中华核医学与分子影像杂志
中華覈醫學與分子影像雜誌
중화핵의학여분자영상잡지
Chinese Journal of Nuclear Medicine and Molecular Imaging
2015年
1期
44-47
,共4页
范光磊%栾玉芬%彭鸣亚%方莉%何雪晴%徐龙宝
範光磊%欒玉芬%彭鳴亞%方莉%何雪晴%徐龍寶
범광뢰%란옥분%팽명아%방리%하설청%서룡보
肾变病综合征%肾性骨营养障碍%生物学标记
腎變病綜閤徵%腎性骨營養障礙%生物學標記
신변병종합정%신성골영양장애%생물학표기
Nephrotic syndrome%Renal osteodystrophy%Biological markers
目的 探讨原发性肾病综合征(PNS)患者肾性骨营养不良(ROD)与骨转换生化指标的关系,评价检测这些指标在PNS患者中的临床价值.方法 应用双能X线骨密度仪分别测定30例PNS患者和50例健康体格检查者的腰椎和股骨BMD,检测血清中骨转换生化指标总Ⅰ型前胶原氨基端延长肽(TP Ⅰ NP)、Ⅰ型胶原羧基端肽β特殊序列(β-CTx)、完整PTH(iPTH)及血清钙、血清磷、ALP、25-羟基维生素D3(25-OH-VD3)、血清β2微球蛋白(β2-MG)、尿微量白蛋白/肌酐比值(UA/Cr)等,分析引起ROD的相关危险因素.采用两独立样本t检验、多元线性回归及偏相关分析对数据进行统计学处理.结果 PNS组腰椎L1～4总BMD、左侧股骨颈和左侧股骨大转子BMD均低于对照组(＜40岁组:t=6.162、5.583和3.891,≥40岁组:t=5.923、5.324和3.129;均P＜0.05).PNS组TPⅠNP、β-CTx、iPTH、ALP、β2-MG、UA/Cr较对照组升高(＜40岁组:t=2.738～ 10.129; ≥40岁组:t=3.226～ 12.581;均P＜0.05),血清钙、25-OH-VD3均低于对照组(＜40岁组:t=3.624和7.223;≥40岁组:t=2.011和2.564;均P＜0.05);血清磷差异无统计学意义(t=0.811和0.513,均P＞0.05);PNS组内相关分析显示,TP ⅠNP与β-CTx、iPTH、ALP、UA/Cr、β2-MG呈正相关(r=0.512～ 0.682,均P＜0.01),与血清钙、25-0H-VD3呈负相关(r=-0.314、-0.562,均P＜0.01);β-CTx与iPTH、ALP、UA/Cr、β2-MG呈正相关(r=0.459～0.618,均P＜0.01),与血清钙、25-OH-VD3呈负相关(r=-0.212、-0.589,均P＜0.01).ALP、UA/Cr、β2-MG与血清iPTH呈正相关(r=0.410、0.606、0.508,均P＜0.05),血清钙、25-OH-VD3与血清iPTH呈负相关(r=-0.315、-0.516,均P＜0.05).结论 PNS患者存在不同程度BMD下降,联合检测TP Ⅰ NP、β-CTx和BMD有助于PNS患者并发ROD的早期诊断.
目的 探討原髮性腎病綜閤徵(PNS)患者腎性骨營養不良(ROD)與骨轉換生化指標的關繫,評價檢測這些指標在PNS患者中的臨床價值.方法 應用雙能X線骨密度儀分彆測定30例PNS患者和50例健康體格檢查者的腰椎和股骨BMD,檢測血清中骨轉換生化指標總Ⅰ型前膠原氨基耑延長肽(TP Ⅰ NP)、Ⅰ型膠原羧基耑肽β特殊序列(β-CTx)、完整PTH(iPTH)及血清鈣、血清燐、ALP、25-羥基維生素D3(25-OH-VD3)、血清β2微毬蛋白(β2-MG)、尿微量白蛋白/肌酐比值(UA/Cr)等,分析引起ROD的相關危險因素.採用兩獨立樣本t檢驗、多元線性迴歸及偏相關分析對數據進行統計學處理.結果 PNS組腰椎L1～4總BMD、左側股骨頸和左側股骨大轉子BMD均低于對照組(＜40歲組:t=6.162、5.583和3.891,≥40歲組:t=5.923、5.324和3.129;均P＜0.05).PNS組TPⅠNP、β-CTx、iPTH、ALP、β2-MG、UA/Cr較對照組升高(＜40歲組:t=2.738～ 10.129; ≥40歲組:t=3.226～ 12.581;均P＜0.05),血清鈣、25-OH-VD3均低于對照組(＜40歲組:t=3.624和7.223;≥40歲組:t=2.011和2.564;均P＜0.05);血清燐差異無統計學意義(t=0.811和0.513,均P＞0.05);PNS組內相關分析顯示,TP ⅠNP與β-CTx、iPTH、ALP、UA/Cr、β2-MG呈正相關(r=0.512～ 0.682,均P＜0.01),與血清鈣、25-0H-VD3呈負相關(r=-0.314、-0.562,均P＜0.01);β-CTx與iPTH、ALP、UA/Cr、β2-MG呈正相關(r=0.459～0.618,均P＜0.01),與血清鈣、25-OH-VD3呈負相關(r=-0.212、-0.589,均P＜0.01).ALP、UA/Cr、β2-MG與血清iPTH呈正相關(r=0.410、0.606、0.508,均P＜0.05),血清鈣、25-OH-VD3與血清iPTH呈負相關(r=-0.315、-0.516,均P＜0.05).結論 PNS患者存在不同程度BMD下降,聯閤檢測TP Ⅰ NP、β-CTx和BMD有助于PNS患者併髮ROD的早期診斷.
