Alvarez L, Peris P, Pons F, Guañabens N, Herranz R, Monegal A, Bedini J L, Deulofeu R, Martínez de Osaba M J, Muñoz-Gómez J, Ballesta A M
Bioquímica Clínica, Hospital Clínic i Provincial, University of Barcelona, Spain.
Arthritis Rheum. 1997 Mar;40(3):461-8. doi: 10.1002/art.1780400312.
To evaluate the relationship between biochemical markers of bone turnover and bone scan indices of disease activity, as well as to analyze their variations based on skeletal involvement, in Paget's disease.
Serum samples were obtained from 51 patients with Paget's disease to determine the levels of total alkaline phosphatase (total AP), bone alkaline phosphatase (bone AP), propeptide carboxyterminal of type I procollagen (PICP), propeptide aminoterminal of type I procollagen (PINP), osteocalcin, tartrate-resistant acid phosphatase, and telopeptide carboxyterminal of type I collagen. Urine samples were analyzed for levels of hydroxyproline (HYP), pyridinoline (PYR), deoxypyridinoline (DPYR), C-terminal telopeptide of type I collagen (CTx), and N-terminal telopeptide of type I collagen (NTx). In addition, 2 semiquantitative scintigraphic indices, disease activity (AI) and disease extent (EI), were obtained. Pagetic skeletal locations were evaluated individually, with special attention to skull involvement.
All biochemical markers correlated with the AI and the EI. Serum PINP, bone AP, and total AP showed the highest proportions of increased values among the bone formation markers (94%, 82%, and 76%, respectively). Among the bone resorption markers, urinary NTx showed the highest proportion of increased values in patients with Paget's disease (96%), compared with PYR (69%), DPYR (71%), CTx (65%), and HYP (64%). In patients with mild disease activity, serum PINP was the marker with the highest proportion of increased values (71%). In contrast, serum PICP and urinary CTx were the most discriminative markers for skull involvement. Except for higher values for most of the biochemical markers of bone turnover in flat bones, no major differences in other skeletal locations were observed.
The determination of serum PINP as a marker of bone formation and urinary NTx as a marker of bone resorption provided the best biochemical profile to ascertain the extent and activity of Paget's disease. In patients with skull involvement, serum PICP and urinary CTx were shown to be the most discriminative markers.
评估佩吉特病中骨转换生化标志物与疾病活动度骨扫描指标之间的关系，并根据骨骼受累情况分析其变化。
从51例佩吉特病患者中获取血清样本，以测定总碱性磷酸酶（总AP）、骨碱性磷酸酶（骨AP）、I型前胶原羧基末端前肽（PICP）、I型前胶原氨基末端前肽（PINP）、骨钙素、抗酒石酸酸性磷酸酶和I型胶原羧基末端端肽的水平。分析尿液样本中羟脯氨酸（HYP）、吡啶啉（PYR）、脱氧吡啶啉（DPYR）、I型胶原C末端端肽（CTx）和I型胶原N末端端肽（NTx）的水平。此外，还获得了2个半定量骨闪烁显像指标，即疾病活动度（AI）和疾病范围（EI）。对佩吉特病的骨骼部位进行单独评估，特别关注颅骨受累情况。
所有生化标志物均与AI和EI相关。在骨形成标志物中，血清PINP、骨AP和总AP的升高值比例最高（分别为94%、82%和76%）。在骨吸收标志物中，与PYR（69%）、DPYR（71%）、CTx（65%）和HYP（64%）相比，佩吉特病患者尿液NTx的升高值比例最高（96%）。在疾病活动度较轻的患者中，血清PINP是升高值比例最高的标志物（71%）。相比之下，血清PICP和尿液CTx是颅骨受累最具鉴别性的标志物。除扁骨中大多数骨转换生化标志物的值较高外，其他骨骼部位未观察到重大差异。
测定血清PINP作为骨形成标志物和尿液NTx作为骨吸收标志物，可为确定佩吉特病的范围和活动度提供最佳生化特征。在颅骨受累的患者中，血清PICP和尿液CTx被证明是最具鉴别性的标志物。
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