老年慢性肾病非透析患者骨代谢相关指标调查分析

Analysis of bone metabolism-related parameters in non-dialysis elderly patients with chronic kidney disease

目的了解老年慢性肾病（chronic kidney disease，CKD）1～5期非透析患者骨代谢相关指标。方法采用回顾性分析方法，对老年慢性肾病1～5期患者203例肝肾功能、血钙、磷、甲状旁腺素、骨钙素、β-胶原特殊序列、25羟基维生素D、I型胶原羧基端前肽进行检测及分析。结果203例患者中，男性109例（53．7％），女性94例（46．3％），平均（72．3±8．2）岁。25羟基维生素D女性明显低于男性（P〈0．01）。随着慢性肾病进展，血钙、25羟基维生素D逐渐下降（P〈0．01），血磷甲状旁腺素、骨钙素、p胶原特殊序列、I型胶原羧基端前肽逐渐升高（P〈0．01），血清骨钙素、β-胶原特殊序列及I型胶原羧基端前肽从CKD3B期即有升高。糖尿病肾病患者较非糖尿病肾病血清骨钙素及25羟基维生素D水平低（P〈0．01）。单因素相关性分析显示，估算的肾小球滤过率（eGFR）与血钙（r=0．284）、磷（r=-0．339）、钙磷乘积（r=-0．245）、骨钙素（r=-0．410）、β-胶原特殊序列（r=-0．509）、甲状旁腺素（r=-0．397）、25羟基维生素D（r=0．209）、I型胶原羧基端前肽（r=-0．434）显著相关（均P〈0．01）；与年龄（r=-0．138）相关（P〈0．05）。结论骨钙素、β-CTX、I型胶原羧基端前肽等新型骨代谢指标在老年慢性肾病患者中的升高较钙磷紊乱出现得早，可用于老年慢性肾病-矿物质与骨异常（mineral and bone disorder in chronic kidney disease，CKD-MBD）的早期监测，老年女性和糖尿病患者应注意监测血25羟基维生素D水平。

Objective To investigate bone metabolism-related parameters in non-dialysis elderly patients with stages 1-5 chronic kidney disease （CKD）. Methods A total of 203 elderly patients with stages 1-5 CKD were retrospectively analyzed. Liver and kidney functions, and levels of serum calcium （Ca）, serum phosphorus （Pi）, parathyroid hormone （iPTH）, osteocalcin （OT）, β- degradation products of C-terminal telopeptides of type I collagen （β-CTX）, 25-dihydroxyvitamin D [25（OH）D], propeptide of type I collagen carboxyl end （PINP） were measured. Results Of the 203 patients, there were 109 males （53.7M） and 94 females （46.3%）, and the average age was （72.3 ±8.2） years. Serum 25 （OH） D levels were lower in females than in males （P〈0.01）. Serum Ca and 25（OH）D levels gradually declined and serum Pi, iPTH, OT, β-CTX and PINP levels gradually increased with the progression of CKD （all P〈0.01）. The increase of blood OT,β-CTX, and PINP levels started from stage at3 CKD （all P〈0.05）. Patients with diabetic kidney disease （DKD） had lower serum levels of OT .and 25 （OH） D than patients without DKD （all P〈0.01）. Univariate correlation analysis showed that the estimated glomerular filtration rate （eGFR） was correlated with serum Ca （r=0. 284, P〈0.01）, serum Pi （r=-0. 339, P〈0.01）, the calcium-phosphorus product （r=-0. 245, P〈0.01）, OT （r=-0. 410, P〈0.01）, β-CTX （r=-0. 509, P〈0.01）, iPTH （r= -0. 397, P〈0.01）, 25（OH）D （r=0. 209, P%0.01）, PINP （r=-0. 434, P〈0.01）, and age （r= -0. 138, P〈0.05）. Conclusions The increase of serum OT, β-CTX, PINP levels and other bone metabolism-related parameters occurs earlier than symptoms of calcium-phosphorus metabolism disorders in elderly patients with chronic kidney disease, and these parameters can be used for early monitoring of chronic kidney disease-mineral and bone disorders in the elderly. Elderly women with CKD and patients with DKD should be closely monitored on serum 25（OH） D levels.