Relationship of the activity of the bone isoenzyme of serum alkaline phosphataseto urinary hydroxyproline excretion in metabolic and neoplastic bone diseases

A significant correlation between the activity of the bone isoenzyme or serum alkaline phosphatase and the urinary hydroxyproline excretion in osteomalacia, osteoporosis, primary hyperparathyroidism with osteodystrophy, Paget's disease, secondary bone tumours, and in a control group was found (P less than 0.001). This close correlation was not observed between these variables in patients with active acromegaly. Diagnosis determined from these indices of formation and turnover of bone matrix agreed with that established by histological and histochemical examination of bone, by X-ray investigation of the skeleton, and by the radionuclear 85Sr test. The relationship between the activity of bone isoenzyme and urinary hydroxyproline excretion differed in metabolic bone diseases with a high bone turnover, in patients with osteoporosis and in patients with early osteoclastic bone metastases.     

联合检测尿脱氧吡啶啉与骨源性碱性磷酸酶诊断骨质疏松症

目的探讨尿脱氧吡啶啉(DPD)排泄率及骨源性碱性磷酸酶(BAP)对骨质疏松症患者的诊断价值及两者的相关性。方法对73例骨质疏松症患者在其治疗前后联合测定尿DPD、Cr,血BAP、钙(Ca)、磷(P)、碱性磷酸酶(ALP)及跟骨骨密度(BMD),以50例健康人作对照。结果骨质疏松症患者BAP(U/L)比对照组(213±8.13比142±6.08),DPD/Cr排泄率(nmol/mmolCr)比对照组(6.11±2.14比3.24±1.62)均显著增高(P<0.01),且治疗前后差异有显著性(P<0.01)。两指标之间成正相关(r=0.52)。结论BAP、DPD/Cr测定结果灵敏,比BMD经济方便,可作为骨质疏松症患者诊断的指标。     

骨碱性磷酸酶测定对小儿佝偻病早期诊断的临床研究

研究应用全血干化学免疫浓缩技术，检测骨碱性磷酸酶，用于佝偻病早期诊断，其灵敏度为８４．８９％，将异度８９．６％，准确度８４．６％，阳性预测值９６．２％。经与血液生化，Ｘ线进行比较分析证明：该法具有敏感、特异、简单、快速、节省材料等优点。是目前佝瘘病早期诊断有价值的实验方法，应普及推广。     

骨关节退行性病变与血清碱性磷酸酶浓度

目的 :探讨骨关节退行性变与血清碱性磷酸酶 (ALP)的关系。方法 :测定149例骨关节退行性变患者血清ALP并与117例对照组比较。结果 :骨关节退行性病变组ALP为(83.46±78.34)U/L,对照组为(75.73±26.12)U/L ,两组差异不明显 (P>0.05)。结论 :骨关节退行性变并不引起ALP的明显变化。     

High-molecular intestinal alkaline phosphatase in chronic liver diseases

The presence of high-molecular intestinal alkaline phosphatase (HIALP) different from bone ALP detected in the alpha(2)beta region was recently clarified. In this study we used a novel method in which HIALP was detected after conversion to ALP(5) by protease to investigate the clinical significance of the appearance of HIALP in patients with chronic liver disease. The subjects were 241 patients with chronic liver disease. When a decrease in ALP(3) in the alpha(2)beta region and an increase in ALP(5) in the beta region were noted, the patient was judged HIALP-positive. In the patients with chronic liver disease, the total ALP activity (T-ALP) increased with progression of the pathology in the order of chronic hepatitis (CH), liver cirrhosis (LC), and hepatocellular carcinoma (HCC). HIALP appeared in 22.4% and 49.3% of patients with CH and LC, respectively, but the positivity rate decreased to 30.4% in HCC. As autoimmune liver diseases, primary biliary cirrhosis (PBC) and autoimmune hepatitis (AIH) were investigated. T-ALP was lower in PBC+AIH than in LC and HCC, but the HIALP-positive rate was high (44.4%). The HIALP-positive rate was dependent on ABO blood groups, and was high in blood groups B and O. In conclusion, the HIALP-positive rate was particularly high in patients with chronic liver disease, and was related to the pathological progression, which suggests that the method is clinically useful.     

