透析前慢性肾脏病患者低骨矿物质密度的高患病率：骨组织形态计量学分析
High prevalence of low bone mineral density in pre-dialysis chronic kidney disease patients: bone histomorphometric analysis.
作者信息
Lobão R, Carvalho A B, Cuppari L, Ventura R, Lazaretti-Castro M, Jorgetti V, Vieira J G, Cendoroglo M, Draibe S A
机构信息
Federal University of São Paulo, Escola Paulista de Medicina, São Paulo, Brazil.
出版信息
Clin Nephrol. 2004 Dec;62(6):432-9. doi: 10.5414/cnp62432.
UNLABELLED
Chronic kidney disease (CKD) leads to reduced bone mineral density (BMD) in pre-dialysis and dialysis patients. A few studies have used dual-energy x-ray absorptiometry (DEXA) to assess BMD in pre-dialysis CKD patients and have shown low BMD to be highly prevalent. Until now there have been no studies reporting the histological features of low BMD in pre-dialysis CKD patients.
AIM
To determine the prevalence and histological features of low BMD in pre-dialysis CKD patients.
METHOD
Pre-dialysis CKD patients (n = 103, 46 females/57 males), median creatinine clearance of 29 (10 - 78) ml/min/ 1.73 m2, were evaluated using biochemical analysis and DEXA. Bone biopsies were obtained from those with low BMD.
RESULTS
Fifty (48.5%) out of the 103 patients had low BMD (LBD group) and 53 (51.5%) had normal BMD (NBD group). The risk for low BMD was increased in those patients with alkaline phosphatase levels above 190 U/l and intact-PTH (iPTH) below 70 pg/ml (p < 0.05). Demographic and biochemical parameters from both groups were comparable, except for lower body mass index (BMI) in LBD subjects (p = 0.04). Women who had been post-menopausal for at least 1 year comprised 65% (13/20) and 50% (13/26) of the LBD and NBD groups, respectively (p = NS). In 40 LBD patients, bone histomorphometry revealed adynamic bone disease (ABD, 52.5%), osteomalacia (OM, 42.5%) and mixed bone disease (MBD, 5%). Trabecular bone volume (BV/TV) was lower in ABD and OM patients. A nearly significant association was found between ABD and iPTH < or = 150 pg/ml (p = 0.056), whereas higher values of iPTH were associated with OM. Total alkaline phosphatase < or = 190 U/l was significantly associated with ABD, whereas higher values were associated with OM. No correlation was observed between BV/TV and BMD.
CONCLUSION
Low BMD is frequent in pre-dialysis CKD patients, and low turnover bone disease, manifesting as ABD and OM, was the hallmark of this bone loss.
未标注
慢性肾脏病（CKD）会导致透析前及透析患者的骨矿物质密度（BMD）降低。一些研究使用双能X线吸收法（DEXA）评估透析前CKD患者的BMD，结果显示低BMD非常普遍。到目前为止，尚无研究报道透析前CKD患者低BMD的组织学特征。
目的
确定透析前CKD患者低BMD的患病率及组织学特征。
方法
对透析前CKD患者（n = 103，女性46例/男性57例）进行评估，其肌酐清除率中位数为29（10 - 78）ml/min/1.73 m²，采用生化分析和DEXA。对低BMD患者进行骨活检。
结果
103例患者中有50例（48.5%）BMD低（低BMD组），53例（51.5%）BMD正常（正常BMD组）。碱性磷酸酶水平高于190 U/l且全段甲状旁腺激素（iPTH）低于70 pg/ml的患者发生低BMD的风险增加（p < 0.05）。两组的人口统计学和生化参数具有可比性，但低BMD组的体重指数（BMI）较低（p = 0.04）。绝经至少1年的女性在低BMD组和正常BMD组中分别占65%（13/20）和50%（13/26）（p = 无显著性差异）。在40例低BMD患者中，骨组织形态计量学显示骨转化减低型骨病（ABD，52.5%）、骨软化症（OM，42.5%）和混合性骨病（MBD，5%）。ABD和OM患者的骨小梁体积（BV/TV）较低。ABD与iPTH≤150 pg/ml之间存在近乎显著的关联（p = 0.056），而较高水平的iPTH与OM相关。总碱性磷酸酶≤190 U/l与ABD显著相关，而较高值与OM相关。未观察到BV/TV与BMD之间的相关性。
结论
透析前CKD患者中低BMD很常见，以ABD和OM表现的低转换型骨病是这种骨质流失的标志。
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