Torres A, Lorenzo V, Hernández D, Rodríguez J C, Concepción M T, Rodríguez A P, Hernández A, de Bonis E, Darias E, González-Posada J M
Servicio de Nefrología, Hospital Universitario, Tenerife, Spain.
Kidney Int. 1995 May;47(5):1434-42. doi: 10.1038/ki.1995.201.
The spectrum of bone disease in predialysis and dialysis patients has changed during the last decade. The incidence of aplastic bone disease has increased and this can not be attributed to bone aluminum deposition; moreover, low bone cellular activity is present despite a moderate elevation in PTH levels. This study compares PTH levels and types of bone disease in both predialysis and dialysis patients from the same geographical area. We prospectively studied 119 unselected end-stage renal disease patients: 38 were immediately predialysis (PreD), 49 on hemodialysis (HD), and 32 on CAPD. A bone biopsy was performed in all patients. Aplastic bone disease with < 5% bone surface aluminum was a common finding (48%, 32%, and 48%, in PreD, HD, and CAPD, respectively). In all groups, an intact PTH level below 120 pg/ml was highly predictive of low bone turnover. Conversely, a PTH level above 450 pg/ml was always associated with histologic features of hyperparathyroid bone disease. Among the bone histomorphometric parameters, osteoblast surface showed the best correlation with intact PTH in each group, and the slope of the regression line for this correlation was significantly steeper in HD and CAPD than PreD patients. Thus, the range of PTH (95% confidence limit bands) needed to obtain a normal osteoblast surface of 1.5% was greater in preD than in HD and CAPD patients (300 to 500 vs. 75 to 260 pg/ml, respectively). In all groups some degree of marrow fibrosis was observed when PTH levels were greater than 250 pg/ml.(ABSTRACT TRUNCATED AT 250 WORDS)
在过去十年中，透析前及透析患者的骨病谱发生了变化。再生障碍性骨病的发病率有所上升，且这不能归因于骨铝沉积；此外，尽管甲状旁腺激素（PTH）水平适度升高，但骨细胞活性仍较低。本研究比较了来自同一地理区域的透析前及透析患者的PTH水平和骨病类型。我们前瞻性地研究了119例未经选择的终末期肾病患者：38例为即将进入透析前阶段（PreD），49例接受血液透析（HD），32例接受持续性非卧床腹膜透析（CAPD）。所有患者均进行了骨活检。骨表面铝含量<5%的再生障碍性骨病是常见表现（PreD、HD和CAPD患者中分别为48%、32%和48%）。在所有组中，完整PTH水平低于120 pg/ml高度预示着低骨转换。相反，PTH水平高于450 pg/ml总是与甲状旁腺功能亢进性骨病的组织学特征相关。在骨组织形态计量学参数中，成骨细胞表面在每组中与完整PTH的相关性最佳，且HD和CAPD患者中该相关性回归线的斜率比PreD患者明显更陡。因此，PreD患者获得正常成骨细胞表面1.5%所需的PTH范围（95%置信限带）比HD和CAPD患者更大（分别为300至500 vs. 75至260 pg/ml）。当PTH水平大于250 pg/ml时，所有组均观察到一定程度的骨髓纤维化。（摘要截断于250字）
