Mohini R, Dumler F, Rao D S
Division of Nephrology, Henry Ford Hospital, Detroit, Michigan 48202.
ASAIO Trans. 1991 Oct-Dec;37(4):635-7.
The authors reviewed the clinical usefulness of routine comprehensive skeletal surveys in monitoring renal osteodystrophy in 66 patients on chronic maintenance hemodialysis. Only fourteen (22%) of the 66 patients had roentgenographic evidence of hyperparathyroid bone disease. There were no significant differences in serum calcium, phosphate, or aluminum levels between patients with and without evidence of phalangeal subperiosteal bone resorption in the hands. However, serum levels of parathyroid hormone (PTH) (both intact and mid-molecule) and alkaline phosphatase values were significantly higher in the group with subperiosteal bone resorption (p less than 0.01 and p less than 0.02, respectively). Serum intact PTH correlated with alkaline phosphatase better than the mid-molecule assay. Neither intact nor mid-molecule PTH values correlated with serum calcium, phosphate, or aluminum. Hand roentgenograms were most sensitive in detecting early changes of hyperparathyroidism; symphysis pubis was the next best. Other skeletal roentgenographic findings were less revealing, and in a subset of 20 patients, roentgenograms correlated poorly with bone histology. During this study the authors found an 8% prevalence of vertebral compression fractures; all in postmenopausal white women.
作者回顾了常规全面骨骼检查在监测66例慢性维持性血液透析患者肾性骨营养不良方面的临床实用性。66例患者中只有14例（22%）有甲状旁腺功能亢进性骨病的X线证据。手部有和没有指骨骨膜下骨质吸收证据的患者之间，血清钙、磷或铝水平没有显著差异。然而，骨膜下骨质吸收组的甲状旁腺激素（PTH）（完整分子和中分子）血清水平和碱性磷酸酶值显著更高（分别为p<0.01和p<0.02）。血清完整PTH与碱性磷酸酶的相关性优于中分子检测。完整分子和中分子PTH值均与血清钙、磷或铝无关。手部X线片在检测甲状旁腺功能亢进的早期变化方面最敏感；耻骨联合次之。其他骨骼X线检查结果显示较少，在20例患者的一个亚组中，X线片与骨组织学的相关性较差。在这项研究中，作者发现椎体压缩骨折的患病率为8%；均发生在绝经后白人女性中。
