Kohlmeier M, Saupe J, Shearer M J, Schaefer K, Asmus G
Department of Nutrition, School of Public Health and School of Medicine, University of North Carolina, Chapel Hill 27599-7400, USA.
Kidney Int. 1997 Apr;51(4):1218-21. doi: 10.1038/ki.1997.166.
This investigation of 68 hemodialysis patients (ages 33 to 91) analyzed the association of biochemical indicators of vitamin K nutriture and bone metabolism, and related both to past bone fracture history and prospective bone fracture risk. Phylloquinone concentrations were significantly lower in the 23 patients with previous fractures compared to those without (0.93 vs. 1.50 nmol/liter, P < 0.003) and a smaller percentage of their serum osteocalcin was carboxylated (48.8 vs. 53.6%, P < 0.03). The 41 patients who never had fractures had nearly three times higher phylloquinone concentrations than the nine patients with fractures during a four-year follow-up period (1.59 vs. 0.55 nmol/liter, P < 0.002) and more carboxylated serum osteocalcin (55.2 vs. 42.0%, P < 0.01). None of the patients with phylloquinone concentrations over 2.2 nmol/liter had elevated intact parathyroid hormone (iPTH) concentrations, and only patients with less than 1 nmol/liter phylloquinone had severe hyperparathyroidism (iPTH > 300 ng/liter). Our data thus indicate that suboptimal vitamin K nutriture in hemodialysis patients is associated both with increased bone fracture risk and with a high prevalence of hyperparathyroidism.
这项针对68名血液透析患者（年龄在33至91岁之间）的调查分析了维生素K营养状况和骨代谢的生化指标之间的关联，并将其与既往骨折史和未来骨折风险联系起来。与无骨折史的患者相比，23名既往有骨折史的患者的叶绿醌浓度显著更低（分别为0.93和1.50纳摩尔/升，P < 0.003），其血清骨钙素羧化的比例也更小（分别为48.8%和53.6%，P < 0.03）。在四年的随访期内，41名从未发生过骨折的患者的叶绿醌浓度比9名发生过骨折的患者高出近三倍（分别为1.59和0.55纳摩尔/升，P < 0.002），且血清骨钙素的羧化程度更高（分别为55.2%和42.0%，P < 0.01）。叶绿醌浓度超过2.2纳摩尔/升的患者中，无一例完整甲状旁腺激素（iPTH）浓度升高，只有叶绿醌浓度低于1纳摩尔/升的患者患有严重甲状旁腺功能亢进（iPTH > 300纳克/升）。因此，我们的数据表明，血液透析患者维生素K营养状况欠佳与骨折风险增加以及甲状旁腺功能亢进的高患病率均有关联。
