血清巨噬细胞集落刺激因子与维持性血液透析患者骨密度的关系

Relationship between serum macrophage colony-stimulating factor and osteoporosis in hemodialysis patients

目的通过对维持性血液透析患者血清中巨噬细胞集落刺激因子（macrophage colonystimulating factor，M—CSF）水平及骨密度（bone mineral density，BMD）的检测，探讨血清M-CSF水平与维持性血液透析患者BMD的关系，以及影响BMD的相关因素。方法选择华中科技大学同济医学院附属同济医院血液透析中心维持性血液透析患者50例为观察组，另选择健康体检者8例为健康对照组。收集入选者的临床资料包括性别、年龄、血红蛋白、血钾、血磷、血钙、甲状旁腺素、尿素氮、尿酸和血肌酐的情况。用ELISA法检测2组患者透析前血清M-CSF浓度。用骨密度仪检测所有患者BMD，结果以T-Score表示。Spearman分析BMD、M-CSF与各临床指标的相关性。血液透析患者分别按照BMD值分为骨质疏松组、骨量减少组和骨密度正常组，分析不同组别中BMD值与M-CSF的相关性。结果①观察组患者M-CSF水平与健康对照组比较明显升高（P〈0．0001）；Spearman相关性分析发现BMD与年龄呈负相关（r=-0．2756，P=0．0264），与性别（r=0．3701，P=0．0041）呈正相关，女性患者骨质疏松的发生率更高。②观察组M-CSF与BMD进行spearman相关性分析，发现按照T-Score分组后，骨质疏松组M-CSF与BMD呈负相关（r=-0．3842，P=0．0522）；骨密度正常组（r=-0．1324，P=0．3490）和骨量减少组（r=-0．02999，P=0．4501）M-CSF与BMD无明显相关。结论M-CSF与BMD呈负相关，随着血清M-CSF水平的升高，骨密度逐渐下降，骨质疏松发生率增加。维持性血液透析患者血清M-CSF水平升高与患者骨质疏松的发生及进展有关。

Objective Macrophage colony-stimulating factor （M-CSF） is the key survival factor for osteoclasts. Its role in hemodialysis （HD） related to osteoporosis is unknown. This study was designed to evaluate the relationship between serum M-CSF levels and osteoporosis in HD patients. Methods Fifty in-center HD patients were recruited, and 8 healthy people were selected as normal controls. Serum M-CSF levels were measured using commercial ELISA kits. The clinical data including age, gender, hemoglobin, serum potassium, serum calcium and phosphorus, parathyroid hormone, urea nitrogen, uric acid and creatinine were analyzed. Bone mineral density （BMD） was detected by Bone Mineral Densitometer. The correlation between BMD, M-CSF and the clinical data were analyzed by spearman analysis. The HD patients were divided into three groups according to the Tscore of BMD. The relationship between BMD and M-CSF in different groups was analyzed by the spearman analysis. Results （1） Serum M-CSF levels were increased significantly in HD patients compared to healthy controls. There was a significantly negative correlation between BMD and age, and a positive correlation between BMI） and gender, suggesting that the female patients had the higher incidence of Osteoporosis. （2） There was a significantly negative correlation between serum M-CSF levels and BMD in the osteoporosis group （r = - 0. 3842,P = 0. 052） as compared with normal group and low BMD group. Conclusions Serum M-CSF levels are significantly high in HD patients, and increased serum M-CSF might contribute to the HD-related osteoporosis.