CAJ | 학술논문

目的观察各期慢性.肾脏病(CKD)患者血清骨代谢生化指标与骨密度(BMD)的变化情况及其相关性,探讨这些指标在肾性骨营养不良(ROD)早期诊断中的意义.方法 78例入选患者共分6组,其中Ccr≥15 ml/min者按CKD临床1～4期分期标准分为4组;Ccr<15 ml/min者按是否行规律血液透析而分为2组.ELISA法测定骨保护素(OPG).放射免疫法测定血清骨钙素(OC)、降钙素(CT).化学发光法测定甲状旁腺素(iPTH).6组患者中共47例行腰椎及股骨不同部位BMD测定.分析各组患者以上指标的差异及其相关性.结果 (1)血清OPG、iPTH及磷分别从CKD 3、4、5期开始显著上升(P<0.01),其中OPG在血液透析后达(5.10±1.34)ng/L,显著高于透析前的(3.35±0.76)ng/L,差异有统计学意义(P<0.05).各期CKD患者血清OC、CT、钙及碱性磷酸酶水平差异无统计学意义,而血液透析可使OC显著升高(P<0.05).股骨沃德三角BMD在CKD 4期患者下降至0.77±0.09,显著低于CKD 1期患者的1.15±0.05,差异有统计学意义(P<0.01),而血液透析不影响其水平.(2)血清OPG与Ccr、磷、iPTH、OC呈负或正相关(r分别为-0.70、0.51、0.39、0.36,均P<0.01).股骨沃德三角BMD与血清iPTH、OC呈负相关(r分别为-0.59、-0.51,均P<0.01);与血清磷、OPG亦呈负相关(r分别为-0.45、-0.48,均P<0.05).结论 CKD患者骨代谢生化指标与BMD均随Ccr下降而出现明显异常,这些变化之间存在一定的相关性.血清OPG改变早于iPTH及BMD,在ROD的早期诊断中意义最大.血液透析可使血清OPG、OC水平升高,但不影响BMD水平.
목적 관찰각기만성.신장병(CKD)환자혈청골대사생화지표여골밀도(BMD)적변화정황급기상관성,탐토저사지표재신성골영양불량(ROD)조기진단중적의의.방법 78례입선환자공분6조,기중Ccr≥15 ml/min자안CKD림상1～4기분기표준분위4조;Ccr<15 ml/min자안시부행규률혈액투석이분위2조.ELISA법측정골보호소(OPG).방사면역법측정혈청골개소(OC)、강개소(CT).화학발광법측정갑상방선소(iPTH).6조환자중공47례행요추급고골불동부위BMD측정.분석각조환자이상지표적차이급기상관성.결과 (1)혈청OPG、iPTH급린분별종CKD 3、4、5기개시현저상승(P<0.01),기중OPG재혈액투석후체(5.10±1.34)ng/L,현저고우투석전적(3.35±0.76)ng/L,차이유통계학의의(P<0.05).각기CKD환자혈청OC、CT、개급감성린산매수평차이무통계학의의,이혈액투석가사OC현저승고(P<0.05).고골옥덕삼각BMD재CKD 4기환자하강지0.77±0.09,현저저우CKD 1기환자적1.15±0.05,차이유통계학의의(P<0.01),이혈액투석불영향기수평.(2)혈청OPG여Ccr、린、iPTH、OC정부혹정상관(r분별위-0.70、0.51、0.39、0.36,균P<0.01).고골옥덕삼각BMD여혈청iPTH、OC정부상관(r분별위-0.59、-0.51,균P<0.01);여혈청린、OPG역정부상관(r분별위-0.45、-0.48,균P<0.05).결론 CKD환자골대사생화지표여BMD균수Ccr하강이출현명현이상,저사변화지간존재일정적상관성.혈청OPG개변조우iPTH급BMD,재ROD적조기진단중의의최대.혈액투석가사혈청OPG、OC수평승고,단불영향BMD수평.
Objective To investigate the correlation between serum bone metabolism biomarkers and bone mineral density (BMD) in chronic kidney disease (CKD) patients with different stages. Methods Seventy-eight CKD patients were enrolled in this study and were assigned to different groups according to their ereatinine clearance (Cer). Patients with Cer ≥ 15 ml/min were divided into 4 groups based on clinical CKD 1-4 stage standard, and those with Ccr<15 ml/min were divided into two groups of hemodialysis (HD) and non-HD. Their levels of serum calcium, phosphorus, alkalinity phosphatase (ALP), urea, Ser, osteocalein (gla-protein, OC), calcitonin (CT), intact parathyroid hormone (iPTH), osteoprotegerin (OPG) and BMD were detected respectively. Results (1) The serum levels of OPG, iPTH and phosphorus increased significantly in stage 3, 4, 5, respectively (P<0.01), and serum OPG level was elevated to (5.1±1.34) ng/L after HD, which was significantly higher than (3.35±0.76) ng/L before HD (P<0.05). The levels of serum OC, CT, calcium, ALP were not significantly different among patients with different CKD stages, while the level of OC was elevated in HD patients (P<0.05). The femoral WARDS triangle BMD of CKD stage 4 patients decreased to 0.77±0.09, which was less than the value of CKD stage 1 patients (P<0.01), with litde influence from hemodialysis treatment. (2) The level of serum OPG was positively correlated with the levels of serum phosphorus, iPTH, OC (r = 0.51, 0.39, 0.36,all P<0.01), and it was negatively correlated with the level of Ccr (r =-0.70, P<0.01). The femoral WARDS triangle BMD was negatively correlated with the levels of iPTH, OC, phosphorus and OPG (r =-0.59,-0.51,-0.45,-0.48, all P<0.05). Conclusions Most of serum bone metabolism biomarkers change according to the declined level of Cer. Compared with serum phosphorus, the levels of iPTH, BGP and femoral WARDS triangle BMD, serum OPG may be early diagnosticmarkers of renal osteodystrophy in CKD patients.