女性骨生化指标与髋部骨密度的关系

目的探讨血清Ⅰ型胶原N末端肽(sNTX)、血清碱性磷酸酶(sALP)与女性年龄、绝经和髋部骨密度(BMD)之间的关系。方法采用酶联免疫吸附法测定824名20-80岁女性志愿者的sNTX;用全自动生化分析仪测定sALP;采用双能X线骨密度仪测量左髋部BMD。结果(1)sNTX和sALP与年龄呈正相关(r分别为0.333和0.541,P<0.01);在30-39岁年龄段最低,自40-49岁明显升高,与30-39岁年龄段比较有显著差异(P<0.01);两者随年龄的变化以三次回归模型拟合最优(R2分别为0.142和0.343,P=0.000);sNTX和sALP在绝经后较绝经前明显升高,分别达25%和48%。(2)sNTX和sALP与BMD呈显著负相关(r=-0.300--0.492,P<0.01);控制年龄、绝经年限和体重指数后,这种负相关关系仍然存在(P<0.05-0.01);与骨量正常组比较,低骨量组和骨质疏松组妇女的sNTX和sALP显著升高(P<0.01),特别在骨质疏松组升高更显著。结论sNTX和sALP能反映女性随年龄和绝经变化的骨转换状态;高骨转换状态是绝经后女性髋部骨量丢失的重要原因之一。     

血清Ⅰ型前胶原氨基端前肽、Ⅰ型前胶原羧基端前肽、Ⅰ型胶原羧基端肽在骨转移性癌诊断中的应用

目的：探讨血清Ⅰ型前胶原氨基端前肽（PINP）、Ⅰ型前胶原羧基端前肽（PICP）、Ⅰ型胶原羧基端肽（ICTP）在骨转移癌诊断中的临床价值。方法：将80例肿瘤患者分为骨转移组41例和无骨转移组（对照组）39例,采用Soloway分级标准,将骨转移组患者再分为A、B、C3个亚组,所有患者空腹抽取静脉血。分析血清PINP、PICP、ICTP与骨转移程度之间的相关性及其彼此之间的相关性。结果：骨转移癌患者血清PINP、PICP、ICTP水平较对照组均升高,其中PICP、ICTP水平与对照组有显著差异（P〈0.01）;PINP、PICP、ICTP水平在A、B、C3组均依次递增;血清PICP水平与骨转移灶数目相关性良好（P〈0.01）,ICTP、PINP水平与骨转移灶数目呈一定相关（P〈0.05）;血清ICTP水平与PINP水平呈中度相关。结论：检测血清PINP、PICP、ICTP水平都能反映骨转移患者的病情变化,以检测血清PICP、ICTP水平临床价值高;血清PICP水平与骨转移数目的相关性良好。     

骨代谢生化指标测定在妇科临床中的应用价值

目的：探讨四项骨代谢酶免疫生化指标：血骨钙素（BGP）、骨碱性磷酸酶（BAP）、I型 前胶原羧基肽（CICP）、尿呲啶酚（PYD）及传统的Ca/Cr及HOP／Cr比值对由于雌激素缺乏引起的高骨转换及骨量减少的诊断意义。并了解上述哪些指标对绝经引起的雌激素缺乏更敏感。方法：测定51名绝经前妇女（I组）,42名绝经后妇女（II组）,和53例双侧卵巢切除术（OVX）患者（III组）的上述各项指标,同时对各项生化指标间作相关分析。并与超声骨密度值（BMD）作相关分析。结果：绝经后组与卵巢切除术组的大部分酶免疫骨生化指标均显著高于绝经前组,与BMD的下降变化一致。但传统的HOP／Cr及Ca/Cr各组间无差异。相关性：所有病例中,BGP、BAP、CICP、PYD间均有相关性,尽管r值较低,但统计学分析差异有显著意义（P＜0.01）。其中BGP与BAP,BGP与PYD／Cr间相关性较好。BMD与BGP、BAP、CICP及PYD呈明显负相关。Ca/Cr及HOP／Cr与所有其他指标无相关。结论：BGP、BAP、CICP、PYD等骨代谢生化指标是反映绝经后（自然绝经及手术后绝经）妇女由于雌激素降低导致的高骨转换及骨量减少的敏感指标,在妇科临床中有较好的应用前景。而传统的Ca/Cr、HOP／Cr测定由于方法的不敏感、不特异而在妇科临床中应用受到限制。     

