558例非透析慢性肾脏病患者骨代谢指标的分析

Analysis of bone metabolic indexes in 558 patients with non-dialysis chronic kidney disease

目的调查我院非透析慢性肾脏病患者骨代谢指标,为早期监测慢性肾脏病的矿物质及骨代谢异常提供依据。方法回顾性分析我科住院的非透析慢性肾脏病患者558例,检测血甲状旁腺素(iPTH)、β-胶原特殊序列测定(β-CTX)、骨钙素、25-羟基维生素D3[25(OH)D3]、钙、磷、碱性磷酸酶(AKP)、肌酐、白蛋白、血糖等指标,留取晨尿进行尿常规及24 h尿蛋白定量检查,并分析相关影响因素。结果 558例CKD患者平均年龄(70.6±15.6)岁,其中男性51.1%,女性48.9%,骨代谢指标男女性别间差异无统计学意义(P>0.05)。iPTH、β-CTX、骨钙素、血磷在CKD1-3期患者间差异无统计学意义,但与CKD4、5期患者差异有统计学意义(P<0.001);AKP在CKD5期明显升高。25(OH)D3在CKD1-5期患者中差异无统计学意义,各期CKD患者均存在25(OH)D3的不足及缺乏,其患病率分别为24.7%、70.1%。单因素相关分析显示,MDRD-eGFR与iPTH(r=-0.457)、β-CTX(r=-0.501)、骨钙素(r=-0.485)、血磷(r=-0.501)、AKP(r=-0.187)、年龄(r=-0.140)水平相关,均P<0.01;与血钙(r=-0.084)水平相关,P<0.05。结论非透析CKD患者各骨代谢指标在CKD早期无明显差异,但随着肾功能的减退进行性升高,且其之间存在正相关关系。CKD患者普遍存在25(OH)D3的缺乏且在CKD早期即有。

Objective To investigate the bone metabolic indexes in patients with non-dialysis chronic kidney disease （CKD） in our hospital, and to provide the basis for the early-stage monitoring of the abnormality of mineral and bone metabolism in CKD. Methods The clinical data of 558 patients with non-dialysis CKD, who were hospitalized in our hospital, were analyzed. Serum iPTH, fl- degradation products of C-terminal telopeptides of type I collagen （β-CTX）, osteocalcin, 25 （OH） D3 , calcium （ Ca）, phosphorus （P）, alkaline phosphatase（AKP）, albumin, and glucose were also detected. Morning urine was collected and urine regular test and 24-hour urinary protein excretion were also detected. Results The average age of 558CKD patients （51.1% male and 48.9% female） was 70.6 ＋ 15.6 years old. No significant difference of bone metabolic indexes was observed between men and women （P 〉 0. 05 ）. The levels of iPTH,β-CTX, osteocalcin, and phosphorus showed significant difference in patients with stage 4-5 CKD （P 〈 0. 001 ） , while no significant difference was observed in patients with stage 1-3 CKD. The level of AKP was significant higher in patients with stage 5 CKD. While no significant difference of 25 （OH）D3 was observed in patients with stage 1-5 CKD, the insufficiency and deficiency of 25 （OH）D3 in patients with each stage CKD existed, and the prevalence was 24.7% and 70. 1%, respectively. Univariate correlation analysis showed that MDRD-eGFR was negatively correlated with iPTH （ r = - 0. 457, P 〈 0. 01 ） , β-CTX （ r = -0.501, P〈O. 01）, osteocalcin （r= -0.485, P〈0. 01）, phosphorus （r= -0.501, P〈O. 01）, AKP （r= -0.187, P〈0.01）, age （r = - 0. 140, P 〈 O. 001 ） , and Ca （ r = - 0. 084, P 〈 0.05）. Conclusion There is no significant difference of bone metabolic indexes at the early stage of CKD in patients with non-dialysis CKD. Along with the decrease of renal function, the serum levels of iPTH, β-CTX, osteocalcin, and phosphorus increase, showing a positive correlation. The deficiency of vitamin D is prevalent in patients with CKD, and it can be observed at the early stage of CKD.