Comparison of five biochemical markers of bone resorption in multiple myeloma: elevated pre-treatment levels of S-ICTP and U-Ntx are predictive for early progression of the bone disease during standard chemotherapy
Comparison of five biochemical markers of bone resorption in multiple myeloma: elevated pre-treatment levels of S-ICTP and U-Ntx are predictive for early progression of the bone disease during standard chemotherapy
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DOI：
10.1046/j.1365-2141.2003.04050.x
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发表时间：
2003-01-01
影响因子：
6.5
通讯作者：
Heickendorff, L
中科院分区：
文献类型：
--
作者：
Abildgaard, N;Brixen, K;Heickendorff, L
骨细胞骨吸收增加是多发性骨髓瘤骨病的主要原因。最近，非侵入性的方法已被开发用于估计骨吸收活性。为了评价5种生化检测方法的生物学敏感性和临床应用价值，我们对34例新诊断的骨髓瘤患者进行了一项研究，这些生化检测方法用于测定血清（β-Crosslaps ELISA和ICTP放射免疫法）和尿肌酐调节的吡啶啉（PYR）、脱氧吡啶啉（DPD）和I型胶原N-末端末端肽（Ntx）排泄量中I型胶原C-末端肽（ICTP）。在治疗开始前采集血清和早晨空腹、第二次排尿尿液样本。总共有40名年龄和性别调整的健康个体作为对照。结果表示为Z分数。所有测试变量在患者中均显著升高（P <0.001）。大多数患者（85%）血清（S）-ICTP升高（Z评分> 2），Z评分值显著高于其他标志物。当从分析中排除肾功能受损的患者时，S-ICTP仍然比尿液检测更敏感。S-ICTP和尿代谢产物与骨骼发病率显著相关。仅当肾功能不全患者被排除在分析之外时，S-β-Crosslaps与骨发病率相关。在标准美法仑-泼尼松龙治疗期间，高水平的S-ICTP和尿（U）-Ntx与骨病变早期进展的风险增加相关。U-Ntx和S-ICTP是评估多发性骨髓瘤骨吸收增加的敏感工具，在临床上可用于识别骨疾病早期进展风险增加的患者。
Increased osteoclastic bone resorption is the major causal factor of bone disease in multiple myeloma. Recently, non-invasive methods have been developed for the estimation of bone resorptive activity. To evaluate the biological sensitivity and clinical usefulness of five biochemical assays for measuring the C-terminal telopeptide of collagen I (ICTP) in serum (beta-Crosslaps ELISA and ICTP radioimmunoassay) and urinary creatinine-adjusted excretions of pyridinoline (PYR), deoxypyridinoline (DPD) and N-terminal telopeptide of collagen I (Ntx), we performed a study of 34 consecutive newly diagnosed myeloma patients. Serum and morning-fasting, second-void urine samples were taken before the start of treatment. In total, 40 age- and sex-adjusted healthy individuals served as controls. Results were expressed as Z-scores. All test variables were highly significantly elevated in the patients (P < 0.001). Serum (S)-ICTP was elevated (Z-score > 2) in most patients (85%) and showed significantly higher Z-score values than the other markers. S-ICTP remained more sensitive than the urinary assays when patients with impaired renal function were excluded from analysis. S-ICTP and the urinary metabolites correlated significantly with skeletal morbidity. S-beta-Crosslaps correlated with the bone morbidity only when patients with renal insufficiency were excluded from the analysis. High levels of S-ICTP and urinary (U)-Ntx correlated with an increased risk for early progression of bone lesions during standard melphalan-prednisolone treatment. U-Ntx and S-ICTP are sensitive tools for estimating the increased bone resorption in multiple myeloma and are clinically useful for identifying patients with increased risk of early progression of bone disease.