Heider Ulrike, Fleissner Claudia, Zavrski Ivana, Kaiser Martin, Hecht Monica, Jakob Christian, Sezer Orhan
Department of Haematology and Oncology, Charité, Universitätsmedizin Berlin, D-10117 Berlin, Germany.
Eur J Cancer. 2006 Jul;42(11):1544-53. doi: 10.1016/j.ejca.2005.11.034. Epub 2006 Jun 9.
Bone disease, a hallmark of multiple myeloma occurs in the majority of the patients, is associated with bone pain, fractures, hypercalcemia and has major impacts on quality of life. Myeloma is characterized by a unique form of bone disease with osteolytic bone destruction that is not followed by reactive bone formation, resulting in extensive lytic lesions. This review will focus on the pathophysiology of osteoclast activation and osteoblast inhibition in multiple myeloma and on biochemical markers of bone turnover. Since osteolytic lesions do not rapidly heal in myeloma, X-rays cannot reflect the activity of bone disease during antimyeloma treatment. Activity in bone turnover does not parallel changes in monoclonal protein levels. Thus, there is a need for biochemical markers reflecting disease activity in bone. The utility, prognostic implications and limitations of classical and novel markers of bone remodeling (e.g. ICTP, NTx, TRACP-5b, osteoprotegerin, sRANKL) will be discussed in this overview.
骨病是多发性骨髓瘤的一个标志，大多数患者都会出现，与骨痛、骨折、高钙血症相关，对生活质量有重大影响。骨髓瘤的特征是一种独特形式的骨病，伴有溶骨性骨破坏，且之后不会有反应性骨形成，导致广泛的溶骨性病变。本综述将聚焦于多发性骨髓瘤中破骨细胞激活和成骨细胞抑制的病理生理学以及骨转换的生化标志物。由于骨髓瘤中的溶骨性病变不会迅速愈合，X射线无法反映抗骨髓瘤治疗期间骨病的活动情况。骨转换活动与单克隆蛋白水平的变化并不平行。因此，需要有反映骨疾病活动的生化标志物。本概述将讨论骨重塑的经典和新型标志物（如I型胶原羧基末端肽、尿N端肽、抗酒石酸酸性磷酸酶5b、骨保护素、可溶性核因子κB受体活化因子配体）的效用、预后意义及局限性。