宝鸡地区2184例儿童骨碱性磷酸酶结果的分析

目的：评价骨碱性磷酸酶对儿童佝偻病早期诊断及疗效评价的临床价值,通过骨碱性磷酸酶的检测了解该地区儿童佝偻病的发病率。方法选择2013年1～12月来宝鸡市中心医院体检的2184例儿童,按年龄分成婴儿、幼儿、学龄前、学龄期4组,采集指血,采用北京中生金域诊断技术有限公司提供的骨源性碱性磷酸酶试剂盒检测末梢血中骨碱性磷酸酶水平。结果2184例受检儿童中,临床佝偻病（NBAP＞250 U／L）的检出率为10.1％,且年龄越小检出率越高;亚临床佝偻病（NBAP 200～250 U／L）的检出率为65.5％,说明宝鸡地区大部分儿童处于亚健康状态;春冬季检出率高于夏秋季;NBAP 检出率无性别差异。结论儿童为生长发育较快时期,易引起维生素 D 缺乏,儿童骨碱性磷酸酶活性检测对维生素 D 缺乏引起的佝偻病的早期诊断有重要的临床价值。预防应从围产期开始,及时检测儿童骨碱性磷酸酶水平,以便早诊断、早治疗。     

骨显像和血清骨型碱性磷酸酶在鼻咽癌骨转移的应用

目的：探讨骨显像和血清骨型碱性磷酸酶对鼻咽癌早期骨转移的诊断价值。方法：对71例鼻咽癌患者进行骨显像并测定血清骨型碱性磷酸酶水平，比较骨转移组和无骨转移组的血清骨型碱性磷酸酶水平。结果：71例鼻咽癌患者中，骨转移者44例，无骨转移者27例，转移率62％；骨转移组血清骨型碱性磷酸酶水平与无骨转移组差异显著（P〈0.01）。结论：鼻咽癌骨转移率较高，且血清骨型碱性磷酸酶与骨显像有一致性。     

热灭活法与干化学法检测骨碱性磷酸酶技术的对照分析

目的应用热灭活法检测大批量儿童骨碱性磷酸酶（bonealk aline phosphatase，BALP）项目以弥补干化学法测定BALP之不足。方法采末梢血于生化分析仪上测定灭活前后的碱性磷酸酶（alkaline phosphatase，ALP）值，计算灭活后与灭活前ALP的百分比以筛出疑似阳性病例。热灭活法筛查出的BALP阳性病例，再用干化学法测定其BALP，之后将二种方法的测定结果进行对照。结果热灭活法筛查出的BALP阳性结果同干化学法测定的BALP结果基本一致。结论热灭活法检测骨碱性磷酸酶技术具有成本低、检测速度快、可定量分析、适合大批量BALP检测的优点。     

骨型碱性磷酸酶在骨肿瘤诊断中的价值

目的检测恶性骨肿瘤、良性骨肿瘤及转移性骨肿瘤患者血清中的总碱性磷酸酶(TALP)和骨型碱性磷酸酶(BALP)活性,以观察TALP和BALP在骨肿瘤的鉴别诊断中的价值及在监测恶性骨肿瘤治疗中的作用。方法对2004年积水潭医院骨肿瘤科收治的40例恶性骨肿瘤、40例良性骨肿瘤及14例转移性骨肿瘤患者,采用法国临床化学会推荐的速率法测定血清TALP及酶联免疫吸附(ELISA)方法测定BALP水平。结果恶性骨肿瘤组的TALP活性为(325·55±356·36)U/L,BALP活性为(177·19±240·67)U/L,与同龄对照组TALP(120·70±70·59)U/L,BALP(61·30±44·45)U/L比较有统计学意义(P<0·05)。转移性骨肿瘤组的TALP(100·14±35·39)U/L,BALP(32·93±15·68)U/L,与同龄对照组TALP(57·64±11·06)U/L,BALP(19·92±7·53)U/L比较有显著性统计学意义(P<0·01)。而良性骨肿瘤组与同龄对照组相比无统计学意义(P>0·05)。同时恶性骨肿瘤与其他两组比较也都有统计学意义(P<0·01),并且恶性骨肿瘤组患者化疗前后的结果也有统计学意义(P<0·05)。结论血清TALP和BALP是反映骨肿瘤骨代谢的一个灵敏而简便的生化指标,并对骨肿瘤的鉴别诊断及疗效观察具有一定的临床意义。作为骨肿瘤的检测指标,血清BALP比TALP更为特异和敏感。     

Bisphosphonate whole body retention test: relations to bone mineralization rate, renal function and bone mineral content in osteoporosis and metabolic bone disorders

