慢性肾脏病患者骨转换标志物和甲状旁腺激素水平及其相关性。

The levels of bone turnover markers and parathyroid hormone and their relationship in chronic kidney disease.

机构信息

Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China.

Chengdu First People's Hospital, Chengdu, Sichuan Province, China.

出版信息

Clin Chim Acta. 2023 Aug 1;548:117518. doi: 10.1016/j.cca.2023.117518. Epub 2023 Aug 22.

DOI:10.1016/j.cca.2023.117518

PMID:37619948

Abstract

BACKGROUND

Chronic kidney disease-mineral bone disease (CKD-MBD) is a major complication of CKD. Bone turnover markers (BTMs) are important for clinicians to evaluate and manage patients with CKD-MBD. This study aimed to assess BTMs in patients with CKD and their correlation with parathyroid hormone (PTH) and other clinical characteristics of CKD.

METHODS

A total of 408 subjects were included in this study. The serum BTMs including N-terminal midfragment osteocalcin (N-MID OC), β-isomerized C-terminal telopeptides (β-CTX), and total procollagen type 1 amino-terminal propeptide (tPINP) were measured. Spearman correlation and multiple stepwise regression models were used to investigate the association of N-MID OC, β-CTX, and tPINP with the clinical characteristics of CKD patients.

RESULTS

BTMs was no significant difference between non-CKD and CKD stages 1, 2, and 3. However, N-MID OC, β-CTX were significantly increased in patients with CKD stage 4 compared to non-CKD patients and patients with CKD stages 1, 2, and 3. Compared with non-dialysis dependent (NDD)-CKD stage 5, BTMs were significantly higher in dialysis patients. The estimated glomerular filtration rate was negatively associated with N-MID OC (r = -0.479, P < 0.001), β-CTX (r = -0.474, P < 0.001), and tPINP (r = -0.375, P < 0.001). Multiple analysis showed that N-MID OC (β = 0.67, P < 0.001), β-CTX (β = 0.64, P < 0.001), and tPINP (β = 0.81, P < 0.001) were independently associated with PTH. CKD patients with secondary hyperparathyroidism (SHPT) have higher β-CTX (P < 0.05), and N-MID OC (P < 0.05) than patients with non-SHPT.

CONCLUSIONS

BTMs in advanced CKD stages were significantly higher than in the early disease stages. PTH level was independently and positively associated with the BTM levels in patients with CKD. In the advanced stage of CKD, β-CTX and N-MID OC levels were significantly higher in those with SHPT than those with non-SHPT.

摘要

背景

慢性肾脏病-矿物质和骨代谢异常（CKD-MBD）是慢性肾脏病的主要并发症。骨转换标志物（BTMs）对于评估和管理 CKD-MBD 患者非常重要。本研究旨在评估 CKD 患者的 BTMs 及其与甲状旁腺激素（PTH）和 CKD 其他临床特征的相关性。

方法

本研究共纳入 408 例受试者。测量血清 BTMs，包括 N 端中段骨钙素（N-MID OC）、β 异构 C 端肽（β-CTX）和总前胶原 1 氨基端前肽（tPINP）。采用 Spearman 相关分析和多元逐步回归模型探讨 N-MID OC、β-CTX 和 tPINP 与 CKD 患者临床特征的相关性。

结果

非 CKD 和 CKD 1、2、3 期患者的 BTMs 无显著差异。然而，与非 CKD 患者和 CKD 1、2、3 期患者相比，CKD 4 期患者的 N-MID OC、β-CTX 明显升高。与非透析依赖（NDD）-CKD 5 期相比，透析患者的 BTMs 明显升高。估算肾小球滤过率与 N-MID OC（r=-0.479，P<0.001）、β-CTX（r=-0.474，P<0.001）和 tPINP（r=-0.375，P<0.001）呈负相关。多元分析显示，N-MID OC（β=0.67，P<0.001）、β-CTX（β=0.64，P<0.001）和 tPINP（β=0.81，P<0.001）与 PTH 独立相关。继发性甲状旁腺功能亢进症（SHPT）的 CKD 患者的β-CTX（P<0.05）和 N-MID OC（P<0.05）高于非 SHPT 患者。