Hodsman A B, Sherrard D J, Alfrey A C, Ott S, Brickman A S, Miller N L, Maloney N A, Coburn J W
J Clin Endocrinol Metab. 1982 Mar;54(3):539-46. doi: 10.1210/jcem-54-3-539.
To evaluate the relationship between aluminum and the characteristics of bone disease in uremia, bone aluminum content and quantitative histomorphometric analysis of bone were evaluated in bone biopsies from 59 uremic patients undergoing maintenance hemodialysis. Biopsies were classified as showing 1) pure osteomalacia (OM) in 23 cases, 2) osteitis fibrosa (OF) in 13, 3) mixed in 7, and 4) mild lesions in 16. There were no significant differences in levels of serum calcium or alkaline phosphatase between the groups, but serum phosphorus levels were slightly higher in those with OF. Serum immunoreactive parathyroid hormone levels were greater in the patients with OF and mixed lesions than in patients with OM or mild lesions (P less than 0.01). Bone aluminum exceeded normal in all groups (P less than 0.01), with values of 175 +/- 18 mg/kg dry wt in OM patients, 46 +/- 7 of OF patients, 81 +/- 29 in mixed subjects, and 67 +/- 7 in patients with mild lesions. Bone aluminum was significantly higher in the OM patients than in any other group (P less than 0.01); also, bone aluminum correlated with the quantitative measure of unmineralized osteoid in OM (r = 0.67; P less than 0.001); no correlations existed for the other groups. There were inverse correlations between bone aluminum and the serum immunoreactive parathyroid hormone (r = -0.35; P less than 0.01) and resorbing surface on biopsy (r = -0.44; P less than 0.001). Bone aluminum correlated with the duration of hemodialysis in patients with OF with mixed and mild lesions (r = 0.49); no relation was seen in OM patients, and bone aluminum was higher for the duration of dialysis, suggesting that aluminum may accumulate more rapidly in OM subjects. These findings are consistent with but do not prove the hypothesis that aluminum plays a pathogenic role in dialysis osteomalacia; the mechanism by which aluminum accumulates remains unknown.
为评估铝与尿毒症骨病特征之间的关系，对59例接受维持性血液透析的尿毒症患者的骨活检组织进行了骨铝含量测定及骨定量组织形态计量学分析。活检组织分为以下几类：1）23例为单纯骨软化症（OM）；2）13例为纤维性骨炎（OF）；3）7例为混合型；4）16例为轻度病变。各组间血清钙或碱性磷酸酶水平无显著差异，但OF组的血清磷水平略高。OF组和混合型病变患者的血清免疫反应性甲状旁腺激素水平高于OM组或轻度病变患者（P<0.01）。所有组的骨铝含量均超过正常水平（P<0.01），OM患者骨铝含量为175±18mg/kg干重，OF患者为46±7mg/kg干重，混合型患者为81±29mg/kg干重，轻度病变患者为67±7mg/kg干重。OM患者的骨铝含量显著高于其他任何组（P<0.01）；此外，骨铝含量与OM中未矿化类骨质的定量测量值相关（r=0.67；P<0.001）；其他组未见相关性。骨铝含量与血清免疫反应性甲状旁腺激素呈负相关（r=-0.35；P<0.01），与活检时的吸收表面呈负相关（r=-0.44；P<0.001）。OF合并混合型及轻度病变患者的骨铝含量与血液透析时间相关（r=0.49）；OM患者未见相关性，且透析期间骨铝含量较高，提示铝可能在OM患者中蓄积更快。这些发现与铝在透析性骨软化症中起致病作用的假说相符，但未得到证实；铝蓄积的机制尚不清楚。
