骨代谢指标在慢性肾脏病-矿物质骨代谢紊乱中的研究进展

Progress of bone metabolic makers in chronic kidney disease-mineral and bone disorder

慢性肾脏病-矿物质骨代谢紊乱(chronic kidney disease-mineral and bone disorder,CKD-MBD)描述了慢性肾脏病(chronic kidney disease,CKD)患者体内钙和磷酸盐稳态的变化,其与钙、磷、甲状旁腺素(parathyroid hormone,PTH)和维生素D的异常循环水平有关,影响了骨矿化、生长和骨强度,导致心血管事件、骨折率及病死率的增加。目前对CKD-MBD的管理主要依赖于对血清钙、磷酸盐和甲状旁腺素浓度等生化指标的临床判断和评估。骨代谢标志物的应用并不广泛。本文主要针对血清骨代谢标志物对慢性肾脏病患者的临床价值做一综述,主要涉及骨特异性碱性磷酸酶(bone-specific alkaline phosphatase,BSAP)、Ⅰ型原胶原前肽(procollagen type-Ⅰ N terminal propeptide,P1NP)、抗酒石酸磷酸酶5b (tartrate-resistant acid phosphatase 5b,TRACP 5b)、Ⅰ型胶原羧基端肽β特殊序列(β-carboxy I terminal peptide,β-CTX)、成纤维细胞生长因子23 (fibroblast growth factor 23,FGF-23)、Klotho蛋白及硬骨抑素(sclerostin)。

Chronic kidney disease-mineral and bone disorder (CKD-MBD) is an umbrella term describing changes in bone mineral metabolism with alterations in calcium and hosphate homeostasis in patients with CKD,which typically affects bone mineralization,growth and strength,causing cardiovascular events,fracture and mortality. The current management of CKD-MBD relies largely on clinical judgement and assessment of biochemical parameters including serum calcium,phosphate and intact parathyroid hormone concentrations. The clinical application of bone metabolic markers is not extensive. This review focus on the clinical value of several serum bone metabolic markers,including bone-specific alkaline phosphatase (BSAP),procollagen type-Ⅰ N terminal propeptide (P1NP),tartrate-resistant acid phosphatase 5b(TRACP 5b),β-carboxyl terminal peptide(β-CTX),α-Klotho and sclerostin in patients with CKD.