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。     

Serum and urine markers of type I collagen metabolism in elderly women with high and low bone mineral density

The serum markers of bone formation (carboxy-terminal propeptide of type I collagen, PICP) and resorption (pyridinoline cross-links containing telopeptide of type I collagen, ICTP), as well as urinary resorption markers, pyridinoline (Pyr) and deoxypyridinoline (Dpyr), were studied in 78-year-old women with high ( n  = 18) and low ( n  = 17) bone mineral density (BMD) measured from the calcaneus and tibia. The low-BMD group had higher values for PICP ( P  = 0.025), Pyr ( P  = 0.001) and Dpyr ( P  < 0.001) than the high-BMD group. No inverse relationship between these markers and BMD was, however, observed within the study groups. ICTP, Pyr and Dpyr correlated with each other in both groups and with PICP in the high-BMD group. Higher levels of both the formation and resorption markers of type I collagen suggest an increased rate of bone turnover and remodelling in osteopenic elderly women.     

I、II型胶原蛋白对人软骨细胞生物学特性的影响

背景：实验证明胶原蛋白底物具有刺激成软骨的作用,但关于不同类型胶原蛋白刺激成软骨作用的能力仍存在争议。 目的：观察I、Ⅱ型胶原蛋白对体外培养人软骨细胞生物学特性的影响。 方法：将P3代人软骨细胞分别加入普通培养板、I型胶原蛋白包被培养板、Ⅱ型胶原蛋白包被培养板继续培养。培养10d内,MTT法绘制细胞生长曲线;培养28d后,采用ELISA法、聚合酶链反应、二甲基亚甲基蓝比色等方法检测3种培养板中软骨细胞分泌I胶原蛋白、Ⅱ型胶原蛋白及糖胺多糖的量。 结果与结论：Ⅱ型胶原蛋白包被培养板中软骨细胞数量最多,增殖速度为I型胶原蛋白包被培养板的2倍、普通培养板的5倍。Ⅱ型胶原蛋白包被培养板中软骨细胞分泌I型胶原蛋白最少,与普通培养板板检测结果差异有显著性意义（P〈0．01）,与I型胶原蛋白包被培养板检测结果差异无显著性意义;Ⅱ型胶原蛋白包被培养板中软骨细胞分泌Ⅱ型胶原蛋白、糖胺多糖最多,与其他两种培养板检测结果差异有显著性意义（P〈0．01）。表明胶原蛋白包被培养板培养软骨细胞优于普通培养板,其中Ⅱ型胶原蛋白包被培养板在培养软骨细胞时更能维持细胞形态,延长去分化现象出现的时间,更利于细胞再分化。     

骨转换生化标志物的临床应用和评估

目的比较妇女绝经前后骨转换生化标志物变化率,研究各指标在各种疾病组的浓度变化,并对临床应用作出初步评价。方法应用酶联免疫测定法或电化学发光免疫法分别测定164名健康成年人和120例患者血清和尿液中10项骨代谢指标。结果绝经后妇女骨代谢指标明显升高;高转换型骨质疏松组与对照组相比骨转换生化标志物的差异有统计学意义;变形性骨炎组和甲状旁腺功能亢进组与对照组比较除Ⅰ型胶原羧基端前肽(PICP)外,骨转换生化标志物的差异有统计学意义;甲状腺功能亢进组和肿瘤骨转移组除PICP和甲状腺激素(PTH)外,与对照组相比差异有统计学意义;风湿性关节炎除吡啶啉(PYD)和脱氧吡啶啉(DPD)与对照组比较差异有统计学意义外,其余差异均无统计学意义。结论各种骨代谢疾病不同程度影响骨转换,PICP应用于临床敏感性较差。     

Changes in serum RANKL and OPG with sexual development and their associations with bone turnover and bone mineral density in a cohort of girls

Objectives

To characterize the variations of serum osteoprotegerin (OPG) and RANK ligand (RANKL) with sexual development in adolescent girls, and to estimate their associations with bone turnover and bone mineral density (BMD).

