不同期慢性肾脏病患者骨密度及骨代谢生化指标关系

Association of bone mineral density and bone metabolic biomarkers in the different stages of chronic kidney disease

目的观察不同阶段慢性肾脏病(CKD)患者的骨密度(BMD)及骨代谢情况。方法选取100例慢性肾脏病患者,根据MDRD公式计算估计肾小球滤过率(eGFR),按eGFR不同分为3组:B组(eGFR为30～59ml/min)、C组(eGFR为15～29ml/min)、D组(eGFR<15ml/min),并设同年龄非CKD患者作为对照组(A组),应用DEXA骨密度仪测定L2～L4正位及股骨颈正位BMD,4组间进行血肌酐(SCr)、全段甲状旁腺激素(iPTH)、超敏C反应蛋白(hs-CRP)、碱性磷酸酶(ALP)及BMD比较。结果不同组之间BMD及骨代谢指标有明显差异,CKD患者早期BMD已有所下降,股骨比腰椎骨质丢失更明显。BMD与iPTH呈负相关,iPTH与SCr、血磷(P)、ALP、hs-CRP呈正相关,与eGFR呈负相关,而与血钙(Ca)不相关。结论随着CKD病程的进展,BMD不断下降,肾性骨病发病增加,应引起足够重视,并于CKD早期积极干预。

Objective To investigate the bone mineral density（BMD） and bone metabolic biomarkers in the different stages of chronic kidney disease （CKD）. Methods One hundred patients with CKD were enrolled in this study and divided into three groups based on the estimated glomerular filtration rate（eGFR） calculated from MDRD： Group B with eGFR 30-59 ml/min, Group C with eGFR 15-29 ml/min and Group D with eGFR 〈 15 ml/min. The age-matched non-CKD people were enrolled as control group （Group A）. The level of BMD was measured at the anteroposterior sites of L2-L4 and femoral neck of the patients by using DEXA. Serum creatinin（SCr） , high sensitive C-reactive protein（hs-CRP） and bone metabolic biomarkers such as intact parathyroid hormone（iPTH） and alkaline phosphatase（ALP） were measured and compared with BMD. Results BMD and bone metabolic biomarkers showed significant differences among the four groups. BMD was decreased at CKD stage 3, and the loss of BMD was more obviously found at fenur than lumbar. BMD was negatively correlated with PTH. PTH was positively ton＇elated with SCr, P, ALP, hs-CRP and negatively correlated with eGFR. There was no significant association between PTH and serum calcium level. Conclusions BMD is continuously decreased and the frequency of renal osteodystrophy is increased during the development of CKD. More attentions should be paid for the active intervention at the early stage of CKD.