Jean Guillaume, Souberbielle Jean-Claude, Granjon Samuel, Lorriaux Christie, Hurot Jean-Marc, Mayor Brice, Deleaval Patrik, Chazot Charles
NEPHROCARE Tassin-Charcot, 7, avenue du Maréchal-Foch, 69110 Sainte Foy-Les-Lyon, France.
Nephrol Ther. 2013 Jun;9(3):154-9. doi: 10.1016/j.nephro.2013.02.006. Epub 2013 Mar 29.
Bone turnover (BT) abnormalities are frequently observed in patients with chronic kidney disease. Bone biopsy remains the gold standard for diagnosis; however, its invasive nature has led to its decreased utilisation. The serum parathyroid hormone (PTH) level is not a reliable bone marker (BM) for BT assessment. The latest international recommendations suggest the use of total alkaline phosphatase (t-ALP) or bone-specific alkaline phosphatase (b-ALP), but not ß-CrossLaps (CTX). We compared b-ALP, t-ALP, and CTX levels in patients on haemodialysis (HD).
All HD patients at a single institution following a standard 3×4 to 3×5 hours schedule were included in the study, provided they were free from liver disease. Serum intact PTH, t-ALP, b-ALP, and CTX values were compared at baseline and after 18 months of treatment. A kinetic study was performed for pre- and postdialysis CTX values over a 2-week period. We described the longitudinal evolution of these BMs in two typical patients.
A total of 98 patients on HD (46% female) were evaluated. The mean age was 69.8±11 years and the mean duration of dialysis was 54.4±61 months. At baseline, CTX (2.1±1 μg/L) correlated well with b-ALP (18±11 μg/L; r=0.64; P<0.001) and PTH (221±165 pg/mL; r=0.62; P<0.001). The changes in these values at 18 months were also correlated (ΔCTX compared with Δb-ALP: r=0.51; P<0.001; Δb-ALP compared with ΔPTH: r=0.37, P<0.01). b-ALP and t-ALP (245±132 U/L) were closely correlated (r=0.78), as was their variation over 18 months (r=0.67), but t-ALP did not correlate with PTH, and correlated poorly with CTX (r=0.38). The CTX reduction ratio during standard dialysis was approximately 70 to 75% over each session, although predialysis values remained stable.
In HD patients, mean CTX values are five times higher than the normal range. CTX appears to be an alternative to b-ALP for assessing BT. b-ALP remains the standard BM, despite being expensive, infrequently available in many laboratories, and not useful for patients with liver disease.
慢性肾脏病患者常出现骨转换（BT）异常。骨活检仍是诊断的金标准；然而，其侵入性导致其使用减少。血清甲状旁腺激素（PTH）水平并非评估BT的可靠骨标志物（BM）。最新的国际建议推荐使用总碱性磷酸酶（t-ALP）或骨特异性碱性磷酸酶（b-ALP），而非β-交联C端肽（CTX）。我们比较了血液透析（HD）患者的b-ALP、t-ALP和CTX水平。
本研究纳入了一家机构中所有按照标准的3×4至3×5小时方案进行透析的HD患者，前提是他们没有肝脏疾病。在基线和治疗18个月后比较血清完整PTH、t-ALP、b-ALP和CTX值。在2周内对透析前和透析后的CTX值进行了动力学研究。我们描述了两名典型患者这些BM的纵向变化。
共评估了98例HD患者（46%为女性）。平均年龄为69.8±11岁，平均透析时长为54.4±61个月。基线时，CTX（2.1±1μg/L）与b-ALP（18±11μg/L；r=0.64；P<0.001）和PTH（221±165pg/mL；r=0.62；P<0.001）相关性良好。18个月时这些值的变化也具有相关性（ΔCTX与Δb-ALP比较：r=0.51；P<0.001；Δb-ALP与ΔPTH比较：r=0.37，P<0.01）。b-ALP和t-ALP（245±132U/L）密切相关（r=0.78），其在18个月内的变化也密切相关（r=0.67），但t-ALP与PTH不相关，与CTX相关性较差（r=0.38）。标准透析过程中每次透析期间CTX的降低率约为70%至75%，尽管透析前值保持稳定。
在HD患者中，平均CTX值比正常范围高五倍。CTX似乎是评估BT的b-ALP的替代指标。尽管b-ALP价格昂贵、许多实验室难以获得且对肝病患者无用，但它仍是标准的BM。
