维持性血液透析患者肾性骨病的相关因素分析

ANALYSIS OF FACTORS ASSOCIATED WITH RENAL OSTEODYSTROPHY IN MAINTENANCE HEMODIALYSIS PATIENTS

目的 :研究维持性血液透析患者肾性骨病的类型、临床特点并分析相关因素。 方法 :49例血液透析患者 ,口服四环素标记后行骨活检 ,同时检测相关生化参数。 结果 :49例患者均有肾性骨病的临床表现 ,其中高转化型 2 4例 (49 0 % ) ,低转化型 19例 (38 8% ) ,混合型 6例 (12 2 % )。三组患者年龄和性别构成无差异 ,4例糖尿病患者均为低转化型 ;透析时间超过 10年者高转化型骨病发生率显著高于透析 5～ 10年和≤ 5年者。骨铝染色阳性率为 6 3 3% ,低转化型高于高转化型及混合型组 ,高通量组和普通透析组骨病类型和骨铝染色无差异 ,高通量组透析前血钙水平显著高于普通组 (P <0 0 5 ) ,iPTH水平低于普通组 ,但无统计学差异。低转化型骨病组服用活性维生素D3 制剂的比例显著高于其它组。骨铝阳性组透析前血磷和iPTH水平显著低于阴性组 ,服用铝制剂的患者比例也高于骨铝阴性组。 结论 :本组患者高转化型骨病与长时间透析、维生素D3 不足等因素相关 ,低转化型骨病可能与维生素D3 制剂使用不当、糖尿病等因素相关 ,而骨铝沉积则与服用铝制剂等因素相关 ,与透析时间长短无关。

OBJECTIVE Renal osterodystrophy is a common complication of chronic renal failure in which different pathogenesis is involved.The histologic classification is important in the choice of specific treatments.The purpose of the study was to analyze the clinical manifestations and the influencing factors of bone diseases in maintenance hemodialysis(HD)patients. METHODOLOGY Forty nine quantitative HD patients dialyzed for 92 3±43 3(30～206)months were involved in this study.The average age was 53 8±11 4(33～78)years,male to female ratio 38∶11.Bone biopsy was perfomed after double tetracycline labeling in all the patients,and biochemical parameters as serum levels of calcium,AKP and intact parathyroid hormone (iPTH) were determined. RESULTS According to the bone histology and biochemistry,24 cases(49 0%)were classified as high turnover bone disease(HTBD),19 cases(38 8%)as low turnover bone disease(LTBD),and the other 6 cases(12 2%)as mixed uremic osteodystrophy(MUO).Aluminum deposition(bone surface aluminum staining≥30%)was detected in the bone tissue of 31 cases(63 3%)of whole patients,with 84 2% in LTBD,54 2% in HTBD and 33 3% in MUO.HTBD was more frequent in patients dialyzed over 5 years,with a prevalence of 83 3% in those dialyzed over 10 years.The bone diseases in all the 4 diabetic patients were classified as LTBD,and patients with a long history of active vitamin D 3 administration were also frequently classified as LTBD.Patients on high flux hemodialysis had higher level of serum calcium( P <0 05).No correlation was found between the dialysis duration and the presence of aluminum deposition.Serum phosphorus and iPTH levels were markedly decreased in the aluminum deposition positive patients as compared to those in the negative patients. CONCLUSION HTBD was the most common type of renal bone diseases in this group of patients,and aluminum deposition positive rate was high as 63 3%.HTBD was associated with longer dialysis duration,deficiency of active vitamin D 3,while LTBD with improper use of active vitamin D 3 and diabetes.Aluminum deposition was found associated not with the duration of hemodialysis treatment,but with the aluminum administration history.