摘要
目的 :了解肾性骨营养不良在血液透析患者中的发病及分布情况 ,观察血生化指标与骨组织形态学有关参数的相关性。 方法 :对 15例血液透析患者行骨活检 ,进行骨活检标本骨组织形态计量学检测 ,同时测定某些血生化指标。 结果 :15例血液透析患者均有程度不等、变化不一的骨组织学病理变化 ;全段甲状旁腺激素(intactparathyroidhormone ,iPTH)与骨矿化率、骨形成率具有相关性 (r=0 5 85 ,P <0 0 5 ;r =0 436 ,P <0 0 5 )。骨特异性碱性磷酸酶 (bonealkalinephosphatase ,BAP)、碱性磷酸酶 (alkalinephosphatase ,ALP)均与类骨质表面、类骨质面积呈正相关关系 ,前者相关性更好 (r=0 70 1vs 0 5 32 ;r=0 82 7vs 0 80 9)。血iPTH在低转化骨病与非低转化骨病两组间差异显著 (P <0 0 1)。 2例铝中毒骨病患者 ,血清铝在正常范围内 ,去铁胺试验后血铝增加值较非铝中毒者高 ,而且iPTH水平较低。 结论 :iPTH、BAP结合起来可以初步估计骨代谢状态 ;而在铝中毒骨病的诊断上 ,去铁胺试验结合血iPTH水平有一定帮助。但以上血生化指标在不同类型的骨病中并无严格的界限 ,所以 ,骨活检仍是诊断肾性骨营养不良的金标准。
OBJECTIVE To evaluate the morbidity and classification of renal osteodystrophies in hemodialysis patients according to bone histomorphometric changes and find more sensitive and specific boichemical parameters to help assess bone metabolic states.METHODOLOGY 15 chronic hemodialysis patients were involved in this study in whom bone biopsy were performed after double tetracycline labeling and serum biochemical parameter were measured at the same time. RESULTS We found that every patient has abnormal bone histomorphometric changes,iPTH has positive correlation with MAR、BFR( r =0 585, P <0 05; r =0 436, P <0 05).Bone alkaline phosphatase(BAP) had a better relation to OS/BS%、O.Ar/B.Ar% than ALP( r =0 701 vs r =0 523, P <0 001; r =0 827 vs r =0 809, P <0 001).There was a statistical difference between low turn over and not low turn over bone disease in serum iPTH.Serum aluminum of the two ABD patients was in the normal range,the increment of serum aluminum after DFO test in aluminum bone disease patients was higher and the serum iPTH lower than non ABD patients. CONCLUSION iPTH、BAP could be used to evaluate bone metabolic changes;in conjunction with iPTH assay,DFO test could be applied to help diagnosis ABD.But there was no absolute distinction on biochemical data among various renal bone diseases.Therefore bone biopsy is still a gold standard for classification of renal osteodystriphies.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2000年第2期108-112,共5页
Chinese Journal of Nephrology,Dialysis & Transplantation
