Gerakis A, Hutchison A J, Apostolou T, Freemont A J, Billis A
Department of Medicine, Evangelismos Hospital, Athens, Greece.
Nephrol Dial Transplant. 1996 Dec;11(12):2430-8. doi: 10.1093/oxfordjournals.ndt.a027210.
The diagnostic and predictive value of serum intact parathyroid hormone (iPTH) and osteocalcin (bone Gla protein, BGP), alone or in combination, have been examined in only a small number of haemodialysis patients.
We studied prospectively 114 patients (46 women, 68 men; mean age 52 +/- 12 years) on regular haemodialysis for a mean of 55 (6-185) months. All patients underwent labelled transiliac bone biopsy, and serum levels of iPTH, BGP and alkaline phosphatase were determined.
Seventy-one patients (62%) showed histological findings of hyperparathyroid bone disease, 24 (21%) mixed bone disease, six (5.5%) osteomalacia and 13 (11.5%) adynamic bone. Bone aluminium deposition over more than 25% of the trabecular bone interface was found in 66 patients (58%). Serum iPTH and BGP correlated with the majority of histomorphometric indices of bone formation, mineralization and resorption (r > 0.5, P < 0.01). iPTH levels > or = 200 pg/ml and BGP > or = 50 ng/ml were found to be indicative of hyperparathyroid bone disease, whilst iPTH levels < 65 pg/ml and BGP < 20 ng/ml were indicative of adynamic bone. However, the positive predictive value of these indices was limited (less than 80%), although their negative predictive value, especially when used in combination, was good (more than 90%) and the exclusion of hyperparathyroid bone disease and adynamic bone was possible. The diagnostic and predictive value of these bone markers were improved when patients with bone aluminium deposition were excluded.
Diagnosis of hyperparathyroid bone disease and adynamic bone is difficult on the basis of iPTH and BGP, especially when bone aluminium deposition is prevalent. However, using these bone markers, preferably in combination, the exclusion of these lesions is feasible.
血清完整甲状旁腺激素（iPTH）和骨钙素（骨γ-羧基谷氨酸蛋白，BGP）单独或联合应用的诊断及预测价值，仅在少数血液透析患者中进行过研究。
我们前瞻性地研究了114例规律血液透析患者（46例女性，68例男性；平均年龄52±12岁），平均透析时间为55（6 - 185）个月。所有患者均接受了标记的经髂骨活检，并测定了血清iPTH、BGP和碱性磷酸酶水平。
71例患者（62%）表现为甲状旁腺功能亢进性骨病的组织学表现，24例（21%）为混合性骨病，6例（5.5%）为骨软化症，13例（11.5%）为骨再生障碍。66例患者（58%）的小梁骨界面超过25%有骨铝沉积。血清iPTH和BGP与大多数骨形成、矿化和吸收的组织形态计量学指标相关（r>0.5，P<0.01）。发现iPTH水平≥200 pg/ml和BGP≥50 ng/ml提示甲状旁腺功能亢进性骨病，而iPTH水平<65 pg/ml和BGP<20 ng/ml提示骨再生障碍。然而，这些指标的阳性预测价值有限（低于80%），尽管它们的阴性预测价值，尤其是联合使用时，较好（超过90%），并且可以排除甲状旁腺功能亢进性骨病和骨再生障碍。排除有骨铝沉积的患者后，这些骨标志物的诊断和预测价值有所提高。
基于iPTH和BGP诊断甲状旁腺功能亢进性骨病和骨再生障碍较为困难，尤其是在骨铝沉积普遍存在时。然而，使用这些骨标志物，最好联合使用，排除这些病变是可行的。
