慢性肾脏病矿物质和骨代谢紊乱血清生化学指标变化的临床分析

Clinical analysis of serum biochemical parameter changes in patients with chronic kidney disease-mineral and bone disorder

目的综合分析骨代谢的状态,指导临床上慢性肾脏病矿物质及骨代谢紊乱(CKD-MBD)的诊断、分型及治疗。方法对2008年11月至2009年2月在中国医科大学附属第一医院肾内科住院的56例CKD4期、5期及长期血液透析(5年以上)三组不同分期的慢性肾功不全患者清晨空腹抽血化验血清钙、磷、iPTH、bAP、TRACP,并行骨密度检查。结果三组不同分期慢性肾功不全患者CKD-MBD的发生率分别为36.4%、73.0%、87.5%(χ2=6.861,P<0.05),其中高转运性骨病占65.79%,低转运性骨病占34.21%。高转运性骨病患者血清bAP和TRACP活性明显升高,而低转运性骨病患者血清bAP和TRACP活性降低。结论CKD-MBD是慢性肾功不全患者常见的并发症,以高转运性骨病为主,但低转运性骨病不容忽视。bAP和TRACP是反映成骨细胞和破骨细胞活性的敏感指标,临床上可作为鉴别高、低转运性骨病的可靠依据,结合血清钙、磷、iPTH、骨密度的改变,可以综合分析骨代谢状态,指导CKD-MBD的诊断、分型、药物的选择和综合治疗。

Objective To provide guide for clinical diagnosis, classification and treatment of chronic kidney disease-mineral and bone disorder（CKD-MBD）. Methods A total of 56 patients with chronic renal insufficiency were divided into three different groups ： CKD4 period, CKD5 period and long-term hemodialysis （ over 5 years）. Their serum calcium, phosphorus, iPTH, hAP, and TRACP levels, and the bone mineral density were examined. Results The incidences of CKD-MBD in the three groups were 36. 4% ,73.0% ,and 87. 5% ,respectively. Highturnover bone disease accounted for 65.79%, and the low-turnover bone disease accounted for 34. 21%. The hAP and TRACP activity was significantly increased in patients with high-turnover bone disease and decreased in those with low-turnover bone disease. Conclusion CKD-MBD is a common complication of patients with chronic renal failure, with the main type being high-turnover bone disease, but the low-turnover bone disease can not be ignored. TRACP and bAP are the sensitive indicators of osteoblasts and osteoelast activity, and they could be used to identify high or low turnover bone disease. TRACP and bAP, together with serum calcium, phosphorus,iPTH, bone mineral density changes, can be used for a comprehensive analysis of bone metabolic state, so as to guide the diagnosis, sub-typing, drug selection and comprehensive treatment of CKD-MBD.