The bisphosphonate whole body retention test (WBR) has been used to estimate bone mineralization rate (bone turnover). Bisphosphonates given i.v. are taken up by bone or excreted in urine. The aim of the present investigation was to test the efficacy of WBR in estimating bone mineralization rate (m) and to evaluate the influence of renal function (Clcr) and bone mass (forearm bone mineral content; BMC) on WBR. The 24-h retention of 3.7 MBq 99mTc-HMBP (1-hydroxymethylene-1,1-bisphosphonate) (Osteoscan) given i.v. was measured by a medium sensitive whole body counter in thirty-one patients with hyperparathyroidism (n = 14), hyperthyroidism (n = 8) or hypothyroidism (n = 9) (group 1) and in seventy-six females with postmenopausal spinal crush fracture osteoporosis (group 2). In the same individuals m was calculated from a 7-day 47Ca-kinetic study using the expanding calcium pool model. Multiple regression analysis of WBR vs. m and Clcr in group 1 disclosed that WBR correlated positively to m [rp = 0.49, P less than 0.01 (rp = partial correlation coefficient)] and inversely to Clcr (rp = -0.44, P less than 0.02). Inclusion of BMC in the analysis did not reveal any significant partial correlation between WBR and BMC (rp = -0.33, 0.05 less than P less than 0.10). In group 2 WBR correlated inversely to Clcr (rp = -0.48, P less than 0.001) but showed no significant relation to m (rp = 0.10, NS).(ABSTRACT TRUNCATED AT 250 WORDS)     

骨代谢指标与骨关节炎及绝经后骨质疏松症的关系

背景：研究显示,在绝经后骨质疏松症及骨关节炎状态下,原本正常的骨转换平衡状态被破坏,血清、尿液中一些特异性指标可以较敏感地反映出骨转换的具体变化过程。 目的：测量绝经后原发性膝骨关节炎及绝经后骨质疏松症患者的骨密度及骨代谢指标,分析两疾病骨密度及骨代谢指标的变化特点。 方法：选取248例绝经女性受试者,行骨密度、膝关节X射线片检查,最终选出180例进入试验,分为骨关节炎组、骨质疏松组及对照组。对比分析各组观察对象的骨代谢指标：骨碱性磷酸酶、骨钙素、Ⅰ型胶原交联C末端肽、血清抗酒石酸酸性磷酸酶5b。通过二元Logistic回归分析判断两疾病发病与各项指标间的相关性。 结果与结论：与对照组比较,骨关节炎组腰椎骨密度升高,Ⅰ型胶原交联C末端肽值降低;骨质疏松组腰椎及全髋部骨密度降低,骨钙素、Ⅰ型胶原交联C末端肽、血清抗酒石酸酸性磷酸酶5b升高。血清Ⅰ型胶原交联C末端肽水平的降低与骨关节炎发病具有显著相关性;血清骨钙素、Ⅰ型胶原交联C末端肽、血清抗酒石酸酸性磷酸酶5b水平的升高与骨质疏松发病具有显著相关性。提示绝经女性骨关节炎患者骨吸收速率减低,骨质疏松患者骨转换率加快,骨代谢水平的差异导致两疾病患者骨密度呈现出负相关趋势。监测Ⅰ型胶原交联C末端肽、血清抗酒石酸酸性磷酸酶5b、骨钙素,特别是Ⅰ型胶原交联C末端肽血清水平对骨关节炎及骨质疏松的早期诊断及治疗有一定的参考价值。     

人重组骨形成蛋白-2对骨髓成骨细胞增殖和碱性磷酸酶活性的影响

目的探讨人重组骨形成蛋白-2(rhBMP-2)对人骨髓成骨细胞增殖和分化的影响以及剂量效应关系。方法以改良方法培养的骨髓成骨细胞为作用底物,加入梯度浓度的rhBMP-2溶液,应用MTT法和碱性磷酸酶(ALP)染色法检测其对细胞增殖和ALP活性的影响。结果rhBMP-2浓度低于1μg/ml时对人骨髓成骨细胞的增殖无明显影响,高于此浓度时对细胞的增殖有明显的促进作用,但无显著的剂量效应关系。从0.1～10μg/ml,ALP与rhBMP-2具有剂量依赖性促进关系,rhBMP-2浓度为10μg/ml时,其ALP活性是对照组的4倍,在高于10μg/ml时ALP活性并没有进一步显著提高。结论rhBMP-2对骨髓成骨细胞的增殖和碱性磷酸酶活性具有促进作用,其最佳效应浓度为10μg/ml。     