Design and methods

We studied 300 girls evaluated at 13 and 17 years of age. Fasting blood samples were collected and the following substances were quantified: RANKL, OPG, C-terminal telopeptide of type I collagen (CTX), and procollagen type I N propeptide (PINP). BMD was measured at the distal forearm. Correlation coefficients were used to quantify associations between those variables at 13 and 17 years of age. Random-effects linear models were used to quantify associations between bone parameters and sexual development (years from menarche).

Results

RANKL was positively correlated with bone resorption (CTX) in early and late adolescence (r₁₃ = 0.15 and r₁₇ = 0.23) and the OPG/RANKL ratio correlated inversely with CTX at 17 (r₁₇ = − 0.24). No significant associations were found between RANKL and OPG and bone formation (PINP). In early adolescence, there was an inverse correlation of BMD with CTX (r₁₃ = − 0.52) but no significant correlations were found between osteoclast regulators and BMD. We observed a linear decrease in serum RANKL with increasing sexual development (− 0.09 pmol/L per year, 95% CI: − 0.10, − 0.07) alongside an increase in OPG (0.02 pmol/L, 95% CI: 0.01, 0.04).

Conclusions

Serum RANKL and OPG levels varied markedly with sexual development in adolescence. These cytokines were not predictive of bone turnover or BMD at 13, but serum RANKL bioactivity was associated with bone resorption in late adolescence.     

醛固酮与转化生长因子-β1在心肌纤维化中的作用机制

目的探讨醛固酮与转化生长因子-β1（TGF-β1）在心肌纤维化的作用机制。方法将体外培养的心肌成纤维细胞（CFs）分为对照组、醛固酮组、醛固酮＋依普利酮组、依普利酮组及SB431542预处理组。给予相应处理后,ELISA检测TGF-β1水平,RT-PCR检测Smad2、Ⅰ型胶原、Ⅲ型胶原表达。结果与对照组比较,醛固酮处理后,能显著促进TGF-β1分泌,促进Smad2、Ⅰ型胶原、Ⅲ型胶原表达（P〈0.01）;与醛固酮组比较,醛固酮＋依普利酮组TGF-β1分泌、Smad2、Ⅰ型胶原、Ⅲ型胶原表达均明显下降（P〈0.01）;与醛固酮组比较,SB43l542预处理组抑制Smad2、Ⅰ型胶原和Ⅲ型胶原表达的差异有统计学意义（P〈0.01）。结论醛固酮通过激活MR促进CFs细胞TGF-β1分泌,激活Smad2,使Ⅰ型胶原、Ⅲ型胶原表达增加,诱导心肌纤维化。     

Bone marrow mesenchymal stem cells,platelet‐rich plasma and nanohydroxyapatite–type I collagen beads were integral parts of biomimetic bone substitutes for bone regeneration

Platelet rich plasma (PRP), which includes many growth factors, can activate osteoid production, collagen synthesis and cell proliferation. Nanohydroxyapatite‐type I collagen beads (CIB), which mimetic natural bone components, are not only flexible fillers for bone defect but also encourage osteogenesis. Bone marrow mesenchymal stem cells (BMSCs) are often used as an abundant cell source for tissue engineering. We used a rabbit model to combine PRP, CIB and BMSCs (CIB+PRP+BMSC) into a bone‐like substitute to study its impact on bone regeneration, when compared to defect alone, PRP, CIB+PRP, and PRP+BMSC. CIB+PRP upregulated more alkaline phosphatase (ALP) activity in BMSCs than PRP alone at 4 weeks postoperation. CIB+PRP+BMSC and PRP+BMSC did not differ significantly in DNA content, total collagen content, and ALP activity at 8 weeks. In histological assay, both CIB+PRP+BMSC and PRP+BMSC showed more bone regeneration at 4 and 8 weeks. Higher trabecular bone volume in tissue volume (BV/TV) (31.15±2.67% and 36.93±1.01%), fractal dimension (FD) (2.30±0.18 and 2.65±0.02) and lower trabecular separation (Tb.Sp) (2.30±0.18 and 1.35±0.16) of CIB+PRP+BMSC than of other groups at 4 and 8 weeks, and approach to of bone tissue (BV/TV=24.35±2.13%; FD=2.65±0.06; Tb.Sp=4.19±0.95). CIB+PRP+BMSC significantly enhanced new bone formation at 4 week. Therefore, nanohydroxyapatite‐type I collagen beads combined with PRP and BMSCs produced a bone substitute with efficiently improved bone regeneration that shows promise to repair bone defects. Copyright © 2012 John Wiley & Sons, Ltd.     

