定量计算机体层扫描检测肾病患者骨质变化的临床意义

Application of quantitative computed tomography in detection of bone mineral density in renal patients

目的 :观察不同时期不同年龄段肾脏病患者的骨代谢及骨密度 (BMD)和BMD与PTH、ALP、SCr、BUN、CCr、β2 M、TP、Alb、Ca2 +、P3-、Hb、HCT等的相关性。 方法 :正常对照组 (A组 ) 3 0例 ,肾脏疾病肾功能正常组 (B组 ) 3 0例 ,肾功能异常非透析组 (C组 ) 3 0例 ,透析组 (D组 ) 3 0例。采用定量CT(QCT)法测腰椎 (L1 L4)的BMD ,采用放射免疫法测血全段甲状旁腺素 (i PTH)和 β2 M ,并测SCr、BUN、TP、Alb、Ca2 +、P3-、ALP、Hb、HCT。 结果 :①A组4 1～ 5 0岁、5 1～ 60岁年龄段的i PTH较 <4 0岁年龄段明显升高 (P <0 0 5 ) ;ALP在三个年龄段随年龄逐渐升高 ,但无明显差别 (P >0 0 5 ) ;BMD在三个年龄段逐渐降低 (P <0 0 5 )。② <4 0岁、4 1～ 5 0岁、5 1～ 60岁三个年龄段i PTH :B、C、D组较A组均有非常显著升高 (P <0 0 1) ;ALP :B、C、D组较A组均有显著升高 (P <0 0 5 ) ,且C、D组分别较B组均有显著升高 (P <0 0 5 ) ;BMD :B组较A组下降无显著性差异 (P >0 0 5 ) ,C、D两组分别较A、B两组均有显著下降 (P <0 0 5 ) ;③B组其BMD与CCr、Alb正相关 (P <0 0 5 ) ,与SCr、BUN、β2 M负相关 (P <0 0 5 ) ,与PTH、ALP、TP、Ca2 +、P3-、Hb、HCT不相关 (P >0 0 5 )。C组其BMD与CCr。

Objective:Bone turnover and renal osteodystrophy can be evaluated with the application of quantitative computed tomography(QCT).In this study,bone mineral density(BMD)was detected in renal patients with or without renal function insufficiency and compared to the control.The clinical relevance of BMD with bone turnover parameters and predisposing factors was investigated. Methodology:This study involved 30 renal patients with normal serum creatinine(Group B,mean Scr:85 1±13 6 μmol/L),30 predialysis ESRD patients(Group C,mean Scr 765 3±89 9 μmol/L),30 dialysis dependant ESRD patients (Group D,mean Scr 939 4±112 3 μmol/L),and 30 healthy individual as the control(Group A).In each group,there were ten under the age of 40,ten between 40 and 50 and ten between 51 and 60 years.BMD was detected at the level of lumbar spines L1 L4 by QCT.Serum i PTH and β 2 microglobulin(β 2 M)were measured by radio immunoassay.Relevant parameters as creatinine clearance(Ccr),Scr,BUN,and serum levels of total protein,albumin,calcium,phosphates,ALP,hemoglobin and hematocrit were analyzed with respect to the detected BMD. Results:Within the normal range,age related increment of serum i PTH and decrement of BMD were found in the healthy control.Between patients of group A and group B under 40 years old,no significant difference of BMD was found.While for those above 40 years in group B,and all age sub groups of Group C and Group D,significantly de creased BMD values were found as compared to the same age sub groups of group A.In patients of Group B and Group C,positive correlations of BMD with Ccr and serum albumin were found,as well as negative correlations of BMD with PTH,BUN and β 2 M.In Group D,positive correlations of BMD with serum albumin and hemoglobin were found,as well as negative correlation of BMD with PTH,but no correlation with Ccr,BUN and β 2 M.BMD was not found correlated with ALP,total protein,Ca 2+ ,P 3- in any group. Conclusion:Increased bone turnover and decreased BMD were found in renal patients,especially in ESRD patients in whom the degree of renal insufficiency and malnutrition were identified as the most relevant factors.