Background and objective: Bone metabolic markers are biomarkers derived from bone matrix or osteocyte reflecting bone metabolic situation. The aim of this study is to explore the diagnostic value of bone markers, cross-linked telopeptide of type I collage (ICTP) and bone-specific alkaline phosphatase (BAP) in lung cancer patients with bone metastases (B.M).
Methods: As a prospective control study, 110 cases were enrolled and divided into 3 groups. Totally 90 pre-treated, stage IV lung cancer cases were divided into two groups: 50 cases with bone metastases, 40 cases without bone metastases, as well as 20 healthy subjects were included as control. Serum ICTP was detected by enzyme-linked immunoassay (ELISA) and serum BAP was detected by electrochemiluminescence immunoassay. The relationships between factors of B.M and serum levels of ICTP, BAP were analyzed.
Results: The levels of serum ICTP and BAP in lung cancer patients with B.M were significantly higher than those in the healthy controls and those without B.M (P < 0.05). The level of serum BAP in patients with multiple B.M (lesions>=3) was significantly higher than that in patients with few B.M (lesions < 3) (P < 0.05). The level of serum BAP in patients with mixed pattern was significantly higher than that with lytic pattern. The sensibility of ICTP and BAP in the diagnosis of B.M in lung cancer patients was 18% and 40% respectively. The specificity of ICTP and BAP was 98.3% and 95% respectively. The accuracy rates of ICTP and BAP were 61.8% and 70.0% respectively. Joint detection of ICTP and BAP had improved sensibility and accuracy in the diagnosis of bone metastases in lung cancer patients (52% and 74.5% respectively).
Conclusions: Serum bone biochemical markers ICTP and BAP have diagnostic values for B.M in lung cancer patients with lower costs, noninvasiveness and convenience.
背景与目的: 骨代谢标志物是一类源于骨基质或骨细胞的代谢指标，可反映骨代谢情况。本研究旨在探讨血清骨代谢生化指标Ⅰ型胶原交联羧基端肽（cross-linked telopeptide of type Ⅰ collage, ICTP）和骨特异性碱性磷酸酶（bone-specific alkaline phosphatase, BAP）在肺癌骨转移诊断中的意义及其临床应用价值。
方法: 采用前瞻性对照方法，共入组110例，分为3组。初治肺癌患者共90例，临床分期为Ⅳ期，分为骨转移组50例和非骨转移组40例，健康对照组20例，采用酶联免疫法和电化学发光免疫测定法检测所有入组者治疗前的血清骨代谢生化指标ICTP和BAP水平，对骨转移的各因素与血清ICTP和BAP的相关性进行统计学分析。
结果: 骨转移组的血清ICTP和BAP水平显著高于非骨转移组和健康对照组（P < 0.05）。多发性骨转移组（骨转移数≥3）的血清BAP水平显著高于少发性骨转移组（骨转移数 < 3）（P < 0.05）。混合性骨转移组的血清BAP水平显著高于溶骨性骨转移组（P < 0.05）。ICTP和BAP在肺癌骨转移诊断中的敏感性分别为18%和40%，特异性分别为98.3%和95%，准确度分别为61.8%和70%。联合检测血清ICTP和BAP可提高其敏感性和准确度（分别为52%和74.5%）。
结论: 由于检测方便、无创性、成本较低，血清骨代谢生化指标ICTP和BAP在肺癌骨转移的临床诊断中有一定的实用价值。