Laroche M, Attal M, Dromer C
Service de Rhumatologie, CHU Rangueil Toulouse, France.
Clin Rheumatol. 1996 Jul;15(4):347-52. doi: 10.1007/BF02230356.
In order to characterize the abnormalities of bone remodelling in the various stages of plasma cell disorders, we studied 60 patients (29 monoclonal gammopathies of uncertain significance (MGUS), 13 stage I myeloma, 18 stage III myeloma). We carried out histomorphometric study of bone biopsies in 34 patients and measurement of osteocalcin and the calciuria/creatinine ratio. Bone remodelling was approximately normal (BV/TV:21.2 +/- 7, ES:4.1 +/- 2, OS:16.5 +/- 10) in MGUS. Stage I myeloma was characterised by parallel increases in resorption surfaces and osteoid surfaces (BV/TV:18 +/- 5, ES/BS:7.4 +/- 3.5, OS/BS:24.8 +/- 11.5), of the ca/cr ratio and osteocalcin. In stage III myeloma, resorption surfaces and the ca/cr ratio showed an even greater increase while osteoid surfaces, osteocalcin and trabecular bone volume decreased (BV/TV 13.6 +/- 6, ES/BS:12.1 +/- 6, OS/BS:13.6 +/- 8.3). Osteocalcin and osteoid surfaces were correlated (r = 0.5). There was a positive correlation between osteocalcin and the number of plasmocytes in stage 1 myeloma (r = 0.64) and a negative correlation in stage III myeloma (r = 0.9). Bone remodeling was normal in MGUS; bone remodelling grew with a parallel increase of formation and resorption in stage I; bone resorption increased while bone formation decreased in stage III myeloma.
为了描述浆细胞疾病各阶段骨重塑异常的特征，我们研究了60例患者（29例意义未明的单克隆丙种球蛋白病（MGUS）、13例I期骨髓瘤、18例III期骨髓瘤）。我们对34例患者的骨活检进行了组织形态计量学研究，并测量了骨钙素和尿钙/肌酐比值。MGUS患者的骨重塑大致正常（骨体积分数：21.2±7，侵蚀表面：4.1±2，骨表面：16.5±10）。I期骨髓瘤的特征是吸收表面和类骨质表面平行增加（骨体积分数：18±5，侵蚀表面/骨表面积：7.4±3.5，骨表面/骨表面积：24.8±11.5），同时钙/肌酐比值和骨钙素升高。在III期骨髓瘤中，吸收表面和钙/肌酐比值进一步升高，而类骨质表面、骨钙素和小梁骨体积减少（骨体积分数13.6±6，侵蚀表面/骨表面积：12.1±6，骨表面/骨表面积：13.6±8.3）。骨钙素和类骨质表面相关（r = 0.5）。I期骨髓瘤中骨钙素与浆细胞数量呈正相关（r = 0.64），III期骨髓瘤中呈负相关（r = 0.9）。MGUS患者骨重塑正常；I期骨重塑随形成和吸收的平行增加而增强；III期骨髓瘤中骨吸收增加而骨形成减少。
