On Spinal Tuberculosis Bone Metabolic Markers Evaluation And Its Clinical Significance

Objective To study the changes of urinary deoxypyridinoline (DPD) and serum alkaline phosphatase (ALP) of spinal tuberculosis. To evaluate the clinical usefulness of urinary DPD and serum ALP in the assessment of Spinal tuberculosis in patient with pulmonary tuberculosis. To compare the clinical value of the urinary DPD and ALP in the diagnosis of spinal tuberculosis in patients with pulmonary tuberculosis. Methods By All subjects were divided into three groups: group 1,patients with STB (n=33); group 2, patients with LTB (n=33). group 3, healthy peasons (n=30); Thirty-three patients with STB (16 males and 17 females) were selected for analyzing the levels of urinary DPD and serum ALP of spinal tuberculosis. And the levels of urinary DPD and serum ALP were determined in 33 PTB patients (17 males and 16 females) and in 30 healthy peasons (15 males and 15 females). DPD were detected by ACS:180 Automated Chemiluminescence System. Their detecting results were analyzed. 33 patients with Spinal tuberculosis who were admitted to the hospital of the Ningxia Medical College between Mar. 2004 to Mar. 2005 were studied. Thirty-three patients with pulmonary tuberculosis who were included in this study were selected from Ningxia Tuberculosis Hospital. The diagnosis of Spinal tuberculosis was confirmed cytologically or histologically. The values for urinary DPD were corrected for urinary creatinine to overcome confounding variables such as body mass index and urine dilution. Their detecting results were analyzed. Results The mean urinary concentrations of DPD in spinal tuberculosis , pulmonary tuberculosis and healthy persons were 14.9±9.8μ mol/molCr., 6.4±2.6μmol/molCr. and 6.3±2.0μmol/molCr.,respectively(P value=0.000, 0.000). The mean serum concentrations of ALP in three groups were 121.5±41.9IU/L, 88.7±18.8IU/L and 89.4±24.1IU/L, respectively(P value=0.001, 0.001). Patients with spinal tuberculosis had a higher urinary excretion of DPD and a higher serum ALP than those without spinal tuberculosis. There was no difference in group of pulmonary tuberculosis and group of healthy persons(P=0.751, P=0.605). DPD had a better receiver operating characteristic (ROC) curve than ALP, since the areas under the ROC curve were 0.83, and 0.73, respectively. DPD showed the better curve characteristics among the two bone markers. For DPD, the sensitivity (87%) and specificity (73%) was seen at the cut-off level of 8.4μmol/mol creatinine. For ALP, the sensitivity (76%) and specificity (69%) was seen at the cut-off level of 108IU/L. Although correlation coefficients among DPD and ALP were significantly positive (P<0.01), the stronger relationship was appeared between DPD and ALP (R=0. 683). Conclusions Bone Matabolic activities can show changed in patients with STB. And the bone resorption can show increased shaply. The determination of urinary DPD may provide a important reference value for the assessment of STB from PTB. Measurement of urinary DPD was valid diagnostic method of spinal tuberculosis from pulmonary tuberculosis. 4. DPD was superior to ALP in detecting spinal tuberculosis in patients with pulmonary tuberculosis.