Bone mass and biochemical parameters of bone metabolism in men with spinal osteoporosis

With advancing age both sexes have an increased incidence of osteoporotic fractures, although fractures are more common in women than in men. Whereas in women several potential risk factors have been identified, less is known about osteoporosis in men. A total of 27 Austrian men (mean age: 65 +/- 2 years) with atraumatic spine fractures were studied. In all patients, medical history gave no evidence of disease or medications causing osteoporosis. Peripheral bone mass was determined by single-photonabsorptiometry on the distal non-dominant forearm; lumbal bone density was measured by quantitative computed tomography. Serum levels of calcium, phosphate, alkaline phosphatase, osteocalcin, testosterone, estrogen, parathyroid hormone and 25-hydroxy-vitamin D as well as 2-h-urinary-OH proline and calcium excretion were measured. All data were compared with those of an age and sex matched control group consisting of 19 healthy males. A significant difference in mean peripheral and axial bone mass (SPA: P less than 0.004; QCT: P less than 0.0001) was observed between osteoporotic men and controls. When compared to controls, serum levels of alkaline phosphatase (P less than 0.012), urinary OH proline (P less than 0.05) and urinary calcium excretion (P less than 0.003) were significantly higher in the osteoporotic males. Additionally, there was a significant positive correlation between serum alkaline phosphatase and urinary OH proline excretion (r = 0.32; P less than 0.04) in the osteoporotics. All other biochemical parameters showed no significant differences. Our results may lead to the assumption that osteopenia in men is related to increased bone turnover.     

骨形态发生蛋白7诱导骨膜细胞碱性磷酸酶的表达

背景：关于骨形态发生蛋白 7 作为刺激因子诱导细胞成骨的报道目前较少见。目的：观察骨膜细胞经骨形态发生蛋白 7 诱导后碱性磷酸酶的表达。方法：取材于成人胫骨骨膜,常规细胞培养法行骨膜细胞体外培养,分为实验组和对照组,分别加入骨形态发生蛋白 7 加成骨细胞培养辅助剂和单纯成骨细胞培养辅助剂,相差显微镜观察骨膜细胞形态特征及超微结构。每组分别在第 7,14,21 天设 3 个时间点,每个时间点设 3 个样本,采用碱性磷酸酶试剂盒法检测成骨细胞特异性标志物碱性磷酸酶表达情况。结果与结论：骨膜细胞经分组培养后,第 7 天时,实验组和对照组骨膜细胞均有明显增殖,碱性磷酸酶的可被检测出,但量不多,细胞外形为梭形,实验组比对照组检测的碱性磷酸酶数量稍多;第 14 天时,实验组及对照组骨膜细胞均显著增殖,细胞外形由梭形变为宽梭形,实验组比对照组检测的碱性磷酸酶数量明显增多。第 21 天时,实验组及对照组骨膜细胞均增殖,其中实验组细胞增殖明显,细胞外形为宽梭形,实验组比对照组检测的碱性磷酸酶数量显著增多。经过统计学分析由骨形态发生蛋白 7 诱导的骨膜细胞的成骨标志物碱性磷酸酶阳性率明显高于对照组（P 〈 0.01）。提示骨膜细胞具有良好的成骨和再生能力, 骨形态发生蛋白 7 能诱导骨膜细胞加强碱性磷酸酶的表达,能诱导骨膜细胞向成骨细胞转化。     

以N-甲基葡胺为磷酸化受体测定血清碱性磷酸酶的实验探讨

目的评估以N-甲基葡胺作为磷酸化受体缓冲液测定血清碱性磷酸酶(ALP)活性的方法。方法通过对试剂的合理组合和实验条件的优选,建立基于N-甲基葡胺的血清ALP测定方法,并与基于其他缓冲液的推荐方法进行对比。结果精密度,批内:CV=0.62%,批间:CV=2.3%;线性范围至少可达到2 073 U/L;分别与以2-氨基-2-甲基-1-丙醇(AMP,X1)和二乙醇胺(DEA,X2)为磷酸化受体的ALP测定法比较:Y=1.29X1 13.25,r=0.999;Y=0.65X2 19.19,r=0.998。健康成人参考区间为44~133 U/L[(80.33±20.97)U/L]。结论N-甲基葡胺可替代AMP或DEA作为磷酸化受体缓冲液用于临床血清ALP活性的常规测定。     

