Pena Y T, Soyibo A K, McGrowder D, Clarke T R, Barton E N
The University Hospital of the West Indies, Kingston 7, Jamaica, West Indies.
West Indian Med J. 2010 Jun;59(3):332-7.
To evaluate the association of serum biochemical markers in patients with chronic kidney disease (CKD) in Jamaica for early detection of renal osteodystrophy (ROD).
The study contained two groups: CKD group (221) which consisted of adult patients, from dialysis units and renal clinics, with stage III to V CKD. The control group (237) had adult individuals, from the medical outpatient clinics, with mild and controlled chronic diseases and absence of renal failure. The patients in the study were between 18-80 years of age and gave informed consent to participate in the study. The differences in distribution of demographic, clinical and pathologic variables between the two groups were evaluated. Pearson's chi-squared test and Spearman' rho correlation coefficient test was used, with p < 0.01 considered statistically significant. Data analysis was conducted using the statistical package for the social sciences (SPSS) version 17.0.
Among the 221 CKD patients in the study, 174 (78.7%) had ROD based on serum intact parathyroid hormone (iPTH) levels. The majority of patients in the control group did not have bone disease ie 95-96%. The majority of CKD patients (70.0%) had high-turnover (HTO) bone disease compared to 29.3% of patients with low-turnover (LTO) bone disease. Dialysis patients who had HTO bone disease compared with those with LTO had significantly higher levels of iPTH and total serum alkaline phosphatase (ALP). A similar relationship was observed among CKD patients not on dialysis. There was a significant individual variation in bone turnover biochemical markers. A total of 237 patients were recruited in the control group. Based on the levels of iPTH and tALP six of them were found to have bone disease. The majority of these patients with bone disease were diabetic (83.3%) while the other patient had cancer (16.7%). The six patients in the control group with bone disease were within the age cohort of 64-80 years, most of whom were 78 years old.
A combination of serum biochemical markers might predict underlying renal osteodystrophy better that would individual biochemical markers. A predictive model using bone histology and biochemical markers can be developed in the future.
评估牙买加慢性肾脏病（CKD）患者血清生化标志物与肾性骨营养不良（ROD）早期检测的相关性。
该研究包含两组：CKD组（221例），由来自透析单位和肾脏诊所的III至V期CKD成年患者组成。对照组（237例）为来自门诊诊所的成年个体，患有轻度且病情得到控制的慢性疾病且无肾衰竭。研究中的患者年龄在18至80岁之间，并已签署知情同意书参与研究。评估了两组之间人口统计学、临床和病理变量分布的差异。使用Pearson卡方检验和Spearman等级相关系数检验，p<0.01被认为具有统计学意义。使用社会科学统计软件包（SPSS）17.0版进行数据分析。
在该研究的221例CKD患者中，基于血清完整甲状旁腺激素（iPTH）水平，174例（78.7%）患有ROD。对照组中的大多数患者没有骨病，即95 - 96%。与29.3%的低转换（LTO）骨病患者相比，大多数CKD患者（70.0%）患有高转换（HTO）骨病。与LTO骨病患者相比，患有HTO骨病的透析患者iPTH和总血清碱性磷酸酶（ALP）水平显著更高。在未接受透析的CKD患者中也观察到类似关系。骨转换生化标志物存在显著的个体差异。对照组共招募了237例患者。基于iPTH和总ALP水平，发现其中6例患有骨病。这些患有骨病的患者大多数为糖尿病患者（83.3%），另1例为癌症患者（16.7%）。对照组中6例患有骨病的患者年龄在64至80岁之间，其中大多数为78岁。
血清生化标志物的组合可能比单个生化标志物能更好地预测潜在的肾性骨营养不良。未来可以开发一种使用骨组织学和生化标志物的预测模型。
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