血清Ⅳ型胶原测定在肾脏及呼吸道疾患中的应用

目的：了解血清Ⅳ型胶原（ＣＬ－Ⅳ）测定在非肝脏疾患中的临床价值。方法：采用双抗体夹心固相酶免疫法检验慢性阻塞性肺病（ＣＯＰＤ）患者，慢性肾炎患者及尿毒症患者血清ＣＬ－ＩＶ水平，结果：尿毒症组血清ＣＬ－ＩＶ明显高于健康对照组，慢性肾炎组对照组虽有升高，但并无显著性差异，ＣＯＰＤ组较对照组并未见显著性升高。结论：血清ＣＩ－Ⅳ测定也是监测病变程度一个较好的指标。     

Interlaboratory variation of biochemical markers of bone turnover

BACKGROUND: Biochemical markers of bone metabolism are used to assess skeletal turnover, but the variability of marker assays is still an issue of practical concern. We describe the results of an international proficiency testing program for biochemical bone markers among clinical laboratories. METHODS: Two serum and two urine pools (normal and increased marker concentrations) were sent on dry ice to 79 laboratories for analysis within 2 weeks of receipt. RESULTS: Data were submitted by 73 laboratories. The within-method interlaboratory CVs (CV(IL)s) were as follows: serum bone-specific alkaline phosphatase (n = 47 laboratories), 16-48%; serum osteocalcin (n = 31), 16-42%; urinary free deoxypyridinoline (n = 30), 6.4-12%; urinary total deoxypyridinoline and pyridinoline (n = 29), 27-28%; urinary N-terminal cross-linked telopeptide of type I collagen (n = 10), 39%; serum C-terminal cross-linked telopeptide of type I collagen (ICTP; n = 8), 22-27%; urinary hydroxyproline (n = 13), 12%. Analytical results showed both systematic and nonsystematic deviations. In identical samples, results obtained for the same marker by the same method differed up to 7.3-fold. In urine-based assays, correction for urinary creatinine slightly increased CVs. CONCLUSION: Even with identical assays and methods, results for most biochemical markers of bone turnover differ markedly among laboratories.     

Biochemical Markers of Bone Metabolism: An Overview

Objectives: An overview of biochemical markers of bone metabolism is presented along with indications for their clinical utilization.

Design and Methods: The structure, cyclical metabolism, and hormone regulation of bone is reflected by markers of resorption, formation and/or turnover. Markers of resorption representing degradation of type 1 collagen, include N-telopeptides, C-telopeptides, hydroxyproline, and the collagen crosslinks pyridinoline and deoxypyridinoline; acid phosphatase, a marker of osteoclast activity, and urinary calcium are also indicators of bone resorption. Bone formation markers indicate osteoblast activity; bone-specific alkaline phosphatase and the N-terminal and C-terminal extension peptides of procollagen reflect formation of organic matrix in bone. Osteocalcin, produced by osteoblasts but also released during osteoclastic degradation, may indicate either formation when resorption and formation are coupled or turnover when they are uncoupled.

Results: Bone markers respond to intervention more rapidly than techniques such bone mineral density. Resorption markers respond approximately 1 to 3 months after intervention; markers of formation respond later, after 6 to 9 months. Bone markers may add useful information for assessing fracture risk and for monitoring osteoporosis, Paget’s disease of bone, cancer metastasis, and metabolic disease. Various therapeutic interventions may affect release of some bone markers.

Conclusion: Bone disease has high prevalence in adults so bone markers will become even more important for assessing fracture risk and monitoring therapy as populations age. Characteristics of bone markers are dependent on biology and the assay used. Substantial work remains in characterizing existing assays, identifying better markers and performing the clinical studies to define which bone markers should be measured and when.     

