Huraib S, Souqqiyeh M Z, Aswad S, al-Swailem A R
Department of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia.
Nephrol Dial Transplant. 1993;8(7):603-8.
In order to know the pattern of renal osteodystrophy in haemodialysis patients in Saudi Arabia we conducted a multicentre study involving 209 patients. The mean age of the patients was 39.4 +/- 14 (18-70) years, 128 were males and 81 females. All patients were on acetate dialysate and their mean duration on dialysis was 3.5 +/- 1.5 years. The major symptom was bone and joint pain (25.8%). The mean serum calcium was 2.1 +/- 0.26 mmol/l, phosphorus 2.0 +/- 0.36 mmol/l, alkaline phosphatase 19.7 +/- 14.6 u/l and parathyroid hormone level was 8.9 +/- 3.9 mg/ml. The mean serum aluminium (AL) level was 25.4 +/- 17.7 micrograms/l, while that of 1,25 vitamin D3 was 8.1 +/- 4.2 ng/l and of fluoride was 92.2 +/- 31.4 micrograms/l. The major radiological finding was osteosclerosis (70%). Dual-photon absorptiometry (DPA) showed low bone mineral density (LBM) in 65% of the patients. Forty-one patients had bone biopsies with AL staining of the biopsies. Of this group, 92% had changes of hyperparathyroidism and 66% of them were pure hyperparathyroidism. Sixty percent of them had variable degrees of AL intoxication. The radiological skeletal survey of those patients could detect abnormalities in only 46% while 70% of them had abnormal bone mineral density (BMD). In conclusion, osteosclerosis is the commonest radiological finding in our dialysis patients while secondary hyperparathyroidism is the main histopathological diagnosis in bone biopsy, even in patients with normal skeletal survey. AL intoxication is a significant problem in our population. DPA is more sensitive in detecting bone abnormalities than X-radiography.
为了解沙特阿拉伯血液透析患者肾性骨营养不良的模式，我们开展了一项涉及209例患者的多中心研究。患者的平均年龄为39.4±14（18 - 70）岁，男性128例，女性81例。所有患者均使用醋酸盐透析液，平均透析时间为3.5±1.5年。主要症状为骨和关节疼痛（25.8%）。平均血清钙为2.1±0.26 mmol/L，磷为2.0±0.36 mmol/L，碱性磷酸酶为19.7±14.6 u/L，甲状旁腺激素水平为8.9±3.9 mg/ml。平均血清铝（AL）水平为25.4±17.7 μg/L，而1,25 - 维生素D3为8.1±4.2 ng/L，氟为92.2±31.4 μg/L。主要放射学表现为骨硬化（70%）。双能光子吸收法（DPA）显示65%的患者骨矿物质密度（BMD）低。41例患者进行了骨活检并对活检组织进行了AL染色。在这组患者中，92%有甲状旁腺功能亢进的改变，其中66%为单纯甲状旁腺功能亢进。60%的患者有不同程度的铝中毒。这些患者的骨骼X线检查仅能发现46%的异常，而70%的患者骨矿物质密度（BMD）异常。总之，骨硬化是我们透析患者最常见的放射学表现，而继发性甲状旁腺功能亢进是骨活检的主要组织病理学诊断，即使在骨骼X线检查正常的患者中也是如此。铝中毒在我们的人群中是一个重要问题。DPA在检测骨异常方面比X线摄影更敏感。
