Baylink D J, Sherrard D J, Shen L, Maloney N A, Wergedal J E
J Clin Endocrinol Metab. 1975 Jun;40(6):1009-17. doi: 10.1210/jcem-40-6-1009.
Bone histologic parameters and serum iPTH and 25-OHD were measured in 20 patients with end-stage renal failure treated with hemodialysis. By bone histologic criteria, the patients were divided into three groups: mild, osteomalacic, and fibrotic. The increase in serum iPTH was much greater in the fibrotic group than in the mild or osteomalacic groups. In the uremic patients as a group, there were significant correlations between serum iPTH and both percent marrow fibrosis and percent resorbing surface. In the mild and fibrotic groups together, serum iPTH was also correlated with percent forming surface. This and other findings suggested that most of the bone changes in the mild and fibrotic groups could be explained by excess PTH. The difference in bone changes and in serum iPTH between the mild and fibrotic groups could be related to our eariler findings that duration of renal disease was much greater in the fibrotic than in the mild group. The lowest increment in serum iPTH was found in the osteomalacic group. In this group, percent resorbing surface was not increased and there was only a slight increase in marrow fibrosis. Thus in all three groups, serum iPTH appeared to reflect parathyroid status. The cause of the elevated serum iPTH and for the intergroup differences was not apparent inasmuch as serum calcium was normal in all three groups. Serum 25-OHD was significantly elevated in the osteomalacic and fibrotic groups. Because none of our patients had received preparations containing vitamin D, the elevated serum 25-OHD in the osteomalacic and fibrotic groups is consistent with altered vitamin D metabolism in these two groups. There was a direct relationship between percent osteroid area and serum 25-OHD. However, whether or not altered vitamin D metabolism contributed to the mineralization defect in uremic bone disease could not be established.
对20例接受血液透析治疗的终末期肾衰竭患者进行了骨组织学参数、血清iPTH和25-OHD检测。根据骨组织学标准，将患者分为三组：轻度组、骨软化组和纤维化组。纤维化组血清iPTH的升高幅度远大于轻度组或骨软化组。作为一个整体的尿毒症患者中，血清iPTH与骨髓纤维化百分比和吸收表面百分比均显著相关。在轻度组和纤维化组中，血清iPTH也与形成表面百分比相关。这一发现及其他结果表明，轻度组和纤维化组的大多数骨改变可用甲状旁腺激素过多来解释。轻度组和纤维化组在骨改变和血清iPTH方面的差异可能与我们之前的发现有关，即纤维化组的肾病病程远长于轻度组。骨软化组血清iPTH的升高幅度最小。在该组中，吸收表面百分比未增加，骨髓纤维化仅有轻微增加。因此，在所有三组中，血清iPTH似乎都反映了甲状旁腺状态。由于三组患者的血清钙均正常，血清iPTH升高的原因及组间差异并不明显。骨软化组和纤维化组的血清25-OHD显著升高。由于我们的患者均未接受过含维生素D的制剂，骨软化组和纤维化组血清25-OHD升高与这两组维生素D代谢改变一致。类骨质面积百分比与血清25-OHD之间存在直接关系。然而，维生素D代谢改变是否导致了尿毒症骨病的矿化缺陷尚无法确定。