목적 탐토원발성신병종합정(PNS)환자신성골영양불량(ROD)여골전환생화지표적관계,평개검측저사지표재PNS환자중적림상개치.방법 응용쌍능X선골밀도의분별측정30례PNS환자화50례건강체격검사자적요추화고골BMD,검측혈청중골전환생화지표총Ⅰ형전효원안기단연장태(TP Ⅰ NP)、Ⅰ형효원최기단태β특수서렬(β-CTx)、완정PTH(iPTH)급혈청개、혈청린、ALP、25-간기유생소D3(25-OH-VD3)、혈청β2미구단백(β2-MG)、뇨미량백단백/기항비치(UA/Cr)등,분석인기ROD적상관위험인소.채용량독립양본t검험、다원선성회귀급편상관분석대수거진행통계학처리.결과 PNS조요추L1～4총BMD、좌측고골경화좌측고골대전자BMD균저우대조조(＜40세조:t=6.162、5.583화3.891,≥40세조:t=5.923、5.324화3.129;균P＜0.05).PNS조TPⅠNP、β-CTx、iPTH、ALP、β2-MG、UA/Cr교대조조승고(＜40세조:t=2.738～ 10.129; ≥40세조:t=3.226～ 12.581;균P＜0.05),혈청개、25-OH-VD3균저우대조조(＜40세조:t=3.624화7.223;≥40세조:t=2.011화2.564;균P＜0.05);혈청린차이무통계학의의(t=0.811화0.513,균P＞0.05);PNS조내상관분석현시,TP ⅠNP여β-CTx、iPTH、ALP、UA/Cr、β2-MG정정상관(r=0.512～ 0.682,균P＜0.01),여혈청개、25-0H-VD3정부상관(r=-0.314、-0.562,균P＜0.01);β-CTx여iPTH、ALP、UA/Cr、β2-MG정정상관(r=0.459～0.618,균P＜0.01),여혈청개、25-OH-VD3정부상관(r=-0.212、-0.589,균P＜0.01).ALP、UA/Cr、β2-MG여혈청iPTH정정상관(r=0.410、0.606、0.508,균P＜0.05),혈청개、25-OH-VD3여혈청iPTH정부상관(r=-0.315、-0.516,균P＜0.05).결론 PNS환자존재불동정도BMD하강,연합검측TP Ⅰ NP、β-CTx화BMD유조우PNS환자병발ROD적조기진단.
Objective To investigate the relationship between the biochemical markers of bone turnover and renal osteodystrophy (ROD) in patients with primary nephrotic syndrome (PNS).Methods A total of 30 patients with PNS and 50 healthy subjects (controls) were included in the study.The BMD of lumbar vertebrae and femur was measured by dual-energy X-ray absorptiometry.The levels of total procollagen type Ⅰ amino-terminal propeptide (TP Ⅰ NP),β-isomerized carboxyterminal propeptide (β-CTx),intact PTH (iPTH),serum calcium,serum phosphorus,ALP,25-OH-Vitamin D3 (25-OH-VD3),β2-micro-globulin(β2-MG),and ratio of urinary to creatinine (UA/Cr) were measured and calculated.The risk factors related to ROD in PNS patients were analyzed.Two-sample t test,multiple linear regression and partial correlation analysis were used to analyze data.Results The BMD values of lumbar vertebrae and femur in the PNS group were significantly decreased compared with those in controls (t =6.162,5.583,3.891 (＜40 years),5.923,5.324,3.129 (≥40 years),all P＜0.05) and the serum levels of TPⅠNP,β-CTx,iPTH,ALP,β2-MG and UA/Cr in the PNS group were significantly higher than those in controls (t:2.738-10.129(＜40 years),3.226-12.581 (≥40 years),all P＜0.05),and the levels of serum calcium and 25-OH-VD3 in the PNS group were significantly lower than those in controls (t =3.624,7.223 (＜40 years),2.011,2.564 (≥40 years),all P＜0.05).But there was no significant difference for serum phosphorus between the 2 groups (t=0.811,0.513,both P＞0.05).TP Ⅰ NP was positively correlated with β-CTx,iPTH,ALP,UA/Cr,β2-MG(r:0.512-0.682,all P＜0.01),and TP Ⅰ NP was negatively correlated with serum calcium and 25-OH-VD3(r=-0.314,-0.562,both P＜0.01)in the PNS group.β-CTx was positively correlated with iPTH,ALP,UA./Cr,β2-MG(r:0.459-0.618,all P＜0.01),and negatively correlated with serum calcium and 25-OH-VD3(r=-0.212,-0.589,both P＜0.01).The iPTH was positively correlated with ALP,UA/Cr and β2-MG (r =0.410,0.606,0.508,all P＜0.05),and negatively correlated with serum calcium and 25-OH-VD3(r=-0.315,-0.516,both P＜0.05).Conclusions The BMD in PNS patients is lower than that in healthy subjects.Combined measurement of TP Ⅰ NP,β-CTx and the BMD is helpful for the diagnosis of ROD in PNS patients.