Effects of low- and conventional-dose transcutaneous HRT over 2 years on bone metabolism in younger and older postmenopausal women

The minimum dosage of transcutaneous hormone replacement therapy (HRT) able to exert protective effects on postmenopausal bone mass, especially in older women, is uncertain. This study investigates the effects of transcutaneous HRT at two different doses of oestradiol [Estraderm 25 and 50 (E25, E50)] over 2 years in 44 postmenopausal women younger than 67 years and 27 of 67 years and older. Circulating biochemical markers of bone and connective tissue turnover, collagen type I (intact PINP, PICP) and type III (PIIINP) propeptides and type I telopeptide (ICTP), osteocalcin (OC) and alkaline phosphatase (AP) were measured. The responses of the biochemical markers in all the groups were very similar, and most of the observed changes occurred within the first year of treatment. E25 had an effect on the bone markers similar to that of E50, and there was little difference in response according to the patient's age. PINP fell markedly after 1 year in all groups to about half the pretreatment level, with a smaller drop in the second year. PICP responded more variably, and mean values were little changed. There was a slight fall at the higher dose in the younger women, and also in the older women (whose baseline level was higher) on the lower dose. The correlation between PINP and PICP was 0.52 at pretreatment and 0.84 after 2 years of treatment. PIIINP showed no changes. OC and AP both fell in all groups by the first year, but less markedly than PINP. Their response was slightly less pronounced in the older women. ICTP fell marginally in the younger women, and only after 2 years, regardless of dose. Postmenopausal serum oestradiol levels increased after HRT and were associated with decreased binding globulin (SHBG) levels in all groups. After E25 patch application individual serum oestradiol levels were variable and peaked between 13 and 36 h with a median value of 83.8 pmol L^–1. Our data suggest that low-dose transcutaneous HRT restores circulating oestradiol levels in postmenopausal osteopenic women of all ages as effectively as conventional-dose HRT and is associated with decreased circulating markers of bone and connective tissue turnover.     

Activity or mass concentration of bone-specific alkaline phosphatase as a marker of bone formation.

BACKGROUND: Recently published data identified bone-specific alkaline phosphatase (BALP) as a good marker of bone formation in different bone diseases and osteoporosis. Two methods are available for BALP determination: one measures enzyme activity, the other its mass concentration. We compared results for BALP activity and its mass concentration in a group of 88 healthy pre- and postmenopausal women to identify which is a more useful marker for detecting early menopausal bone remodelling changes. METHODS: We measured BALP activity and BALP mass concentration in relation to femoral neck (FN) and lumbar spine (LS) bone mineral density (BMD) and some other widely used bone markers: osteocalcin (OC), procollagen type I N-terminal propeptide (PINP) and serum C-terminal telopeptide cross-links of type I collagen (CTx) in serum samples from 50 premenopausal (age 45.9+/-4.6 years) and 38 postmenopausal (age 54.4+/-4.5 years) women. RESULTS: Healthy postmenopausal women exhibited 34.2% (p<0.01) and 27.3% (p=0.000) higher levels of BALP activity and mass concentration than premenopausal women, respectively. At the same time, FN and LS BMD were not significantly different between the groups. CTx values were significantly higher in postmenopausal women (p=0.018), while OC and PINP were not. We observed significant correlation between BALP activity and mass concentration (r=0.85, p<0.01). The correlation between BALP activity and FN BMD or LS BMD was insignificant. BALP mass correlated significantly with LS BMD (r=-0.370, p=0.033) but not with FN BMD. As expected, we proved a significant positive correlation for both BALP methods with the other bone markers measured in our study. CONCLUSIONS: Postmenopausal women have slightly higher bone turnover. Since LS and FN BMD were not significantly lower in our group of healthy postmenopausal women, but BALP and CTx were markedly higher, we suggest that measurements of BALP and CTx might be useful as early markers of higher bone turnover. Finally, our results did not show any differences between the clinical utility of BALP activity and BALP mass concentration measurements.     

Bone and collagen markers in paediatric practice

Biochemical markers of bone and collagen turnover have been found to be a valuable adjunct to measurements of bone mineral density in post-menopausal women in whom they appear to be independent predictors of osteoporosis and fracture risk. In children, they have been less extensively studied but have begun to find a similar complementary role in a number of disorders affecting bone turnover and growth. Although they may give helpful information in their reflection of recent bone turnover and growth in various disorders, their principal value appears to be in giving an early and sensitive indication of response to treatment, before changes in either height velocity or bone mineral density can be accurately determined. This review discusses the use and limitations of these markers in children, the clinical conditions in which they have been studied and their potential value in monitoring either beneficial or adverse effects of treatment on bone turnover and growth.     

