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骨生理学和骨转换的生化标志物

Author
Harold N Rosen, MD
Section Editor
Clifford J Rosen, MD
Deputy Editor
Jean E Mulder, MD
Translators
宁志伟, 主任医师

引言

成人的骨骼在不断重构，首先被破坏(骨质吸收)，而后是重建(骨形成)[1,2]。骨质吸收和再形成对于微小骨折的修复，还有应对压力和其他生物机械力时的结构修饰都十分重要正常情况下，骨形成与骨质吸收紧密偶联，因此骨量不会改变。当骨形成与骨质吸收失偶联时，会发生骨骼疾病。(参见“正常骨骼发育及骨形成与骨吸收的调节”)

骨转换率的改变是骨骼疾病的重要决定因素，因此，骨转换率相关的检查参数可为骨疾病患者的评估提供重要信息。过去，测定骨转换率的最佳方法是以四环素行双重标记后进行骨活检[1,3]。该技术可提供骨形成率和骨质吸收率的测定值，并确定正在发生活跃的骨质吸收和骨形成的骨表面所占的比例。不过，该操作复杂且花费较高，不适用于常规临床实践。

目前已有数种测定骨转换标志物(bone turnover marker, BTM)的检查可作为替代方法(表 1)。这些方法可测定胶原分解产物及破骨细胞和成骨细胞在骨吸收和骨质形成过程中释放的其他分子。尽管检查方法的改善提高了BTM反映骨转换率的能力，但生物学和实验室检查方面的差异成为BTM在临床实践中广泛应用的混杂因素。

本专题将总结骨生理学和BTM的测定。BTM的临床效用见其他专题。 (参见“骨转换生化标志物在骨质疏松中的应用”和“研究中的生物标志物在类风湿关节炎诊断和评估中的作用”和“多发性骨髓瘤的临床特征、实验室表现及诊断”)

骨重构

本文将简要叙述骨形成和骨质吸收的步骤，详细内容将单独介绍。 (参见“正常骨骼发育及骨形成与骨吸收的调节”)

           

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Literature review current through: 2017-06 . | This topic last updated: 2015-11-16.
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