各期慢性肾脏病患者腰椎定量CT骨密度与骨代谢指标的关系  

Relationship between spinal bone mineral density measured by quantitative CT and bone metabolism related index in the patients with chronic kidney disease

作　　者：杨洁[1] 康建国[2] 吕艳伟[3] 程晓光[4] 王晓飞[1] 李欣[1] 张利平[1] 付晨[1] 丁致民[1] 

机构地区：[1]北京积水潭医院肾内科,北京100035 [2]首都医科大学教学医院北京电力医院骨科 [3]北京积水潭医院临床流行病学研究室 [4]北京积水潭医院放射科

出　　处：《中国老年学杂志》2016年第14期3518-3522,共5页Chinese Journal of Gerontology

基　　金：国家自然科学基金青年科学基金项目(81400923)

摘　　要：目的 分析慢性肾脏病（CKD）1~5D期患者腰椎骨密度（BMD）与钙磷代谢、25羟维生素D〔25（OH）D〕和骨转换生化标志物的关系。方法 CKD患者142例,根据估算肾小球滤过率（e GFR）及是否透析分为CKD1~5D期,腰椎定量CT（QCT）测定患者BMD,检测血白蛋白（ALB）、钙（Ca）、磷（P）、25（OH）D、全段甲状旁腺激素（i PTH）、碱性磷酸酶（ALP）、总I型前胶原氨基端延长肽（t PINP）、I型胶原羧基端肽β特殊序列（β-CTX）、骨钙素（OC）,分析QCT-BMD与骨代谢相关指标关系。结果 BMD值、血ALB、Ca、ALP、25（OH）D在CKD1~5D各期之间均无统计学差异（P〉0.05）。〈70岁组,CKD5~5D期患者P高于CKD1~4期;CKD4~5D期患者t PINP高于CKD1~3期;CKD4~5期患者β-CTX高于CKD1~3期,CKD5D期患者高于CKD1~3及5期;CKD4~5期患者OC、i PTH均高于CKD1~3期,CKD5D期患者高于CKD1~5期（P〈0.05）。≥70岁组,CKD5D期患者血P高于CKD1~5期;CKD5期患者t PINP、OC均高于CKD1~4期,CKD5D期高于CKD1~5期;CKD5~5D期患者β-CTX高于CKD1~4期;CKD5期患者i PTH高于CKD1~4期,CKD5D期患者高于CKD2~3期（P〈0.05）。BMD值与e GFR、Ca、P、25（OH）D及骨转换生化标志物无相关性（P〉0.05）。e GFR与P、t PINP、β-CTX、OC、i PTH呈负相关（P〈0.01）。多因素Logistic回归分析CKD骨质疏松或CKD-MBD伴低BMD的独立危险因素为年龄（≥70岁）,性别（女性）和血钙水平（高钙血症）。结论 维持正常血钙对于CKD骨质疏松或低BMD非常重要。Objective To analyze the relationship between spinal bone mineral density and calcium and phosphorus metabolism,25 hydroxyvitamin D [ 25 （OH） D ], and biochemical markers of bone turnover （BMT） in patients with chronic kidney disease （CKD）. Methods 142 CKD patients were divided into stages CKD1 -5D according to the eGFR and dialysis. The spinal BMD was measured by quantitative CT （ QCT）, serum calcium （ Ca）, phosphorus （ P）, 25 （OH） D, intact parathyroid hormone （ iPTH）, alkaline phosphatase （ ALP）, total procollagen type I propeptides （tPINP）, [3-crosslaps （ [3-CTX）, osteocalcin （OC）were tested. Results In the group （ 〈70 years old）, the levels of serum phosphorus in stages CKD5 -5D were increased compared with that of stages CKD1 - 4, the levels of tPINP in stages CKD4 - 5D were in- creased compared with those of stages CKD1 - 3 ;the levels of β-CTX in stages CKD4 - 5 were increased compared with those of stages CKD 1- 3 ,and it was increased in stage CKD5D compared with those of stages CKD1 - 3 and 5;the levels of OC and iPTH in stages CKD4 - 5 were increased compared with those of stages CKD1 - 3, and it was increased of stage CKD5D compared with that of stages CKD1 - 5 （P〈0. 05 ）. In another group（ ≥70 years old） ,the level of serum phosphorus in stage CKD5D was increased compared with that of stages CKDI - 5;the levels of tPINP and OC in stage CKD5 were increased compared with those of stages CKD1 - 4,and they were increased in stage CKD5D compared with those of stages CKD1 - 5 ; the levels of β-CTX in stages CKD5 - 5D were increased compared with those of stage CKD1 - 4;the level of iPTH in stage CKD5 was increased compared with that of stages CKD1 -4, and it was increased of stage CKD5D com- pared with that of stages CKD1 - 3 and 5 （P〈0. 05 ）. BMD values versus eGFR, Ca, P,25 （OH）D and BMT showed no correlation （P〉0.05）. The eGFR versus serum phosphorus, tPINP, 13-CTX, OC and iPTH showed negatively correlation （P〈0.01

关 键 词：慢性肾脏病 骨密度 骨转换生化标志物 

分 类 号：R692[医药卫生—泌尿科学]