Nawawi H, Samson D, Apperley J, Girgis S
Department of Metabolic Medicine, Royal Postgraduate Medical School London, UK.
Clin Chim Acta. 1996 Sep 30;253(1-2):61-77. doi: 10.1016/0009-8981(96)06334-6.
Enhanced bone resorption is a characteristic finding in multiple myeloma (MM). The aim of this study was to assess the newer biochemical bone markers in patients with myeloma. We studied 17 MM patients--10 males (3 untreated, 5 in remission, 2 responding), 7 females (3 in remission, 4 responding) and 15 normal controls. Serum bone specific alkaline phosphatase (BSALP), osteocalcin (OC) and procollagen type 1 C-terminal peptide (PICP) were determined as markers of bone formation, while serum tartrate resistant acid phosphatase (TRAP), urinary deoxypyridinoline (Dpyr) and calcium (Ca) were determined as markers of bone resorption and the ratio of the levels of bone formation/resorption were determined. All markers were measured by enzyme immunoassays (Metra Biosystems), except for TRAP by an in-house enzymatic assay and Ca by the cresolphthalein method. The Dpyr and Ca were expressed as a ratio to urinary creatinine (Cr) excretion. There were significantly higher (i) (Dpyr/Cr)/PICP ratio in male MM patients than in controls (P < 0.05); (ii) (a) urinary Dpyr excretion (P < 0.001), (b) (Dpyr/Cr)/BSALP ratio (P < 0.0001) and (c) (Dpyr/Cr)/PICP (P < 0.0001) in the untreated male MM subgroup than controls; (iii) (Dpyr/Cr)/BSALP ratio (P < 0.05) in the untreated than in the responding male MM subgroup, (iv) (Dpyr/Cr)/PICP ratio (P < 0.05) in untreated male patients than in those in the remission subgroup. In conclusion, (a) Dpyr is a sensitive marker in assessment of bone resorption in MM patients; (b) (Dpyr/Cr)/BSALP or (Dpyr/Cr)/PICP ratio is even more sensitive in distinguishing the untreated from the other MM subgroups and controls. Therefore, the use of a combination of these markers may have a potential role in the management of patients with MM.
骨吸收增强是多发性骨髓瘤（MM）的一个典型特征。本研究的目的是评估骨髓瘤患者中更新的生化骨标志物。我们研究了17例MM患者——10例男性（3例未治疗，5例缓解，2例有反应），7例女性（3例缓解，4例有反应）以及15名正常对照者。测定血清骨特异性碱性磷酸酶（BSALP）、骨钙素（OC）和Ⅰ型前胶原C端肽（PICP）作为骨形成标志物，同时测定血清抗酒石酸酸性磷酸酶（TRAP）、尿脱氧吡啶啉（Dpyr）和钙（Ca）作为骨吸收标志物，并测定骨形成/吸收水平的比值。除TRAP采用内部酶法测定以及Ca采用甲酚红法测定外，所有标志物均通过酶免疫测定法（Metra Biosystems）进行检测。Dpyr和Ca均以与尿肌酐（Cr）排泄量的比值表示。结果显示：（i）男性MM患者的（Dpyr/Cr）/PICP比值显著高于对照组（P < 0.05）；（ii）（a）未治疗男性MM亚组的尿Dpyr排泄量（P < 0.001）、（b）（Dpyr/Cr）/BSALP比值（P < 0.0001）和（c）（Dpyr/Cr）/PICP（P < 0.0001）均显著高于对照组；（iii）未治疗男性MM亚组的（Dpyr/Cr）/BSALP比值（P < 0.05）高于有反应的男性MM亚组；（iv）未治疗男性患者的（Dpyr/Cr）/PICP比值（P < 0.05）高于缓解亚组的男性患者。总之，（a）Dpyr是评估MM患者骨吸收的敏感标志物；（b）（Dpyr/Cr）/BSALP或（Dpyr/Cr）/PICP比值在区分未治疗的MM亚组与其他亚组及对照组时更为敏感。因此，联合使用这些标志物可能在MM患者的管理中具有潜在作用。
