早期干预钙磷代谢对慢性肾脏病血管钙化的影响  

Effect of early intervention in calcium and phosphorus metabolism on vascular calcification in patients with chronic kidney disease

作　　者：罗福漳[1] 邓洁尧[1] 洪国保[1] 陈健智[2] 李璇[2] 曹修怀[2] 

机构地区：[1]南方医科大学附属南海医院肾内科,佛山528200 [2]南方医科大学附属南海医院病理科,佛山528200

出　　处：《中国血液净化》2010年第5期251-254,共4页Chinese Journal of Blood Purification

基　　金：佛山市卫生局科技立项(2007257)

摘　　要：目的观察慢性肾脏病(chronic kidney disease,CKD)3期开始纠正钙磷代谢紊乱对CKD患者桡动脉血管钙化的防治作用。方法入选南方医科大学附属南海医院CKD3、4和5期非透析患者106例,随机分为干预组及对照组,干预组进行钙磷代谢达标治疗。待进展到终末期肾病并行维持性血液透析治疗前作动静脉内瘘术并取部分桡动脉观察血管钙化程度及骨桥蛋白(osteopontin,OPN)、á平滑肌肌动蛋白(alpha smooth muscle actin,á-SMA)的表达。结果 49例进入终末期肾病患者茜素红染色提示干预组血管钙化病例减少且程度明显减轻,免疫组化提示钙化病例较未钙化病例OPN表达增多、á-SMA表达减少,干预组较对照组OPN表达相对减少、á-SMA表达相对增多。结论从CKD3和4期开始纠正钙磷代谢紊乱能有效减轻尿毒症患者桡动脉血管钙化。OPN、á-SMA的表达变化先于明确钙化表现,OPN表达量与钙化正相关,á-SMA表达量与钙化负相关。Objective To investigate the effect of early intervention in calcium and phosphorus metabolism beginning from the disease stage 3 on vascular calcification （VC） in patients with chronic kidney disease （CKD）. Methods We recruited 106 CKD patients at stage 3,4 or 5 but without dialysis treatment,and randomly assigned them into intervention group or control group. Patients in intervention group were treated with phosphate binding drugs or 1,25-dihydroxy-vitamin D to maintain their serum calcium,intact phosphate and parathyroid hormone （iPTH） within the appropriate ranges recommended by the K/DOQI guideline. The treatment would be terminated if the patient progressed to end stage renal disease （ESRD） and required hemodialysis or other replacement treatment. During the A-V fistula operation for hemodialysis but before hemodialysis,a segment of radial artery was taken and examined after Alizarin red and immunohistochemical staining. Results In the disease course,49 patients progressed to ESRD and required replacement therapy. A-V fistula operation was performed for the 49 patients,and a segment of radial artery was obtained during the operation. Cases with VC and the severity of VC were less in intervention group than in control group （P〈0.05）. Osteopontin （OPN） expression was significantly higher and á-smooth muscle actin （á-SMA） expression was significantly lower in the samples with VC than in those without VC. Compared with the samples from control group,those from intervention group demonstrated less OPN expression and higher á-SMA expression. Conclusion Earlier intervention of calcium and phosphorus metabolism from disease stage 3 or 4 can effectively ameliorate VC in CKD patients. Changes of OPN and á-SMA expression are earlier than the presence of VC. VC was positively correlated with OPN expression,and negatively correlated with á-SMA expression. OPN and á-SMA may be the earlier markers of VC in CKD patients.

关 键 词：血管钙化 磷 慢性肾脏病 终末期肾病 骨代谢障碍 

分 类 号：R692.5[医药卫生—泌尿科学]