血清骨代谢指标对慢性肾脏病患者骨质量的评价作用  

The Role of Serum Biochemical Markers of Bone Metabolism in Evaluating Bone Quality of Patients with Chronic Kidney Disease

作　　者：周娲 薛勤[2] 盛晓华[2] 许涛[2] 程东生[2] 汪年松[2] 

机构地区：[1]江西省南昌市第三医院肾内科,南昌330006 [2]上海交通大学医学院附属上海市第六人民医院肾内科,上海200233

出　　处：《中国中西医结合肾病杂志》2014年第6期499-502,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：国家自然基金面上项目(No.81270824)

摘　　要：[摘要]目的：探讨血清骨代谢指标对慢性肾脏病（CKD）患者骨质量好坏的评价意义。方法：收集2012年1月～2013年11月上海市第六人民医院肾内科首次住院的CKD患者95例，将患者按GFR分为CKD3期组、CKD4期组及CKD5期组。测定各组患者血清钙（ca2＋）、磷（P3-）、骨代谢指标碱性磷酸酶（ALP）、骨钙素N端中分子（N—MID）、13胶原特殊序列（B—CTX）、25-羟维生素D[25-（OH）VD]和甲状旁腺激素（PTH）水平。结果：CKD三组患者随着GFR的逐渐下降，血ca2＋、25（OH）D呈下降趋势，血P”、PTH、N—MID、B—CTX则呈逐渐上升趋势，组间差异有统计学意义（P〈0．05）；血ALP组间差异总体无统计学意义（P〉0．05）；Pearson直线相关分析显示GFR分别与血P3-（r=-0．494）、N—MID（r=-0．577）、B—CTX（r=-0．518）呈负相关（P＜0．001），与25（OH）D（r=0.289，P=0.008）呈正相关；血P3-与N—MID（r=0.5）、B—CTX（r=0．497）、PTH（r=0．528）分别呈正相关（P＜0.001），与25（OH）D呈负相关（r=-0．276，P=0．012）；PTH、N—MID、B—CTX三者互为正相关，PTH与N—MID（r=0．532）、PTH与B—CTX（r=0．551）、N—MID与β-CTX（r=0．641）分别呈正相关（P＜0．001）。结论：CKD患者血清Ca2＋、P3-、PTH、AKP、N—MID、B—CTX、25（OH）D相互作用影响骨质量。血清骨代谢生化指标在评估CKD患者骨质量方面具有重要有益作用。Objective：To explore the role of serum biochemical markers of bone metabolism in evaluating bone quality of chronic kidney disease（CKD） patients. Methods ：95 patients with CKD from department of Nephrology of the shanghai jiao tong university affiliated sixth people＇ s Hospital were collected from January 2012 to November 2013. Patients were divided into stage CKD3, CKD4 and CKD5 group by the GFR. The leves of serum calcium （ Ca2 ＋ ） , phosphorus （ p3- ） , serum biochemical markers of bone metabolism such as alkaline phosphatase （ALP）, osteocalein N -terminus of the molecule （N -MID）, β -collagen special sequence （β -CTX）, 25 -hydroxyvitamin D [ 25 - （OH） VD ], parathyroid hormone （PTH） levels were measured in each group of patients. Results ： As the GFR gradually decline, the leves of serum Ca2＋ , 25 （OH） D were on the decline, the leves of serum p3- , PTH, N- MID, β- CTX were increased gradually. There were a significant statistical significance difference between the groups （P 〈0.05）. There was no statistically significant difference of the leves of serum ALP（P 〉0.05 ）. Pearson correlation analysis results display ： GFR was negatively correlated with serum p3 - （ r = 0.494）, N - MID （ r = 0. 577 ）, β - CTX correlation （ r = 0, 518 ） respec- tively （P 〈0. 001 ）, and positively correlated with 25 （OH） D （ r = 0. 289, P = 0.008 ） ; serum p3- was positively correlated with N - MID （ r = 0.5）, β - CTX （ r = 0. 497 ）, PTH （ r = 0. 528 ） respectively （ P 〈0. 001 ）, and negatively correlated with 25 （OH） D （ r = 0. 276, P = 0. 012） ; PTH, N - MID, [3 - CTX mutually positive correlation, PTH and N - MID （ r = 0.532）, PTH and β - CTX （ r = 0.551 ）, N - MID and β - CTX （ r = 0. 641 ） were positively correlated （ P 〈 0. 001 ）. Conclusion： Serum Ca2＋, p3-, PTH, AKP, N- MID, β- CTX, 25 （OH） D interaction effects bone quality in patients with CKD. Serum biochemical markers of bon

关 键 词：慢性肾脏病 骨质量 骨钙素N端中分子 β胶原特殊序列 25-羟维生素D 

分 类 号：R692[医药卫生—泌尿科学]