Van de Vyver F L, Visser W J, D'Haese P C, De Broe M E
Department of Nephrology-Hypertension, University of Antwerp (UIA), Belgium.
Nephrol Dial Transplant. 1990;5(9):781-7. doi: 10.1093/ndt/5.9.781.
Bone pathology was studied in 27 patients showing either iron or aluminium accumulation in bone. These patients belonged to a group of 120 unselected chronic haemodialysis patients in whom transiliac bone biopsies had been obtained. Group A consisted of 12 patients with bone iron deposits (positive Perls' staining at the calcified bone boundary, CBB) and only minimal aluminium accumulation (bone aluminium below 20 micrograms/g wet weight). Group B included 15 patients with pronounced aluminium accumulation (positive aluminium staining at the CBB and bone aluminium of 20 micrograms/g wet weight or more) and without significant bone iron deposition (negative Perls' staining at the CBB). Bone diseases were classified as early hyperparathyroidism, osteitis fibrosa, mixed disease, osteomalacia, adynamic bone disease or other bone condition using osteoid volume, relative osteoblastic activity (ROBA%), and the presence of fibrosis, as criteria. In group A, 5 of 12 patients showed adynamic bone disease, a fairly uncommon condition in the general population of non-parathyroidectomised dialysis patients. In fact, in a control group of 80 patients without iron and without aluminium overload, only five patients showed adynamic bone disease. In group B, 8 of 15 patients showed osteomalacia, and 2 of 15 presented with mixed disease, which is in agreement with the established relationship between bone aluminium accumulation and the occurrence of defective bone mineralisation. It is concluded that iron overload in dialysis patients is associated with an increased frequency of adynamic bone disease.
对27例骨中显示有铁或铝蓄积的患者进行了骨病理学研究。这些患者来自一组120例未经挑选的慢性血液透析患者，均已获取了经髂骨骨活检样本。A组由12例有骨铁沉积（钙化骨边界处Perls染色阳性）且仅有微量铝蓄积（骨铝低于20微克/克湿重）的患者组成。B组包括15例有明显铝蓄积（钙化骨边界处铝染色阳性且骨铝为20微克/克湿重或更高）且无明显骨铁沉积（钙化骨边界处Perls染色阴性）的患者。根据类骨质体积、相对成骨细胞活性（ROBA%）以及纤维化的存在情况，将骨病分类为早期甲状旁腺功能亢进、纤维性骨炎、混合性疾病、骨软化症、动力缺乏性骨病或其他骨病情况。在A组中，12例患者中有5例表现为动力缺乏性骨病，这在未行甲状旁腺切除术的透析患者总体中是一种相当罕见的情况。事实上，在一个由80例无铁和无铝过载的患者组成的对照组中，只有5例患者表现为动力缺乏性骨病。在B组中，15例患者中有8例表现为骨软化症，15例中有2例表现为混合性疾病，这与骨铝蓄积和骨矿化缺陷发生之间已确立的关系相符。得出的结论是，透析患者的铁过载与动力缺乏性骨病的发生率增加有关。
