Burnell J M, Teubner E, Wergedal J E, Sherrard D J
J Clin Invest. 1974 Jan;53(1):52-8. doi: 10.1172/JCI107558.
Calcium, phosphorus, sodium, carbonate, magnesium, and hydroxyproline were measured in iliaccrest biopsies of 22 normal volunteers and 24 selected patients with renal osteodystrophy. Histologic classification revealed that 10 were mildly abnormal, 8 osteomalacic, and 6 osteofibrotic. Bone density measurements were performed on an additional 12 normal, 11 mildly abnormal, 6 osteomalacic, and 10 osteofibrotic subjects. The results revealed an increase in magnesium and adecrease in carbonate apparent in the minimal and osteomalacic lesions and a much greater change in osteofibrosis. The bone density was decreased in patients with osteofibrosis. These observations would appear to be explained by postulation of an impairment of the normal maturational process of bone whereby there is an increase in amorphous calcium phosphate and a decrease in apatite crystal. The data suggest that the maturational defect is present as soon as any abnormality can be identified histologically, is present to the same degree in osteomalacia, and is most severe in osteofibrosis. In comparison of two sets of six patients matched for age and duration of dialysis, neither acidosis nor vitamin D therapy appeared to influence the severity of the maturational defect.
对22名正常志愿者和24名选定的肾性骨营养不良患者的髂嵴活检组织进行了钙、磷、钠、碳酸盐、镁和羟脯氨酸的检测。组织学分类显示，10例轻度异常，8例骨软化，6例骨纤维囊性变。对另外12名正常、11名轻度异常、6名骨软化和10名骨纤维囊性变受试者进行了骨密度测量。结果显示，在最小病变和骨软化病变中，镁含量增加，碳酸盐含量降低，而在骨纤维囊性变中变化更大。骨纤维囊性变患者的骨密度降低。这些观察结果似乎可以通过假设正常骨成熟过程受损来解释，即无定形磷酸钙增加，磷灰石晶体减少。数据表明，一旦在组织学上能够识别出任何异常，成熟缺陷就存在，在骨软化中程度相同，在骨纤维囊性变中最为严重。在比较两组年龄和透析时间相匹配的6名患者时，酸中毒和维生素D治疗似乎都不影响成熟缺陷的严重程度。
