骨转换生化指标在诊断原发性肺癌骨转移中的应用

目的　探讨骨转换生化指标对原发性肺癌患者发生骨转移的监测作用。方法　选择10例已经确诊为原发性肺癌伴骨转移的患者,10例无骨转移的原发性肺癌患者以及10例健康人,分别应用化学发光免疫分析法测定患者血清骨特异性碱性磷酸酶(b AL P)、电化学发光免疫分析法测定 型胶原羟基末端肽(s CTX)和骨钙素(N-MID)以及酶免疫荧光法测定血清总碱性磷酸酶(t AL P)。结果　健康人群组和原发性肺癌不伴骨转移组中各生化指标的个性指数均小于0 .6。两组中N- MID的临界差异(CD)最小,s CTX的CD值最大。经统计学分析,无骨转移组和对照组中的各骨代谢指标比较结果无明显差异(P>0 .0 5 ) ;骨转移组与无骨转移组中的t AL P、b AL P和s CTX有明显差异(P<0 .0 5 ) ,N- MID无明显差异(P=0 .0 8)。结论　b AL P和s CTX可以用于随访无骨转移的原发性肺癌患者,早期监测骨转移的发生。

Bone Turnover Markers in the Detection of Bone Metastases in Primary Lung Cancer

OBJECTIVE: To study which markers can be applied to monitor the presence of the bone metastases in primary lung cancer without bone lesion during the follow-up period. METHODS: Based on the criteria for inclusion, we screened and selected 10 cases of lung cancer with bone metastases, 10 cases of lung cancer without bone metastases and 10 healthy subjects. Then we measured their serum bone alkaline phosphatases (bALP) by chemiluminescence immunoassay, their serum beta-carboxyterminal telopeptide of type I collagen (sCTX) and their serum N-terminal midfragment osteoclacin (N-MID) by electro-chemiluminescence immunoassay, and their serum total alkaline phosphatases (tALP) by flurorescence enzyme immunoassay. RESULTS: The individuality indices (II) of all biochemical markers were less than 0.6 in the healthy group and the primary lung cancer without bone metastases group. sCTX was the marker showing the highest critical difference (CD) in these groups, whereas N-MID was the marker displaying the lowest CD. Comparison on the means of these markers between the healthy group and the primary lung cancer without bone metastases group showed that P value for N-MID, tALP, bALP and sCTX was higher than 0.05. The means of these markers between the primary lung cancer without bone metastases group and the primary lung cancer with bone metastases group showed that the P value for N-MID was 0.08, and the P values for tALP, bALP and sCTX were less than 0.05. CONCLUSION: These results support the use of bALP and sCTX as a tool to follow up the lung cancer patients without bone metastases in order to monitor the presence or absence of bone metastases.