase 5b and the relationship with bone mineral density in Chinese women[J]. Acta Pharmacol Sin, 2008, 29(12):1493-1498.
19.	王鴻度, 陳莊, 扶世杰, 等. 骨轉換生化標志物晝夜節律的研究進展[J]. 中國骨質疏松雜志, 2009, 15(12):944-948, 943.
20.	何娟文, 肖爭. 骨代謝標志物研究進展[J]. 中外健康文摘, 2013(48):146-147.
21.	賈成瑤, 李萍. 尿吡啶啉和脫氧吡啶啉是骨吸收特異性生化標志物[J]. 中國臨床康復, 2002, 6(15):2256-2257.
22.	Halleen JM. Tartrate-resistant acid phosphatase 5B is a specific and sensitive marker of bone resorption[J]. Anticancer Res, 2003, 23(2A):1027-1029.
23.	宋志榮, 張淑琴, 闞耀東. 尿脫氧吡啶啉測定和骨密度檢測對診斷骨質疏松癥的對比觀察[J]. 上海醫學檢驗雜志, 2002, 17(2):105-106.
24.	Schlemmer A, Hassager C. Acute fasting diminishes the circadian rhythm of biochemical markers of bone resorption[J]. Eur J Endocrinol, 1999, 140(4):332-337.
25.	Bauer D, Krege J, Lane N, et al. National bone health alliance bone turnover marker project:current practices and the need for US harmonization, standardization, and common reference ranges[J]. Osteoporos Int, 2012, 23(10):2425-2433.
26.	Vasikaran S, Eastell R, Bruyère O, et al. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment:a need for international reference standards[J]. Osteoporos Int, 2011, 22(2):391-420.
27.	李萌, 李玉坤. 骨轉換標志物及其臨床應用[J]. 臨床薈萃, 2014, 29(1):104-108.
28.	Kindblom JM, Ohlsson C, Ljunggren O, et al. Plasma osteocalcin is inversely related to fat mass and plasma glucose in elderly Swedish men[J]. J Bone Miner Res, 2009, 24(5):785-791.
29.	Eastell R, Vrijens B, Cahall DL, et al. Bone turnover markers and bone mineral density response with risedronate therapy:relationship with fracture risk and patient adherence[J]. J Bone Miner Res, 2011, 26(7):1662-1669.
30.	Garnero P, Hausherr E, Chapuy MC, et al. Markers of bone resorption predict hip fracture in elderly women:the EPIDOS Prospective Study[J]. J Bone Miner Res, 1996, 11(10):1531-1538.
31.	Manavalan JS, Cremers S, Dempster DW, et al. Circulating osteogenic precursor cells in type 2 diabetes mellitus[J]. J Clin Endocrinol Metab, 2012, 97(9):3240-3250.
32.	張金山, 羅良平. 絕經前期婦女血清PINP、ICTP和25-OH-VitD3水平的變化及其與BMD的相關性分析[J]. 放射免疫學雜志, 2010, 23(6):603-605.

