老年慢性肾功能不全患者的骨密度及骨代谢变化  

Alteration of bone mineral density and bone metabolism in elder patients with chronic renal failure

作　　者：毛旭东 张汝忠 曲毅 何悦 沈海燕 王伟 

机构地区：[1]徐汇区中心医院老年科,上海200031

出　　处：《中国骨质疏松杂志》2011年第4期321-323,337,共4页Chinese Journal of Osteoporosis

摘　　要：目的探讨老年慢性肾功能不全患者的骨密度及骨代谢,以及影响因素。方法用DEXA骨密度仪测定120例70岁以上的老年患者(60例慢性肾功能不全者、60例肾功能正常者)的腰椎及股骨端骨密度,并检测生化及骨代谢指标。结果慢性肾功能不全组的腰椎及股骨端各部位骨密度明显下降,骨代谢指标中血磷、甲状旁腺素、降钙素、Ⅰ型胶原吡啶交联终肽显著升高(P<0.01),血钙明显下降,碱性磷酸酶、25羟维生素D3和骨钙素变化不大。血肌酐水平与甲状旁腺素、降钙素、Ⅰ型胶原吡啶交联终肽呈正相关,其中与Ⅰ型胶原吡啶交联终肽水平相关程度最高。结论慢性肾功能不全者主要表现在骨吸收增加,骨密度下降,骨吸收活跃程度与血肌酐水平密切相关。Objective To explore the relationship between bone mineral density （BMD） and bone metabolic markers in elder patients with chronic renal failure （CRF） , and the related factors. Methods BMDs of the lumbar spines and the proximal femur were measured using dual energy X-ray absorptiometry in 120 elder people aged over 70 years old （60 cases combined with CRF and 60 eases with normal renal function）. Bone metabolic and biochemical markers were examined. Results BMDs of the lumbar spine and the proximal femur of patients in CRF group decreased significantly. Serum phosphorus, parathyroid hormone （PTH）, calcitonin （CT）, and pyridinoline cross-linked carboxy-terminal telopeptiele type I collagen （ICTP） increased significantly （P 〈 0.01 ）. Serum calcium decreased significantly. Alkaline phosphatase, 25-dihydroxyvitamin D3, and osteocalcin were constant. Serum creatinine was positively correlated with PTH, CT, ICTP, and the highest correlation was with ICTP. Conclusion CRF were mainly indicated in the increase of bone resorption, resulting in decreased BMD. Bone resorption activity was closely related to serum creatinine level.

关 键 词：慢性肾功能不全 骨质疏松 骨密度 I型胶原吡啶交联终肽 

分 类 号：R589.9[医药卫生—内分泌]