Yajima A, Tanaka K, Tominaga Y, Ogawa Y, Tanizawa T, Inou T, Otsubo O, Otsubo K
Department of Nephrology, Towa Hospital, Japan.
Clin Nephrol. 2001 Jul;56(1):27-34.
There have so far been no reports on the changes in bone histology in the early period after parathyroidectomy and autografting (PTX-AG). We investigated the effects of PTX-AG on bone histology during the initial 12 weeks after undergoing these surgical procedures.
We performed bone histomorphometry 3 times (before as well as 4 and 12 weeks after PTX-AG) in 6 patients and 2 times (before and 4 weeks after PTX-AG) in 3 hemodialysis patients. In addition, the circulating parameters of bone metabolism were also assessed before and after PTX-AG in all 9 patients. The changes in the histomorphometric (static) parameters between pre-surgery and 4 weeks after surgery and those between 4 weeks and 12 weeks after surgery were assessed by the t-test while changes in the circulating parameters of bone metabolism were analyzed by Friedman's test.
Bone formation parameters including carboxy terminal propeptide of human type I procollagen (PICP), alkaline phosphatase (ALP) and intact osteocalcin (i-OC) were all extremely high before surgery. These parameters initially increased after PTX-AG and thereafter gradually declined. In contrast, the circulating bone resorption parameters including tartrate-resistant acid phosphatase (TRAP) and deoxypyridinoline (Dpyr) were also extremely high at baseline but markedly declined after operation. Osteoid-related parameters including osteoid volume (OV/BV), osteoid surface (OS/BS), and osteoid thickness (O.Th) all initially increased at 4 weeks after PTX-AG. In contrast, osteoblast surface (Ob.S/BS), osteoclast surface (Oc.S/BS), eroded surface (ES/BS), and fibrosis volume (Fb.V/TV) all decreased at 4 weeks after surgery, while Ob.S/BS decreased further at 12 weeks in cases 1-6. Although bone mineralization was ongoing at 4 weeks after surgery, both the mineral apposition rate (MAR) and bone formation rate (BFR) remained below the mean for normal individuals.
The circulating bone formation parameters and osteoid-related parameters showed an initial increase after PTX-AG. The concomitant decline in the circulating bone resorption parameters reflected the reduction in bone resorption. BFR decreased, but bone mineralization did not stop after PTX-AG.
迄今为止，尚无关于甲状旁腺切除及自体移植术（PTX - AG）后早期骨组织学变化的报道。我们研究了PTX - AG对接受这些外科手术后最初12周内骨组织学的影响。
我们对6例患者进行了3次骨组织形态计量学检测（PTX - AG术前以及术后4周和12周），对3例血液透析患者进行了2次检测（PTX - AG术前和术后4周）。此外，还对所有9例患者在PTX - AG前后评估了骨代谢的循环参数。术前与术后4周之间以及术后4周与12周之间组织形态计量学（静态）参数的变化采用t检验进行评估，而骨代谢循环参数的变化采用Friedman检验进行分析。
骨形成参数，包括人I型前胶原羧基末端前肽（PICP）、碱性磷酸酶（ALP）和完整骨钙素（i - OC）在术前均极高。这些参数在PTX - AG后最初升高，随后逐渐下降。相比之下，循环骨吸收参数，包括抗酒石酸酸性磷酸酶（TRAP）和脱氧吡啶啉（Dpyr）在基线时也极高，但术后明显下降。类骨质相关参数，包括类骨质体积（OV/BV）、类骨质表面（OS/BS）和类骨质厚度（O.Th）在PTX - AG术后4周均最初升高。相比之下，成骨细胞表面（Ob.S/BS）、破骨细胞表面（Oc.S/BS）、侵蚀表面（ES/BS）和纤维化体积（Fb.V/TV）在术后4周均下降，而在病例1 - 6中，Ob.S/BS在术后12周进一步下降。尽管术后4周骨矿化仍在进行，但矿化沉积率（MAR）和骨形成率（BFR）仍低于正常个体的平均值。
循环骨形成参数和类骨质相关参数在PTX - AG后最初升高。循环骨吸收参数的相应下降反映了骨吸收的减少。BFR下降，但PTX - AG后骨矿化并未停止。
