20～75岁妇女血清护骨素、核因子-κB受体活化子配体的变化与年龄、停经、骨生化指标和骨密度的关系

目的　研究血清护骨素 (OPG)和核因子 κB受体活化子配体 (RANKL)与年龄、停经、骨生化指标和骨密度的关系 ,了解影响血清OPG和RANKL的因素。方法　在 5 0 4例 2 0～ 75岁的绝经前和绝经后妇女中 ,以双能X线吸收仪测定腰椎和股骨各处骨密度。按WHO标准 ,将绝经后妇女分为骨量正常、骨量减少和骨质疏松 3组。测定血清骨钙素 (BGP)、尿Ⅰ型胶原交联N端肽 (NTx)、血清OPG和RANKL ,计算RANKL/OPG比值。结果　年龄与血清OPG正相关 (r =0 4 4 2 ,P <0 0 0 1) ,与血清RANKL负相关 (r=- 0 2 6 3,P <0 0 0 1)。绝经后妇女的血清OPG(10 7 6± 3 0 )ng/L明显高于绝经前妇女 (72 0± 1 8)ng/L ,而血清RANKL(4 7± 0 4 )ng/L显著低于绝经前妇女 (5 8± 0 3)ng/L。校正年龄、停经年限和体重指数后 ,血清OPG、RANKL与腰椎和股骨各处骨密度无相关性。血清OPG与尿NTx/肌酐正相关 ;血清RANKL与血清BGP负相关。血清OPG和RANKL在绝经后骨质疏松组、骨量减少组和正常骨量组间差异无显著性。多元逐步回归分析显示 ,年龄、停经年限和骨转换指标是决定血清OPG RANKL系统的独立因素。结论　随年龄而升高的血清OPG可能是人体对抗绝经后骨吸收加快的一个代偿性反应 ,随年龄而下降的血清RANKL可能有益于恢复绝经后妇女的骨

The relationships between changes of serum osteoprotegerin, nuclear factor-kappa B ligand receptor activator, and age, menopause, bone biochemical markers and bone mineral densities in women aged 20 - 75

OBJECTIVE: To investigate the relationships between the serum levels of osteoprotegerin (OPG), receptor activator of nuclear factor-kappa B ligand (RANKL) with age, menopause, bone biochemical markers and bone mineral densities (BMDs) in pre- and postmenopausal women and to determine the contributing factors for serum OPG and RANKL. METHODS: 504 pre- and postmenopausal women aged between 20 and 75 years were enrolled in this study. BMDs at lumbar spine and proximal femur were measured with dual-energy X-ray absorption meter. The serum osteocalcin (BGP), OPG, RANKL and urinary type I collagen (NTx) were also tested. RESULTS: Age was positively related with serum OPG (r = 0.442, P < 0.001) and was negatively in association with serum RANKL (r = -0.263, P < 0.001). Postmenopausal women showed higher levels of serum OPG (107.6 +/- 3.0) ng/L], while their serum concentrations of RANKL (4.7 +/- 0.4) ng/L] and RANKL/OPG ratios (0.045 +/- 0.004) were significantly lower than those of premenopausal women (72.0 +/- 1.8) ng/L, (5.8 +/- 0.3) ng/L and 0.099 +/- 0.008]. Neither serum OPG nor RANKL or RANKL/OPG was in association with BMDs at lumbar spine or proximal femur after adjustment of age, years-since-menopause (YSM) and body mass index. Serum OPG was positively related with urinary NTx/creatinine. Serum RANKL was negatively related with serum BGP. Serum OPG, RANKL and RANKL/OPG showed no differences among normal, osteopenic and osteoporotic postmenopausal women. In multiple regression analysis, YSM, age and bone markers were the independent contributors to OPG-RANKL system. CONCLUSIONS: The elevation of serum OPG along with age might be a compensatary mechanism against the accelerated bone resorption, while the decreased level of serum RANKL might be helpful for restoring the reduced bone formation in postmenopausal women. YSM, age, together with bone tune-over markers were the main factors affecting serum concentrations of OPG and RANKL.