Cavalier Etienne, Delanaye Pierre, Collette Julien, Krzesinski Jean-Marie, Chapelle Jean-Paul
Department of Clinical Chemistry, University Hospital of Liege, University of Liege, B-35 Domaine du Sart-Tilman, B-4000 Liege, Belgium.
Clin Chim Acta. 2006 Sep;371(1-2):107-11. doi: 10.1016/j.cca.2006.02.029. Epub 2006 Mar 2.
Routinely, nephrologists rely on different biochemical markers like intact PTH (iPTH), bone-specific alkaline phosphatase (BALP), plasmatic calcium and phosphate. The aim of the present study was to evaluate different other bone markers like N-terminal propeptide of type 1 procollagen (P1NP), active isoform 5b of the tartrate-resistant acid phosphatase (TRAP 5b) and beta-crossLaps (CTXS) as well as full-length PTH (wPTH), presumed non-(1-84) PTH, and their ratio in the diagnosis of renal osteodystrophy with high and low turnover. We also determined 25 hydroxyvitamin D (25VTD), 1-25 dihydroxyvitamin D and homocystein (HCY).
We performed those parameters on 73 patients with end-stage renal disease according to the manufacturers' instructions.
There were very strong correlations between the bone markers concentrations, particularly between BALP and P1NP (r=0.953). We did not observe any correlation between the ratio whole PTH/non-(1-84) PTH and any of the usual bone markers. This ratio was significantly (p<0.05) higher in low and high bone turnover patients than in normal patients according to the K/DOQI. We found a correlation between low levels of 25VTD and high levels of HCY.
BALP offers the best clinical and analytical profile as the easier marker of choice in hemodialyzed patients for the diagnosis of bone disease.
通常，肾病学家依赖不同的生化标志物，如完整甲状旁腺激素（iPTH）、骨特异性碱性磷酸酶（BALP）、血浆钙和磷。本研究的目的是评估其他不同的骨标志物，如I型前胶原N端前肽（P1NP）、抗酒石酸酸性磷酸酶活性异构体5b（TRAP 5b）和β-交联C端肽（CTXS），以及全长甲状旁腺激素（wPTH）、推测的非（1-84）甲状旁腺激素及其比值，以诊断高转换型和低转换型肾性骨营养不良。我们还测定了25羟维生素D（25VTD）、1,25二羟维生素D和同型半胱氨酸（HCY）。
我们按照制造商的说明，对73例终末期肾病患者进行了这些参数的检测。
骨标志物浓度之间存在非常强的相关性，尤其是BALP和P1NP之间（r=0.953）。我们未观察到全甲状旁腺激素/非（1-84）甲状旁腺激素比值与任何常见骨标志物之间存在相关性。根据K/DOQI标准，低骨转换和高骨转换患者的该比值显著高于正常患者（p<0.05）。我们发现25VTD水平低与HCY水平高之间存在相关性。
BALP具有最佳的临床和分析特征，是血液透析患者诊断骨病时更容易选择的标志物。