骨转换生化标志物在骨质疏松症治疗中的临床应用

目的探讨并分析骨转换生化标志物在骨质疏松症治疗中的临床价值。方法将104例骨质疏松症患者随机分成观察组(54例)和对照组(50例)。观察组在治疗前后均进行Ⅰ型胶原蛋白氨基端前胶原肽(PINP)、Ⅰ型胶原分解片段C端肽β型(β-CTx)及骨钙素变化情况的监测,并根据监测结果调整治疗方案,及早预防骨折发生。对照组则根据常规治疗方法进行治疗,不进行骨转换生化标记物监测。治疗结束时通过骨密度检查判定并比较两组的临床治疗效果及骨折发生情况。结果观察组治愈率为88.89%;对照组治愈率66.00%。两组治愈率比较有显著性差异(P<0.05)。观察组治疗结束后骨转换生化指标均处于本地区临床标准范围内。研究期间观察组发生骨折患者3例,占5.56%;对照组发生骨折患者4例,占8.00%,两组比较骨折发生率无显著性差异(P>0.05)。结论骨转换生化指标能敏感反应患者骨形成与骨吸收情况,检测简便且廉价,在骨质疏松症的预防和治疗方面有显著的医疗效益、社会效益和经济效益。     

Asian multicenter trials on urinary type IV collagen in patients with diabetic nephropathy.

To investigate the changes of renal type IV collagen turnover in diabetic nephropathy, urinary type IV collagen was measured by a highly sensitive one-step sandwich enzyme immunoassay (EIA). Urinary samples were obtained from 698 diabetic patients and 191 healthy adults. Among the patients, 264 had urinary albumin levels of less than 29 mg/g.creatine (Cr) (Stage I: normoalbuminuric stage), 169 had microalbuminuria from 30 to 299 mg/g.Cr (Stage II: microalbuminuric stage), 84 patients had macroalbuminuria of more than 300 mg/g.Cr and serum Cr of less than 1.1 mg/dl (Stage IIIA: macroalbuminuric stage without renal dysfunction), 97 had macroalbuminuria of more than 300 mg/g.Cr and serum Cr of more than 1.2 mg/dl (Stage IIIB: macroalbuminuric stage with renal dysfunction), and 84 had renal failure (Stage IV). The levels of urinary type IV collagen in Stages II, IIIA, IIIB, and IV were significantly higher than those in Stage I (P < 0.0001). The level of urinary type IV collagen in Stage I (5.00 +/- 0.23 microg/g.Cr; mean +/- SE) was also higher than that in normal adults (3.44 +/- 0.11 microg/g.Cr; mean +/- SE). These levels increased gradually due to progression of the clinical stage of diabetic nephropathy. It appears that the levels of urinary type IV collagen can be a useful marker for detecting renal injuries in diabetes according to our Asian multicenter trials.     

Connective tissue response to major surgery and postoperative infection

Type I and type III collagen are components of a healing wound, and major structural proteins. According to our previous study, wound fluid concentrations of the liberated propeptide extensions of procollagens can be used to monitor collagen synthesis in the wound. Serum concentrations of the carboxyterminal propeptide of type I procollagen (PICP), and the aminoterminal propeptide of type III procollagen (PIIINP) were studied here for up to half a year in 102 patients, admitted for major abdominal surgery. In a frequent follow-up (n = 9), one minimum and two maxima were found for S-PICP, occurring 1 day, 7 days, and 2 months after surgery, respectively. S-PIIINP had a minimum at 1 day and a peak at 10 days. Relative changes (follow-up result/pre-operative concentration) of the propeptides in 50 uncomplicated patients were compared. The 1-day minimum of S-PICP was 0.60 (SD 0.18), and that of S-PIIINP 0.89 (0.27), (P less than 0.0001, 95% CI for the mean difference 0.21 to 0.36). The 7-day peak of S-PICP was 1.4 (0.5), and that of S-PIIINP 2.5 (1.2), (P less than 0.0001, CI 0.81 to 1.42). The 2-month-peak of S-PICP was 1.6 (0.3), and at the same time the relative S-PIIINP was still 1.7 (0.3) without any separate peak. Major infectious (n = 8) and other (12) complications, exploratory procedures (22) and patients with abnormal pre-operative propeptide levels (8) were studied separately. Two early deaths were excluded. Only major infection had a remarkable effect on the responses of S-PICP (3/8) and S-PIIINP (5/8).(ABSTRACT TRUNCATED AT 250 WORDS)