Withold W, Friedrich W, Degenhardt S
Institut für Klinische Chemie und Laboratoriumsdiagnostik, Heinrich-Heine-Universität, Düsseldorf, Germany.
Clin Chim Acta. 1997 May 28;261(2):105-15. doi: 10.1016/s0009-8981(97)06519-4.
The plasma concentrations of two bone matrix proteins (osteocalcin, osteonectin) were monitored in 56 samples from 14 patients receiving renal transplants and the values compared with serum bone alkaline phosphatase mass concentrations and osteotropic hormone levels (parathyroid hormone, calcitriol). There were no significant changes in the concentrations of plasma osteonectin at any time after transplantation, as compared with the values before transplantation (P > 0.1). None of the plasma samples showed osteonectin levels above the reference interval. There was a weak but significant relationship between platelet counts and plasma osteonectin levels (r = +0.322; P < 0.05). Osteocalcin showed a marked decrease of the values 1 week following transplantation as compared with the values before transplantation without further change of the values 1 and 3 months after transplantation (P > 0.5) whereas 3 months after transplantation bone alkaline phosphatase levels were higher than before transplantation (P < 0.05). Multiple regression analysis (performed with data from 42 samples obtained after transplantation) revealed serum creatinine as an independent predictor of plasma osteocalcin whereas serum calcitriol was an independent predictor of serum bone alkaline phosphatase (P < 0.05). No correlation was observed between serum calcitriol/plasma parathyroid hormone on the one hand and plasma osteocalcin on the other (P > 0.05). After transplantation there was a lack of correlation between serum bone alkaline phosphatase mass concentrations and plasma osteocalcin values (P > 0.05). In conclusion, serum bone alkaline phosphatase should be preferred to bone matrix proteins for the assessment of bone metabolism in patients receiving renal transplants: (a) bone alkaline phosphatase-but not osteocalcin-is significantly correlated with calcitriol and adequately reflects increased bone formation after renal transplantation; (b) interpretation of osteocalcin values is severely hampered by their strong correlation with serum creatinine concentrations; (c) plasma osteonectin determinations are not useful for monitoring bone formation.
对14例接受肾移植患者的56份样本监测了两种骨基质蛋白（骨钙素、骨连接蛋白）的血浆浓度，并将这些值与血清骨碱性磷酸酶质量浓度及促骨激素水平（甲状旁腺激素、骨化三醇）进行比较。与移植前的值相比，移植后任何时间血浆骨连接蛋白浓度均无显著变化（P>0.1）。所有血浆样本的骨连接蛋白水平均未高于参考区间。血小板计数与血浆骨连接蛋白水平之间存在微弱但显著的关系（r=+0.322；P<0.05）。与移植前的值相比，骨钙素在移植后1周时值显著降低，而移植后1个月和3个月时值无进一步变化（P>0.5），然而移植后3个月时骨碱性磷酸酶水平高于移植前（P<0.05）。多元回归分析（使用移植后获得的42份样本的数据进行）显示血清肌酐是血浆骨钙素的独立预测因子，而血清骨化三醇是血清骨碱性磷酸酶的独立预测因子（P<0.05）。一方面血清骨化三醇/血浆甲状旁腺激素与另一方面血浆骨钙素之间未观察到相关性（P>0.05）。移植后血清骨碱性磷酸酶质量浓度与血浆骨钙素值之间缺乏相关性（P>0.05）。总之，在评估肾移植患者的骨代谢时，血清骨碱性磷酸酶应优于骨基质蛋白：（a）骨碱性磷酸酶而非骨钙素与骨化三醇显著相关，并能充分反映肾移植后骨形成增加；（b）骨钙素值与血清肌酐浓度的强相关性严重妨碍了对其的解读；（c）血浆骨连接蛋白测定对监测骨形成无用。
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