1. Genant HK, Cooper C, Poor G, et al. Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis[J]. Osteoporos Int, 1999, 10(4):259-264.
2. 中華醫學會骨質疏松和骨礦鹽疾病分會. 原發性骨質疏松癥診治指南(2011年)[J]. 柳州醫學, 2012, 04(3):188-199.
3. 李寧華, 朱漢民, 區品中, 等. 中國部分地區中老年人群原發性骨質疏松癥患病率研究[J]. 中華骨科雜志, 2001, 21(5):18-21.
4. Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis:synopsis of a WHO report. WHO Study Group[J]. Osteoporos Int, 1994, 4(6):368-381.
5. 肖恩, 孟萍. 骨質疏松骨代謝生化指標的研究進展[J]. 中國骨質疏松雜志, 2008, 14(3):212-216, 147.
6. 張紅, 羅湘杭, 謝輝, 等. 基質金屬蛋白酶-1、-2與女性年齡、骨轉換生化指標及骨密度的關系[J]. 中華內科雜志, 2006, 45(4):306-309.
7. 張新菊, 李融. 骨代謝標志物相關研究進展[J]. 山東醫藥, 2014(16):93-95.
8. Pedersen BJ, Schlemmer A, Rosenquist C, et al. Circadian rhythm in typeⅠcollagen formation in postmenopausal women with and without osteopenia[J]. Osteoporos Int, 1995, 5(6):472-477.
9. Hernández MV, Gua?abens N, Alvarez L, et al. Immunocytochemical evidence on the effects of glucocorticoids on typeⅠcollagen synthesis in human osteoblastic cells[J]. Calcif Tissue Int, 2004, 74(3):284-293.
10. DeFranco DJ, Glowacki J, Cox KA, et al. Normal bone particles are preferentially resorbed in the presence of osteocalcin-deficient bone particles in vivo[J]. Calcif Tissue Int, 1991, 49(1):43-50.
11. 王琳, 牛愛軍. 骨代謝標志物在多發性骨髓瘤診治中的應用現狀[J]. 實用醫藥雜志, 2011, 28(9):844-846.
12. 闕文君, 馮正平. 骨轉換生化標志物的研究進展[J]. 中國骨質疏松雜志, 2014(5):575-579.
13. L?fman O, Magnusson P, Toss G, et al. Common biochemical markers of bone turnover predict future bone loss:a 5-year follow-up study[J]. Clin Chim Acta, 2005, 356(1/2):67-75.
14. 楊國君, 呂龍. 骨轉換標志物與骨質疏松癥的研究進展[J]. 內蒙古醫科大學學報, 2012, 34(增刊1):105-110.
15. O'brien CA. Control of RANKL gene expression[J]. Bone, 2010, 46(4):911-919.
16. Jabbar S, Drury J, Fordham JN, et al. Osteoprotegerin, RANKL and bone turnover in postmenopausal osteoporosis[J]. J Clin Pathol, 2011, 64(4):354-357.
17. Chen YH, Wu YW, Yang WS, et al. Relationship between bone mineral density and serum osteoprotegerin in patients with chronic heart failure[J]. PLoS One, 2012, 7(8):e44242.
18. Qin YJ, Zhang ZL, Zhang H, et al. Age-related changes of serum tartrate-resistant acid phosphatase 5b and the relationship with bone mineral density in Chinese women[J]. Acta Pharmacol Sin, 2008, 29(12):1493-1498.
19. 王鴻度, 陳莊, 扶世杰, 等. 骨轉換生化標志物晝夜節律的研究進展[J]. 中國骨質疏松雜志, 2009, 15(12):944-948, 943.
20. 何娟文, 肖爭. 骨代謝標志物研究進展[J]. 中外健康文摘, 2013(48):146-147.
21. 賈成瑤, 李萍. 尿吡啶啉和脫氧吡啶啉是骨吸收特異性生化標志物[J]. 中國臨床康復, 2002, 6(15):2256-2257.
22. Halleen JM. Tartrate-resistant acid phosphatase 5B is a specific and sensitive marker of bone resorption[J]. Anticancer Res, 2003, 23(2A):1027-1029.
23. 宋志榮, 張淑琴, 闞耀東. 尿脫氧吡啶啉測定和骨密度檢測對診斷骨質疏松癥的對比觀察[J]. 上海醫學檢驗雜志, 2002, 17(2):105-106.
24. Schlemmer A, Hassager C. Acute fasting diminishes the circadian rhythm of biochemical markers of bone resorption[J]. Eur J Endocrinol, 1999, 140(4):332-337.
25. Bauer D, Krege J, Lane N, et al. National bone health alliance bone turnover marker project:current practices and the need for US harmonization, standardization, and common reference ranges[J]. Osteoporos Int, 2012, 23(10):2425-2433.
26. Vasikaran S, Eastell R, Bruyère O, et al. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment:a need for international reference standards[J]. Osteoporos Int, 2011, 22(2):391-420.
27. 李萌, 李玉坤. 骨轉換標志物及其臨床應用[J]. 臨床薈萃, 2014, 29(1):104-108.
28. Kindblom JM, Ohlsson C, Ljunggren O, et al. Plasma osteocalcin is inversely related to fat mass and plasma glucose in elderly Swedish men[J]. J Bone Miner Res, 2009, 24(5):785-791.
29. Eastell R, Vrijens B, Cahall DL, et al. Bone turnover markers and bone mineral density response with risedronate therapy:relationship with fracture risk and patient adherence[J]. J Bone Miner Res, 2011, 26(7):1662-1669.
30. Garnero P, Hausherr E, Chapuy MC, et al. Markers of bone resorption predict hip fracture in elderly women:the EPIDOS Prospective Study[J]. J Bone Miner Res, 1996, 11(10):1531-1538.
31. Manavalan JS, Cremers S, Dempster DW, et al. Circulating osteogenic precursor cells in type 2 diabetes mellitus[J]. J Clin Endocrinol Metab, 2012, 97(9):3240-3250.
32. 張金山, 羅良平. 絕經前期婦女血清PINP、ICTP和25-OH-VitD3水平的變化及其與BMD的相關性分析[J]. 放射免疫學雜志, 2010, 23(6):603-605.

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骨代謝指標物在骨質疏松癥診療中的應用進展

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