继发性甲状旁腺功能亢进的血液透析患者骨代谢及骨密度研究

Study on bone metabolism and bone mineral density in patients with secondary hyperparathyroidism on hemodialysis

目的探讨继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的维持性血液透析患者骨密度及骨代谢特点。方法 156例患者纳入本研究,常规检测透析前血钙、血磷、碱性磷酸酶、C反应蛋白,化学发光法检测血清全段甲状旁腺素(iPTH)、骨钙素(OC)、I型前胶原氨基末端前肽(PINP)、β胶原蛋白水平(β-CTX),双能X线法测定患者骨密度。结果维持性血液透析患者诊断SHPT 66例,非SHPT 90例。SHPT患者较非SHPT患者OC[(197.36±44.19)ng/ml vs.(527.89±85.53)ng/ml,P<0.001],PINP[(327.15±40.40)ng/ml vs.(616.99±125.82)ng/ml,P<0.001]、β-CTX[(1.99±0.16)ng/ml vs.(2.47±0.15)ng/ml,P=0.049]水平增高。SHPT患者较非SHPT患者骨密度结果全身平均BMD值[(1.01±0.12)vs.(0.93±0.14),P=0.017],Z值[(-0.78±0.50)vs.(-1.00±0.79),P=0.043]减低;logistic回归分析,透析前血磷(P=0.000)、OC(P=0.007)、透析龄(P=0.002)是SHPT的独立影响因素。结论全面评估SHPT患者骨代谢指标及骨密度情况,对于患者SHPT骨病的诊断及治疗有着重要意义。

Objective To explore the characteristics of bone metabolism and bone mineral density in maintenance hemodialysis patients with secondary hyperparathyroidism （SHPT）. Methods 156 patients in total were enrolled into the study. Serum calcium, phosphorus, alkaline phosphatase, C-reactive protein levels were determined by standard method. Their levels of serum intact parathyroid （iPTH）, osteocalcin （OC）, procollagen type I amino-terminal propeptide （PINP）,β-crosslaps （β-CTX） were measured by Chemiluminescence. Bone mineral density was measured by dual energy X ray absorptiometry. SPSS software was used for statistical analysis. Results Sixty-six maintenance hemodialysis patients were diagnosed with SHPT. The levels of serum OC （ng/ml） （197.36±177;44.19 vs. 527.89±177;85.53, P＆lt;0.001）, PINP （ng/ml） （327.15±177; 40.40 vs. 616.99±177;125.82, P＆lt;0.001）, β-CTX （ng/ml） （1.99±177;0.16 vs. 2.47±177;0.15, P=0.049） in SHPT patients were signifi-cantly higher than the levels in non-SHPT patients. BMD of whole body （1.01±177;0.12 vs. 0.93±177;0.14, P=0.017）and the to-tal Z score （-0.78 ±177;0.50 vs. -1.00 ±177;0.79, P= 0.043）in SHPT patients were decreased. In Logistic regression analysis, serum phosphorus （P＆lt;0.001）, OC （P=0.007）, duration of dialysis （P=0.002）were independent risk factors of SHPT. Conclusion Comprehensive assessment of bone metabolism and bone mineral density in patients with SHPT is important for patients with maintenance hemodialysis.