标题：定量超声测定跟骨骨密度对骨质疏松性骨折的判断价值及其与血清骨代谢、骨转化指标的相关性

      作者：吴定宇 1，温运年 2，曹恒昌 1，范国裕 3，唐向阳 4    （1.北京大学深圳医院急诊外科，广东 深圳 518036；2.北京大学深圳医院超声影像科，广东 深圳 518036；3.深圳市龙岗区人民医院超声影像科，广东 深圳 518172；4.深圳市龙岗区人民医院骨科，广东 深圳 518172）

      卷次： 2016年27卷22期

      【摘要】 目的 分析定量超声测定跟骨骨密度(BMD)对骨质疏松性骨折的判断价值，并探讨BMD与患者血清骨代谢、骨转化指标的相关性。方法 将2013年8月至2015年8月期间在北京大学深圳医院接受检查治疗的骨质疏松性骨折患者72例作为观察组，另取同期在本院接受健康体检、不伴骨质疏松的老年人群68例作为对照组，比较两组患者的定量超声下BMD值、血清骨代谢、骨转化指标值的差异，并进一步分析BMD与骨质疏松性骨折患者病情的关系。结果 观察组患者的BMD为(0.23±0.04) g/cm2、25羟维生素D (25OHD)为(39.27±4.51) nmol/L、骨钙素N端中分子片段(N-MID)为(56.18±7.29) ng/mL、人降钙素(HCT)为(2.41±0.32) ng/L，均相应低于对照组的(0.35±0.05) g/cm2、(57.63±6.92) nmol/L、(82.55±9.04) ng/mL、(3.17±0.42) ng/L，而碱性磷酸酶(ALP)为(56.27±6.19) IU/L、Ⅰ型前胶原N末端前肽（PINP）为(42.18±5.29) ?g/L、抗酒石酸酸性磷酸酶(TRAP)为(4.63±0.53) U/L、β-胶原降解产物 (β-CTX)为 (64.39±7.11) ng/mL，均高于对照组的 (27.45±3.38) IU/L、(24.76±3.08) ?g/L、(3.11±0.37) U/L、(45.28±5.29) ng/mL，差异均有统计学意义(P<0.05)。经一元线性回归分析发现，骨质疏松性骨折患者的BMD值与血清 25OHD、N-MID、HCT 值呈正相关 (r=0.627、0.701、0.598)，与 ALP、PINP、TRAP、β-CTX 呈负相关(r=-0.582、-0.672、-0.693，P<0.05)。结论 定量超声测定跟骨骨密度可以客观判断骨质疏松性骨折的严重度，其与患者的血清学指标存在良好的相关关系，可以作为临床病情监测及预后判断的可靠手段。
      【关键词】 骨质疏松性骨折；骨密度(BMD)；定量超声；骨代谢；骨转化；相关性
      【中图分类号】 R683 【文献标识码】 A 【文章编号】 1003—6350（2016）22—3703—03

Value of detecting calcaneus bone mineral density by quantitative ultrasound in diagnosing osteoporotic fracturesand relationship between bone mineral density and patients'serum bone metabolism, bone turnover indicators.WU Ding-yu 1, WEN Yun-nian 2, CAO Heng-chang 1, FAN Guo-yu 3, TANG Xiang-yang 4.
1. Department of Emergency,Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, CHINA; 2. Department of Ultrasonography, PekingUniversity Shenzhen Hospital, Shenzhen 518036, Guangdong, CHINA; 3. Department of Ultrasonography, Longgang DistrictPeople’s Hospital of Shenzhen, Shenzhen 518172, Guangdong, CHINA; 4. Department of Orthopadic Surgery, LonggangDistrict People’s Hospital of Shenzhen. Shenzhen 518172, Guangdong, CHINA
【Abstract】 Objective To analyze the value of detecting calcaneus bone mineral density (BMD) by quantitativeultrasound (QUS) in diagnosing osteoporotic fractures and relationship between bone mineral density and patients' serumbone metabolism, bone turnover indicators. Methods Seventy-two patients of osteoporotic fractures from August 2013to August 2015 in Peking University Shenzhen Hospital were chosen as observation group, and 68 normal old personswithout osteoporosis were selected as control group, The patients’BMD value under QUS, serum bone metabolism,bone turnover indicators were compared between the two groups. The correlation between BMD and disease conditionwas further analyzed. Results The patients' BMD, 25OHD, N-MID, human calcitonin (HCT) in the observation groupwere (0.23±0.04) g/cm2, (39.27±4.51) nmol/L, (56.18±7.29) ng/mL, (2.41±0.32) ng/L, respectively, which were lowerthan (0.35±0.05) g/cm2, (57.63±6.92) nmol/L, (82.55±9.04) ng/mL, (3.17±0.42) ng/L in the control group, with statisti-cally significant difference (P<0.05). The levels of alkaline phosphates (ALP), procollagen I N-terminal propeptide(PINP), tartrate resistant acid phosphatase (TRAP), β-C-terminal telopeptide of type I collagen (β-CTX) in the observa-tion group were (56.27±6.19) IU/L, (42.18±5.29) μg/L, (4.63±0.53) U/L, (64.39±7.11) ng/mL, respectively, which werehigher than (27.45±3.38) IU/L, (24.76±3.08) μg/L, (3.11±0.37) U/L, (45.28±5.29) ng/mL in the control group, with statis-tically significant differences (P<0.05). Linear regression analysis showed that osteoporotic fractures patients' BMD waspositively correlated with 25OHD, N-MID, HCT values (r=0.627, 0.701, 0.598), and negatively correlated with ALP,PINP, TRAP, β-CTX values (r=-0.582, -0.672,-0.693, P<0.05). Conclusion BMD measured by QUS can objectivelydetermine the severity of osteoporotic fractures. The BMD shows a good correlation with serum markers, and it can beused as a reliable mean for monitoring disease condition and evaluating prognosis.
      【Key words】 Osteoporotic fractures; Bone mineral density (BMD); Quantitative ultrasound (QUS); Bone metabo-lism; Bone turnover; Correlation·论 著·doi:10.3969/j.issn.100