用于诊断透析前终末期肾衰竭患者肾性骨营养不良的有用生化标志物。

Useful biochemical markers for diagnosing renal osteodystrophy in predialysis end-stage renal failure patients.

作者信息

Bervoets An R J, Spasovski Goce B, Behets Geert J, Dams Geert, Polenakovic Momir H, Zafirovska Katica, Van Hoof Viviane O, De Broe Marc E, D'Haese Patrick C

机构信息

Department of Nephrology-Hypertension, University of Antwerp, Belgium.

出版信息

Am J Kidney Dis. 2003 May;41(5):997-1007. doi: 10.1016/s0272-6386(03)00197-5.

DOI:10.1016/s0272-6386(03)00197-5

PMID:12722034

Abstract

BACKGROUND

Various biochemical markers have been evaluated in dialysis patients for the diagnosis of renal osteodystrophy (ROD). However, their value in predialysis patients with end-stage renal failure (ESRF) is not yet clear.

METHODS

Bone histomorphometric evaluation was performed and biochemical markers of bone turnover were determined in serum of an unselected predialysis ESRF population (N = 84).

RESULTS

Significant (P < 0.005) differences between the five groups with ROD (ie, normal bone [N = 32], adynamic bone [ABD; N = 19], hyperparathyroidism [N = 8], osteomalacia [OM; N = 10], and mixed lesion [N = 15]) were noted for intact parathyroid hormone, total (TAP) and bone alkaline phosphatase (BAP), osteocalcin (OC), and serum calcium levels. Serum creatinine and (deoxy)pyridinoline levels did not differ between groups. For the diagnosis of ABD, an OC level of 41 microg/L or less (< or =7.0 nmol/L) had a sensitivity of 83% and specificity of 67%. The positive predictive value (PPV) for the population under study was 47%. The combination of an OC level of 41 ng/L or less (< or =7.0 nmol/L) with a BAP level of 23 U/L or less increased the sensitivity, specificity, and PPV to 72%, 89%, and 77%, respectively. ABD and normal bone taken as one group could be detected best by a BAP level of 25 U/L or less and TAP level of 84 U/L or less, showing sensitivities of 72% and 88% and specificities of 76% and 60%, corresponding with PPVs of 89% and 85%, respectively. In the absence of aluminum or strontium exposure, serum calcium level was found to be a useful index for the diagnosis of OM.

CONCLUSION

OC, TAP, BAP, and serum calcium levels are useful in the diagnosis of ABD, normal bone, and OM in predialysis patients with ESRF.

摘要

背景

已对透析患者中的多种生化标志物进行评估，用于诊断肾性骨营养不良（ROD）。然而，它们在终末期肾衰竭（ESRF）的透析前患者中的价值尚不清楚。

方法

对一组未经挑选的透析前ESRF患者（N = 84）进行骨组织形态计量学评估，并测定血清中骨转换的生化标志物。

结果

在五组ROD患者（即正常骨[ N = 32]、骨转化低下[ ABD；N = 19]、甲状旁腺功能亢进[ N = 8]、骨软化症[ OM；N = 10]和混合性病变[ N = 15]）之间，完整甲状旁腺激素、总碱性磷酸酶（TAP）和骨碱性磷酸酶（BAP）、骨钙素（OC）以及血清钙水平存在显著（P < 0.005）差异。血清肌酐和（脱氧）吡啶啉水平在各组之间无差异。对于ABD的诊断，OC水平≤41 μg/L（≤7.0 nmol/L）时，敏感性为83%，特异性为67%。所研究人群的阳性预测值（PPV）为47%。OC水平≤41 ng/L（≤7.0 nmol/L）与BAP水平≤23 U/L相结合，可使敏感性、特异性和PPV分别提高到72%、89%和77%。将ABD和正常骨归为一组时，BAP水平≤25 U/L和TAP水平≤84 U/L时检测效果最佳，敏感性分别为72%和88%，特异性分别为76%和60%，对应的PPV分别为89%和85%。在无铝或锶暴露的情况下，血清钙水平是诊断OM的有用指标。