Kim C D, Kim S H, Kim Y L, Cho D K, Lee J T
Department of Internal Medicine, Kyungpook University Hospital, Taegu, Korea.
Adv Perit Dial. 1998;14:183-7.
One of the classic histologic forms of renal osteodystrophy is osteitis fibrosa, and its distinguishing characteristic is bone marrow (BM) fibrosis, caused by the activation of marrow parenchymal cells. A bone biopsy must be performed in order to establish the diagnosis of renal osteodystrophy. The clinical use of bone biopsy is restricted, however, due to the invasiveness of the procedure. In recent studies, bone scans have provided information useful for the differential diagnosis between osteomalacia and osteitis fibrosa. However, bone scans can not provide information on the bone marrow status. Bone marrow immunoscintigraphy (BMIS) using Tc-99m anti-granulocyte antibody (AGA), a highly sensitive test for the detection of bone marrow abnormalities which is also a noninvasive method, has rarely been reported in chronic renal failure (CRF). BMIS can provide information in patients with myelofibrosis. The purpose of this study was to evaluate the usefulness of BMIS in CRF patients with special regards to biochemical parameters. Nineteen CRF patients (13 men, 6 women; mean age: 48 +/- 11 years) in whom bone scintigraphy using Tc-99m MDP (methylene diphosphonate) showed the so-called superscan pattern were included in the study. Their primary renal diseases were chronic glomerulonephritis (n = 14), diabetes (n = 4), and polycystic kidney disease (n = 1). Modes of therapies were continuous ambulatory peritoneal dialysis (CAPD) (n = 13; mean duration: 9.5 months), HD (n = 5; mean duration: 7.8 months), and conservative treatment (n = 1). BMIS using Tc-99m labeled anti-granulocyte monoclonal mouse antibody BW250/183 was performed, and the results were compared with the biochemical parameters of the patients. According to the presence of BM expansion, which may represent marrow fibrosis, the 19 patients were divided into two groups: Group I (n = 7) with BM expansion and Group II (n = 12) with normal marrow distribution. The biochemical parameters and bone markers of Group I were compared with those of Group II. There was no significant difference in biochemical parameters (blood hemoglobin, serum ferritin, erythropoietin, BUN, creatinine) between the two groups. There were no significants difference in serum calcium, phosphorus, tartate-resistant acid phosphatase (TRAP), and intact parathyroid hormone (iPTH) between the two groups. Serum alkaline phosphatase (ALP) and osteocalcin were significantly (P < 0.05) higher in Group I than in Group II. These results suggest that patients with bone marrow expansion in BMIS have increased levels of ALP and osteocalcin, indicating an increased osteoblastic activity. BMIS may be useful for the detection of bone marrow expansion due to marrow fibrosis in renal osteodystrophy, and for the evaluation of the extent of bone marrow fibrosis.
肾性骨营养不良的经典组织学形式之一是纤维性骨炎，其显著特征是骨髓（BM）纤维化，由骨髓实质细胞的激活引起。必须进行骨活检以确诊肾性骨营养不良。然而，由于该操作具有侵入性，骨活检的临床应用受到限制。在最近的研究中，骨扫描为骨软化症和纤维性骨炎的鉴别诊断提供了有用信息。然而，骨扫描无法提供关于骨髓状态的信息。使用锝-99m抗粒细胞抗体（AGA）的骨髓免疫闪烁显像（BMIS），这是一种检测骨髓异常的高灵敏度检测方法，也是一种非侵入性方法，在慢性肾衰竭（CRF）中鲜有报道。BMIS可为骨髓纤维化患者提供信息。本研究的目的是评估BMIS在CRF患者中的实用性，特别关注生化参数。19例CRF患者（13例男性，6例女性；平均年龄：48±11岁）纳入研究，这些患者使用锝-99m亚甲基二膦酸盐（MDP）进行的骨闪烁显像显示出所谓的超级骨显像模式。他们的原发性肾脏疾病为慢性肾小球肾炎（n = 14）、糖尿病（n = 4）和多囊肾疾病（n = 1）。治疗方式为持续性非卧床腹膜透析（CAPD）（n = 13；平均持续时间：9.5个月）、血液透析（HD）（n = 5；平均持续时间：7.8个月）和保守治疗（n = 1）。使用锝-99m标记的抗粒细胞单克隆小鼠抗体BW250/183进行BMIS，并将结果与患者的生化参数进行比较。根据可能代表骨髓纤维化的BM扩张情况，将19例患者分为两组：I组（n = 7）有BM扩张，II组（n = 12）骨髓分布正常。比较I组和II组的生化参数和骨标志物。两组之间的生化参数（血红蛋白、血清铁蛋白、促红细胞生成素、尿素氮、肌酐）无显著差异。两组之间的血清钙、磷、抗酒石酸酸性磷酸酶（TRAP）和完整甲状旁腺激素（iPTH）无显著差异。I组的血清碱性磷酸酶（ALP）和骨钙素显著高于II组（P < 0.05）。这些结果表明，BMIS中出现骨髓扩张的患者ALP和骨钙素水平升高，表明成骨细胞活性增加。BMIS可能有助于检测肾性骨营养不良中因骨髓纤维化导致的骨髓扩张，并评估骨髓纤维化的程度。
