Kopp J B, Andress D L, Maloney N A, Sherrard D J
Department of Medicine, Seattle Veterans Administration Medical Center.
Am J Kidney Dis. 1988 Sep;12(3):214-9. doi: 10.1016/s0272-6386(88)80124-0.
Serial bone biopsies obtained from 19 chronic hemodialysis patients asymptomatic for bone disease were examined retrospectively. We found only modest amounts of stainable bone aluminum after the first few years of hemodialysis therapy. Over the ensuing 5 to 15 years, there was a progressive increase in stainable bone aluminum (% of total bone surface): 0 to 4.9 years, 19.9 +/- 3.8% (mean +/- SEM); 5.0 to 9.9 years, 28.4 +/- 5.3%; and greater than or equal to 10.0 years, 58.0 +/- 7.7%. At final biopsy, the extent of bone surface aluminum was significantly correlated with duration of hemodialysis therapy (r = 0.54) and with bone formation rate (BFR) (r = -0.54). Patients who developed aluminum-associated bone disease did not differ from other patients in duration of hemodialysis, intake of 1-hydroxylated vitamin D3 compounds, or the findings on early bone biopsy. High-turnover renal osteodystrophy remains the dominant bone lesion throughout the course of hemodialysis in patients with intact parathyroid glands. In individual patients, bone histology frequently changes over time and in some patients, aluminum-associated bone disease may improve spontaneously. Bone biopsy in an asymptomatic patient who has received hemodialysis therapy for less than 5 years does not appear to be useful in predicting the subsequent appearance of aluminum-associated bone disease.
对19例无骨病症状的慢性血液透析患者进行回顾性检查，获取其系列骨活检样本。我们发现，血液透析治疗开始后的最初几年，可染色骨铝含量仅为少量。在随后的5至15年中，可染色骨铝（占总骨表面积的百分比）逐渐增加：0至4.9年，19.9±3.8%（均值±标准误）；5.0至9.9年，28.4±5.3%；大于或等于10.0年，58.0±7.7%。在最后一次活检时，骨表面铝含量与血液透析治疗时长（r = 0.54）以及骨形成率（BFR）（r = -0.54）显著相关。发生铝相关性骨病的患者在血液透析时长、1-羟化维生素D3化合物摄入量或早期骨活检结果方面与其他患者并无差异。在甲状旁腺功能正常的患者中，高转换型肾性骨营养不良在整个血液透析过程中仍然是主要的骨病变。在个体患者中，骨组织学常常随时间变化，并且在一些患者中，铝相关性骨病可能会自发改善。对于接受血液透析治疗少于5年的无症状患者，骨活检似乎无法用于预测随后铝相关性骨病的出现。
