Fujian Blood Center, Fuzhou 350004, China.
Bone. 2011 Sep;49(3):506-12. doi: 10.1016/j.bone.2011.05.014. Epub 2011 May 24.
Citrate is the anticoagulation of choice in apheresis procedures. Citrate anticoagulation results in a short-term increase in serological markers of bone turnover, with uncertain clinical significance.
To understand the effect of calcium supplementation on serological bone turnover markers during an acute citrate load as a mimic of citrate anticoagulation during apheresis procedures.
A placebo-controlled, crossover study was conducted in 22 healthy volunteers. Volunteers received a standardized citrate load at a fixed dose of 1.5 mg/kg of body weight/min for 80 min for three times and a single placebo infusion as a control. Each intervention was separated by a wash-out interval of 2 to 3 weeks. During two citrate infusions, volunteers received an additional calcium supplementation, consisting of either oral administration of calcium carbonate or an i.v. bypass infusion of calcium gluconate. Serial blood samples were collected for the determination of ionized calcium (iCa), intact parathyroid hormone (iPTH) and markers of bone remodeling, C-telopeptide of type 1 collagen (CTX) and osteocalcin (OC).
The infusion of citrate without calcium supplementation resulted in an increase in the bone formation marker OC and the bone resorption marker CTX, in addition to the changes in iPTH and iCa. The administration of calcium by either oral administration or as an i.v. bypass infusion attenuated the observed changes in CTX, but showed no effects on the elevation of the bone formation marker OC. There was no difference in the attenuation of CTX between the two calcium formulations. However, the i.v. application of calcium gluconate had a superior effect in reducing the change of serum iPTH and iCa as compared to the oral administration of calcium carbonate.
Calcium supplementation is an effective method in damping the citrate-related transient increase of the serological bone resorption marker CTX. As a mimic for the citrate-based apheresis procedure, our data may enforce the prophylactic application of calcium supplementation to attenuate the short-term elevation of bone resorption related to an acute citrate load.
柠檬酸盐是体外循环程序中首选的抗凝剂。柠檬酸盐抗凝会导致血清骨转换标志物短期增加，但其临床意义尚不确定。
了解在急性柠檬酸盐负荷期间补充钙对血清骨转换标志物的影响，该负荷模拟体外循环程序中的柠檬酸盐抗凝。
在 22 名健康志愿者中进行了一项安慰剂对照、交叉研究。志愿者以 1.5mg/kg 体重/分钟的固定剂量接受 80 分钟的三次标准化柠檬酸盐负荷，并进行单次安慰剂输注作为对照。每次干预之间间隔 2 至 3 周洗脱期。在两次柠檬酸盐输注期间，志愿者接受了额外的钙补充，包括碳酸钙口服或葡萄糖酸钙静脉旁路输注。连续采集血样以测定离子钙 (iCa)、全段甲状旁腺激素 (iPTH) 和骨重塑标志物，包括 1 型胶原 C 端肽 (CTX) 和骨钙素 (OC)。
未补充钙的柠檬酸盐输注会导致骨形成标志物 OC 和骨吸收标志物 CTX 的增加，同时还会引起 iPTH 和 iCa 的变化。口服或静脉旁路输注钙可减轻观察到的 CTX 变化，但对骨形成标志物 OC 的升高没有影响。两种钙制剂在 CTX 衰减方面没有差异。然而，与碳酸钙口服相比，静脉葡萄糖酸钙的应用在降低血清 iPTH 和 iCa 变化方面具有更好的效果。
钙补充是一种有效方法，可以抑制柠檬酸盐相关的血清骨吸收标志物 CTX 的短暂增加。作为基于柠檬酸盐的体外循环程序的模拟，我们的数据可能会加强预防性钙补充以减轻与急性柠檬酸盐负荷相关的短期骨吸收升高。
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