Jorgetti V, Soeiro N M, Mendes V, Pereira R C, Crivellari M E, Coutris G, Borelli A, Leite M O, Nussenzweig I, Marcondes M
Laboratorie de Fisiopatologia Renal, Facultade de Medicina, Universidade de Sao Paulo, Brazil.
Nephrol Dial Transplant. 1994;9(6):668-74. doi: 10.1093/ndt/9.6.668.
We investigated (1) the prevalence of aluminium overload among 96 patients with symptomatic bone disease haemodialysed from 1987 to 1989 in the Sao Paulo area, Brazil; (2) the effect of 6 months desferrioxamine (DFO) treatment (1-2g/week). All patients underwent a first bone biopsy. Aluminium overload (extent of stainable bone aluminium more than 20% trabecular surface) was observed in 74 of 96 patients. Forty overloaded patients were divided into patients with high bone formation rate (BFR) (group 1; n = 17) and patients with low BFR (group 2; n = 23), and had a second biopsy after DFO therapy. In both groups aluminium surface was reduced after treatment (P < 0.001), osteoblast surface (P < 0.02-P < 0.01) and plasma parathyroid hormone (iPTH) (P < 0.01) increased. In group 1 BFR remained high. In group 2 BFR remained low in 16 patients (2a) and increased in seven (P < 0.02) (2b). In group 2a plasma phosphorus was below that in group 2b patients, before (P < 0.03) and after (P < 0.01) DFO. The histological features of group 2a patients resembled hypophosphataemic osteomalacia, those of group 2b patients aluminium osteodystrophy. These data show a high prevalence of aluminium overload in Brazilian patients. Low-dose DFO therapy was safe, decreased bone pain, prevented fractures, and reduced stainable bone aluminium. Bone lesions only partially improved, suggesting that low phosphorus intake and/or plasma calcitriol concentrations may have prevented improvement of bone formation and mineralization.
（1）1987年至1989年在巴西圣保罗地区接受血液透析的96例有症状骨病患者中铝过载的患病率；（2）6个月去铁胺（DFO）治疗（1 - 2g/周）的效果。所有患者均接受了首次骨活检。96例患者中有74例观察到铝过载（可染色骨铝超过20%的小梁表面）。40例过载患者被分为高骨形成率（BFR）患者（第1组；n = 17）和低BFR患者（第2组；n = 23），并在DFO治疗后进行了第二次活检。两组治疗后铝表面均减少（P < 0.001），成骨细胞表面（P < 0.02 - P < 0.01）和血浆甲状旁腺激素（iPTH）（P < 0.01）增加。第1组BFR仍高。第2组中，16例患者（2a）BFR仍低，7例患者（P < 0.02）（2b）BFR增加。在第2组a中，DFO治疗前（P < 0.03）和治疗后（P < 0.01）血浆磷均低于第2组b患者。第2组a患者的组织学特征类似于低磷性骨软化症，第2组b患者的组织学特征类似于铝骨营养不良。这些数据表明巴西患者中铝过载的患病率很高。低剂量DFO治疗是安全的，可减轻骨痛、预防骨折并减少可染色骨铝。骨病变仅部分改善，提示低磷摄入和/或血浆骨化三醇浓度可能阻碍了骨形成和矿化的改善。
