Peters Barbara Santarosa Emo, Moyses Rosa Maria Affonso, Jorgetti Vanda, Martini Lígia Araújo
Department of Nutrition, School of Health Public, University of Sao Paulo, Av. Dr. Arnaldo, 715, Sao Paulo, 01246-904, Brazil.
Int Urol Nephrol. 2007;39(4):1251-6. doi: 10.1007/s11255-007-9254-2. Epub 2007 Aug 7.
BACKGROUND/AIMS: Chronic renal failure (CRF) is often associated with bone disorders including chronic kidney disease-mineral and bone disorder (CKD-MBD). Parathyroid hormone (PTH) has a relationship to bone remodeling, and so this study was undertaken to evaluate changes in bone remodeling markers after parathyroidectomy (PTX).
Twelve adult patients, mean age 43.4 +/- 12.7 years, of both genders, were evaluated, prior to and six months after PTX. Analysis of biochemical markers of bone metabolism, such as total and ionized calcium, phosphorus, 25(OH)D(3), total alkaline phosphatase (TAP), bone-specific alkaline phosphatase (BAP), intact PTH, osteoprotegerin (OPG), and tartrate-resistant acid phosphatase isoform 5b (TRAP), were measured.
No changes were observed after PTX in the serum total and ionized calcium, TAP, BAP, and 25(OH)D(3). After surgery there was a significant decrease in serum phosphorus, iPTH, and TRAP (P < 0.001). No significant change was observed in OPG; however there was a positive correlation between OPG and 25(OH)D(3) before and after surgery (r = 0.774, P = 0.014; and r = 0.706, P = 0.01, respectively). The percentage of patients with vitamin D deficiency decreased from 16.7% to 8.3%, while those with sufficient levels increased from 41.7% to 58.3%.
The small number of patients in the study notwithstanding, the present study is unique because it provides information on bone metabolism and vitamin D status six months after PTX. The removal of parathyroid glands significantly decreased bone resorption and indicated a tendency of 25(OH)D(3) concentration to increase. However, the precise role of OPG and BAP in the improvement in bone remodeling in patients with CKD-MBD requires further study.
背景/目的：慢性肾衰竭（CRF）常与包括慢性肾脏病 - 矿物质和骨异常（CKD - MBD）在内的骨骼疾病相关。甲状旁腺激素（PTH）与骨重塑有关，因此本研究旨在评估甲状旁腺切除术（PTX）后骨重塑标志物的变化。
对12例成年患者（平均年龄43.4±12.7岁，男女均有）在PTX术前及术后6个月进行评估。检测骨代谢生化标志物，如总钙和离子钙、磷、25（OH）D₃、总碱性磷酸酶（TAP）、骨特异性碱性磷酸酶（BAP）、完整PTH、骨保护素（OPG）和抗酒石酸酸性磷酸酶同工酶5b（TRAP）。
PTX术后血清总钙和离子钙、TAP、BAP及25（OH）D₃未见变化。术后血清磷、iPTH和TRAP显著降低（P < 0.001）。OPG未见显著变化；然而，术前和术后OPG与25（OH）D₃之间均存在正相关（分别为r = 0.774，P = 0.014；r = 0.706，P = 0.01）。维生素D缺乏患者的比例从16.7%降至8.3%，而维生素D水平充足的患者比例从41.7%增至58.3%。
尽管本研究中的患者数量较少，但本研究具有独特性，因为它提供了PTX术后6个月骨代谢和维生素D状态的信息。甲状旁腺切除显著降低了骨吸收，并显示出25（OH）D₃浓度升高的趋势。然而，OPG和BAP在CKD - MBD患者骨重塑改善中的精确作用需要进一步研究。
