肾性继发性甲状旁腺功能亢进患者甲状旁腺切除手术前后骨代谢标志物水平变化

Changes of bone metabolism markers before and after parathyroidectomy in patients with renal secondary hyperparathyroidism

目的探讨行甲状旁腺切除术(parathyroidectomy,PTX)的肾性继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)患者手术前、后骨代谢标志物水平变化及意义。方法行PTX的SHPT患者32例,检测术前及术后第4天骨特异性碱性磷酸酶(bone-specific alkaline phosphatase,BAP)、Ⅰ型胶原氨基末端前肽(typeⅠcollagen amino-terminal propeptide,PINP)、抗酒石酸酸性磷酸酶(tartrate-resistant acid phosphatase 5b,TRAP-5b)和Ⅰ型胶原C端肽(typeⅠcollagen C-terminal peptide,CTX-Ⅰ)水平;比较PTX前、后临床指标及骨代谢标志物水平;采用Spearman或Pearson相关性分析法分析PTX术前全段甲状旁腺激素(intact parathyroid hormone,iPTH)、碱性磷酸酶(serum alkaline phosphatase,ALP)与骨代谢标志物等的相关性及术前骨代谢标志物间的相关性。结果PTX术后4d血清磷[(0.97±0.30)mmol/L]、iPTH[6.70(1.35,32.10)ng/L]、TRAP-5b[6.76(3.55,11.81)u/L]、CTX-Ⅰ[0.27(0.20,0.35)μg/L]较术前[(2.30±0.60)mmol/L、2517.85(2003.58,3056.75)ng/L、11.33(6.37,23.78)u/L、1.32(1.13,1.68)μg/L]降低(P<0.05),BAP[(614.93±359.52)μg/L]较术前[(251.33±202.29)μg/L]升高(P<0.05),血清钙[(2.10±0.37)mmol/L]和PINP[5456.82(1399.81,7826.43)μg/L]与术前[(2.39±0.23)mmol/L、4228.70(1632.93,6327.04)μg/L]比较差异无统计学意义(P>0.05);患者术前血清iPTH与透析龄(r=0.424,P=0.016)、ALP(r=0.394,P=0.026)、PINP(r=0.458,P=0.012)均呈正相关,与BAP(r=0.394,P=0.086)、CTX-Ⅰ(r=0.127,P=0.513)、TRAP-5b(r=0.181,P=0.357)无相关性;血清ALP与BAP(r=0.890,P<0.001)、PINP(r=0.379,P=0.042)、TRAP-5b(r=0.844,P<0.001)均呈正相关,与CTX-Ⅰ无相关性(r=0.212,P=0.269);术前血清BAP与TRAP-5b(r=0.877,P<0.001)、CTX-Ⅰ与PINP(r=0.488,P=0.010)均呈正相关。结论SHPT患者成骨细胞、破骨细胞活性均增强,PTX术后较短时间内成骨细胞活性进一步上调,而破骨细胞活性下降。

Objective To investigate the changes and significances of bone metabolism markers before and after parathyroidectomy(PTX)in patients with renal secondary hyperparathyroidism(SHPT).Methods The levels of bone-specific alkaline phosphorous(BAP),typeⅠcollagen amino-terminal propeptide(PINP),tartrate-resistant acid phosphatase 5b(TRAP-5b)and typeⅠcollagen C-terminal peptide(CTX-Ⅰ)were detected in 32patients undergoing PTX for SHPT.The clinical indicators and bone metabolism markers were compared before and after PTX.Spearman or Pearson correlation analysis method was used to analyze the correlations of intant parathyroid hormone(iPTH)and serum alkaline phosphatase(ALP)with bone metabolism markers as well as correlations among bone metabolism markers before PTX.Results The levels of phosphorus((0.97±0.30)mmol/L),iPTH(6.70(1.35,32.10)ng/L),TRAP-5b(6.76(3.55,11.81)u/L)and CTX-Ⅰ(0.27(0.20,0.35)μg/L)after PTX were significantly lower than those before PTX((2.30±0.60)mmol/L,(2517.85(2003.58,3056.75)ng/L,11.33(6.37,23.78)u/L,1.32(1.13,1.68)μg/L)(P<0.05),the level of BAP was higher after PTX((614.93±359.52)μg/L)than that before operation((251.33±202.29)μg/L)(P<0.05),and serum calcium((2.10±0.37)mmol/L)and PINP(5456.82(1399.81,7826.43)μg/L showed no significant differences after PTX compared with those before PTX((2.39±0.23)mmol/L),4228.70(1632.93,6327.04)μg/L)(P>0.05).Serum iPTH before PTX was positively correlated with dialysis age(r=0.424,P=0.016),ALP(r=0.394,P=0.026)and PINP(r=0.458,P=0.012),and not correlated with BAP(r=0.394,P=0.086),CTX-Ⅰ(r=0.127,P=0.513)and TRAP-5b(r=0.181,P=0.357).Serum ALP was positively correlated with BAP(r=0.890,P<0.001),PINP(r=0.379,P=0.042)and TRAP-5b(r=0.844,P<0.001),and not correlated with CTX-Ⅰ(r=0.212,P=0.269).There were positive correlations between serum BAP and TRAP-5b(r=0.877,P<0.001),as well as between CTX-Ⅰand PINP(r=0.488,P=0.010)before PTX.Conclusion The activity of osteoblasts and osteoclasts enhance significantly in patients with SHPT.The activity of osteoblasts up-regulates further,while osteoclasts decreases within a short time after PTX.