Rodriguez-Perez J C, Plaza C, Torres A, Vega N, Anabitarte A, Fernandez A, Lorenzo V, Hortal L, Palop L
Nephrology Service, Hospital Ntra Sra del Pino, Las Palmas de Gran Canaria, Spain.
Adv Perit Dial. 1992;8:376-80.
CAPD is considered a risk factor for low turnover bone disease. This was previously attributed to aluminum accumulation. We evaluated by biochemical and histomorphometric parameters (including double tetracycline labelling), 26 patients maintained on CAPD for 12-14 months. Three (11.5%) showed mild hyperparathyroidism, 5 (19.2%) osteitis fibrosa, 3 (11.5%) mixed forms, 4 (15%) osteomalacia and 11 (42.3%) adynamic bone disease. Only one patient with diabetes mellitus showed an aluminum stained bone surface > 10%. Intact PTH serum levels were lower in LTBD (133.2 +/- 128 vs 468.2 +/- 451 pg/ml; p < 0.05). We also evaluated prospectively 11 patients who underwent a bone biopsy at start of dialysis and after 12 months of CAPD treatment. Bone biopsies pre CAPD demonstrated normal-high bone turnover disease in 8/11 (72.7%) and low turnover bone disease in 3/11 (27%). In the follow-up biopsies, 2 patients showed osteitis fibrosa and other two mild forms. Low turnover bone disease was found in 7 patients (3 osteomalacia and 4 adynamic bone disease). We conclude that the predominant bone lesion in our CAPD patients is low turnover bone disease, predominantly adynamic forms, and aluminum does not seem to play a role on its genesis. Low intact PTH serum levels may be a predictor of low turnover bone disease.
持续性非卧床腹膜透析（CAPD）被认为是低转换骨病的一个危险因素。这一点以前被归因于铝的蓄积。我们通过生化和组织形态计量学参数（包括双四环素标记）对26例接受CAPD治疗12至14个月的患者进行了评估。3例（11.5%）表现为轻度甲状旁腺功能亢进，5例（19.2%）为纤维性骨炎，3例（11.5%）为混合形式，4例（15%）为骨软化症，11例（42.3%）为骨再生障碍。只有1例糖尿病患者的骨铝染色表面>10%。低转换骨病患者的血清完整甲状旁腺激素（PTH）水平较低（133.2±128 vs 468.2±451 pg/ml；p<0.05）。我们还对11例在透析开始时和CAPD治疗12个月后接受骨活检的患者进行了前瞻性评估。CAPD治疗前的骨活检显示，11例中有8例（72.7%）为正常-高骨转换疾病，3例（27%）为低转换骨病。在随访活检中，2例表现为纤维性骨炎，另外2例为轻度形式。7例患者存在低转换骨病（3例骨软化症和4例骨再生障碍）。我们得出结论，我们的CAPD患者中主要的骨病变是低转换骨病，主要是骨再生障碍形式，铝似乎在其发生过程中不起作用。血清完整PTH水平低可能是低转换骨病的一个预测指标。
