肾性骨营养不良的治疗新进展

Recent advances in the treatment of renal osteodystrophy

肾性骨病是慢性肾脏病(chronic kidney disease,CKD)患者的主要并发症之一。肾性骨营养不良(renal osteodystrophy,ROD)是狭义的“肾性骨病”,即与CKD相关的骨组织学异常,是CKD继发的严重骨骼损害,增加了CKD患者发生骨折甚至死亡的风险,其按病理生理学变化可分为高转换型骨病、低转换型骨病和混合型骨病3种类型。随着CKD发病率的升高,ROD的发病率也越来越高,及时有效的治疗对预后影响越发重要。目前临床上对于ROD的治疗主要集中于针对其相关的矿物质及代谢异常,作用靶点单一,缺乏研究证实对后期骨疾病存在较好的疗效,且针对不同类型ROD的药物相关研究较少,临床应用选择中存在较大困难。现研究发现,通过调控参与ROD发病机制的不同分子可干预ROD进展,有望成为ROD治疗的新靶标,提高ROD预后及治疗效果。然而目前关于混合型骨病治疗的相关研究甚少,本文主要对于高转换型和低转换型骨病的治疗新进展做一综述。

Renal bone disease is one of the main complications of chronic kidney disease(CKD).As a narrower term of"renal bone disease",renal osteodystrophy(ROD)refers to histological abnormalities of bone associated with CKD.Such a severe bone damage secondary to CKD boosts the risk of fracture or even death in CKD patients.According to the pathophysiological changes,ROD can be divided into three types of high conversion,low conversion and mixed bone diseases.With a higher incidence of CKD,ROD becomes more and more common.Timely and effective treatment is vital for obtaining a better prognosis.Currently clinical treatment of ROD is targeting its related minerals and metabolic abnormalities.For lacking research evidence of an excellent effect on advanced bone disease,drug-related studies have rarely addressed different types of ROD so that greater difficulties exist in the selection of clinical applications.Manipulating different molecules involved in the pathogenesis of ROD may intervene its progress.A new therapeutic target of ROD is bound to further improve its prognosis and therapeutic efficacy.However,few researches have focused upon the treatment of mixed bone disease.This review summarized the latest treatments of high-conversion and low-conversion bone diseases.