25例高转换型肾性骨病的骨组织学研究

目的通过对慢性肾脏病(chronic kidney disease,CKD)5期维持性血液透析(maintenance hemodialysis,MHD)患者行骨活检获得骨标本,对骨病理进行骨形态计量学分析,观察各型骨病尤其是高转换型肾性骨病的骨病理学特点并探讨临床各项常用无创性检查的意义。方法选择40例CKD5期MHD患者和3例正常人进行髂骨活检术,获得骨标本。采用全自动图像分析系统进行骨组织形态计量学测定。外周血各项检测指标和临床常用的骨密度和骨骼摄片与骨病理学指标行相关分析。结果25例CKD5期MHD患者经骨病理学检查证实为高转换型骨病,占同期骨活检的62.5%(25/40),骨病理学检查以破骨细胞活化形成骨吸收陷窝伴或不伴骨矿化不全为特点。外周血钙、骨钙素水平与骨病理指标呈显著正相关。骨密度和骨骼摄片的阳性率低于骨活检。结论通过对CKD5期MHD患者行骨活检发现,高转换性肾性骨病的比例仍占大多数。在高转换型肾性骨病中,目前的各种无创性检查中血钙、骨钙素可能具有一定的预测价值。骨活检仍是诊断肾性骨病的金指标。     

运动与骨代谢：骨密度、骨生物力学及生化指标的评价

背景：运动对于骨代谢的影响通过相关血尿生化指标的改变表现出来,以运动类型和强度影响为主。同时,这些生化指标也显示了如何标记不同个体的生理以及反映运动对骨骼的影响,可以将这些指标看成是骨生长代谢过程的一种监测。目的：从存在于血液和尿液中与骨生长代谢的相关生化指标入手,详细阐述运动对其影响,进一步讨论对机体骨形成和骨吸收的影响。方法：应用计算机检索中国学术期刊全文数据库（CNKI）和PubMed数据库中2000年1月至2014年9月关于骨代谢的文章,检索主题词为“运动;骨代谢;生化指标”;英文为“Exercise;Bone metabolism;Biochemical indicators”。初检文献236篇,根据纳入标准保留38篇进行分析、综述。结果与结论：低强度的运动对骨骼基本上起不到作用,而过度的运动对于骨骼是有害的,可以导致应力性骨折,更重要的是导致年轻女性雌激素缺乏,因而会使骨量减少。运动对骨代谢相关血尿生化指标的影响以运动类型和强度影响为主,只有把握适当的训练强度才会对骨形成和骨吸收产生积极影响,辅助骨密度、骨生物力学等指标作为制定运动处方和安排康复锻炼时的重要参考。对于运动引起骨转换的机制需要进一步结合各种通路,到细胞层面进一步讨论。     

Value of serum alkaline phosphatase in evaluating hyperplasia of parathyroid glands in chronic hemodialysis patients

To investigate the value of serum alkaline phosphatase in evaluating hyperplasia of parathyroid glands in hemodialysis patients, 28 hemodialysis patients who had parathyroid sonography examinations for secondary hyperparathyroidism were studied retrospectively. There were significant elevations of serum alkaline phosphatase, parathyroid hormone (PTH), serum total calcium, and dialysis duration in patients with sonography-detectable parathyroid (N = 17) as compared with those of sonography-undetectable (N = 11) parathyroid. Hemodialysis patients who have both higher serum alkaline phosphatase (>94 IU/ L) and considerably elevated serum PTH (9× or higher) are likely to have sonography-detectable parathyroids (positive predictive value of 93%). Patients with mildly or moderately elevated serum PTH but normal serum alkaline phosphatase are less likely to have sonography-detectable parathyroids (negative predictive value is 100%). These findings suggest that the elevation of serum alkaline phosphatase could be a valuable parameter in addition to the high serum PTH level in predicting hyperplasia of parathyroid glands in chronic hemodialysis patients. © 1994 John Wiley & Sons, Inc.     

脑瘫患儿的碱性磷酸酶分析

目的探讨脑瘫患儿的碱性磷酸酶 (ALP)在不同型别脑瘫的差异及在分型诊断中的意义。方法对 40例不同类型的脑瘫患儿进行ALP测定。结果痉挛型脑瘫患儿的ALP值在正常范围内 ,手足徐动型脑瘫患儿的ALP值明显高于痉挛型脑瘫患儿的ALP值 (P <0 .0 0 1)。结论ALP值还可做为鉴别诊断的客观指标。