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。

Assessment of bone metabolic biochemical indexes measurement in gynecological clinical practice

Objectives To evaluate prospectively the bone markers of serum osteocalcin (BGP), bone specific alkaline phosphatase (BAP), C terminal peptide of type I collagen (CICP), urinary pyridinoline (PYD), urinary calcium to creatinine value (uCa/Cr), and hydroxyprolin to creatinine ratio (uHOP/Cr), and to assess their responsiveness to subtle changes of bone metabolism, and furthermore to compare which of the bone markers are more sensitive to estrogen shortage caused by menopause. Methods Markers of above bone formation and bone resorption were measured in 146 women classified into three groups: group I: 51 normal premenopausal women, group II:42 postmenopausal women, and group III: 53 bilateral ovariectimized women. Correlation analysis was made between these indexes and bone mineral density (BMD). Results The mean values of the four bone markers of BGP, BAP, CICP, PYD in group II and III were significantly higher than those in group I ( P <0 05). All correlations between the biochemical markers of BGP, BAP, CICP and PYD for bone turnover were highly significant and exhibited a significant connection to BMD. The best correlation was found between BGP and PYD, BGP and BAP. However, the levels of Ca/Cr and HOP/Cr made no difference in the three groups, and there was no correlation with any other indexes. Conclusion In postmenopausal women (natural menopause and surgical menopause) suffering from severe E 2 dificiency, BGP, BAP, CICP and PYD are significantly increased, indicating a clear correlation between E 2 diffciency and these markers of bone turnover, so they are clinically useful in the assessment of bone turnover during changes of the estrogen status that modify the metabolic activity of the skeleton. But the traditional markers of Ca/Cr and HOP/Cr have limitations in gynecological practice because of lack of sensitivity and specificity.