骨转换标志物可预测甲状旁腺切除术后甲状旁腺功能亢进症患者的骨密度变化。

Bone turnover markers predict changes in bone mineral density after parathyroidectomy in patients with renal hyperparathyroidism.

机构信息

Division of Nephrology, Department of Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.

出版信息

Clin Endocrinol (Oxf). 2012 May;76(5):634-42. doi: 10.1111/j.1365-2265.2011.04265.x.

DOI:10.1111/j.1365-2265.2011.04265.x

PMID:22007930

Abstract

OBJECTIVE

Patients on long-term dialysis may develop secondary hyperparathyroidism (SHPT), which causes varying degrees of bone mass loss. This condition is treated with parathyroidectomy (PTX). We investigated whether serial serum bone turnover markers could predict changes in bone mineral density (BMD) after PTX.

DESIGN AND PATIENTS

Renal patients on maintenance haemodialysis who received PTX for refractory SHPT (n = 26, male/female: 13/13; mean age: 48·6 ± 10·7 year) and control subjects without SHPT (n = 25) were prospectively followed for 1 year at two tertiary hospitals in Taiwan.

MEASUREMENTS

Serum intact parathyroid hormone (iPTH), bone-specific alkaline phosphatase (BAP) and type 5b tartrate-resistant acid phosphatase (TRAP) were measured serially. Additionally, femoral neck (FN) and lumbar spine (LS) BMD were measured before and 1 year after PTX.

RESULTS

After PTX, iPTH levels decreased markedly and persistently. BMDs increased in both the FN and LS, but particularly in the LS. Serum BAP progressively increased to a peak at 2 weeks after PTX. Serum TRAP levels progressively decreased over 6 months after PTX. In univariate correlation analyses, baseline iPTH correlated positively with T-score changes in FN (r = 0·45, P = 0·021) and LS (r = 0·48, P = 0·013). In multivariate regression models, changes in FN T-scores were negatively predicted by baseline BAP levels (r = -0·615, P = 0·005) and baseline FN T-scores (r = -0·563, P = 0·012), and they were positively predicted by baseline TRAP(r = 0·6, P = 0·007). Changes in LS T-scores were positively predicted by baseline TRAP values (r = 0·528, P = 0·01) and negatively predicted by the percentage change in BAP after 2 weeks (r = -0·501, P = 0·015).

CONCLUSIONS

Parathyroidectomy provided marked, sustained improvements in BMD for up to 1 year. Furthermore, markers of bone turnover predicted 1-year changes in FN and LS BMDs after PTX.

摘要

目的

长期接受透析治疗的患者可能会出现继发性甲状旁腺功能亢进症（SHPT），这会导致骨量不同程度的丢失。这种病症通过甲状旁腺切除术（PTX）进行治疗。我们研究了连续的血清骨转换标志物是否可以预测 PTX 后骨密度（BMD）的变化。

设计和患者

这项前瞻性研究在台湾的两家三级医院中对接受 PTX 治疗难治性 SHPT 的维持性血液透析患者（n=26，男/女：13/13；平均年龄：48.6±10.7 岁）和无 SHPT 的对照组患者（n=25）进行了为期 1 年的随访。

测量

连续测量血清全段甲状旁腺激素（iPTH）、骨特异性碱性磷酸酶（BAP）和 5b 型对甲苯磺酰基赖氨酰基磷酸酶（TRAP）。此外，在 PTX 前和 1 年后测量股骨颈（FN）和腰椎（LS）的 BMD。

结果

PTX 后，iPTH 水平显著且持续下降。FN 和 LS 的 BMD 均增加，但 LS 的增加更为明显。血清 BAP 逐渐增加，在 PTX 后 2 周达到峰值。血清 TRAP 水平在 PTX 后 6 个月内逐渐下降。在单变量相关分析中，基线 iPTH 与 FN（r=0.45，P=0.021）和 LS（r=0.48，P=0.013）的 T 评分变化呈正相关。在多元回归模型中，FN T 评分的变化可由基线 BAP 水平（r=-0.615，P=0.005）和基线 FN T 评分（r=-0.563，P=0.012）负预测，可由基线 TRAP（r=0.6，P=0.007）正预测。LS T 评分的变化可由基线 TRAP 值正预测（r=0.528，P=0.01），可由 2 周后 BAP 变化的百分比负预测（r=-0.501，P=0.015）。