Giannini S, Nobile M, Sartori L, Calò L, Tasca A, Dalle Carbonare L, Ciuffreda M, D'Angelo A, Pagano F, Crepaldi G
Institute of Internal Medicine and National Research Council-Centre for Aging Studies of Padova, Italy.
Clin Nephrol. 1998 Aug;50(2):94-100.
To study bone density in hypercalciuric patients, when classified according to the main metabolic defect.
We studied 49 patients, aged 19-60 years with calcium stones and idiopathic hypercalcuria. All subjects underwent an evaluation of mineral metabolism and a spinal and femoral DEXA measurement. Then, patients were classified as having Fasting (FH, 31 subjects) or Absorptive (AH, 18 patients) Hypercalciuria according to a standard oral calcium load.
Spinal bone density was lower only in FH patients as compared to controls (p <0.001). Bone alkaline phosphatase and urine hydroxyproline were higher with respect to controls only in patients with FH (p <0.005 and p <0.015, respectively). After low calcium diet, hydroxyproline excretion continued to be higher in FH patients (p <0.05). Although in the normal range, serum and urine uric acid were higher in hypercalciuric subjects (p <0.03 and p <0.005, respectively); blood pH was lower in hypercalciuric patients than in controls (p <0.01). In FH patients urine hydroxyproline negatively correlated with spinal and femoral density (p <0.001 and p <0.005, respectively), and blood pH positively correlated with spinal density.
a disordered bone metabolism and bone loss are present only in patients with fasting hypercalciuria. An excessive acid load, possibly of dietary origin, might be involved as a pathogenetic factor.
根据主要代谢缺陷对高钙尿症患者进行分类，研究其骨密度。
我们研究了49例年龄在19至60岁之间、患有钙结石和特发性高钙尿症的患者。所有受试者均接受了矿物质代谢评估以及脊柱和股骨的双能X线吸收测定（DEXA）。然后，根据标准口服钙负荷，将患者分为空腹高钙尿症（FH，31例受试者）或吸收性高钙尿症（AH，18例患者）。
与对照组相比，仅FH患者的脊柱骨密度较低（p<0.001）。仅在FH患者中，骨碱性磷酸酶和尿羟脯氨酸相对于对照组更高（分别为p<0.005和p<0.015）。低钙饮食后，FH患者的羟脯氨酸排泄仍较高（p<0.05）。尽管在正常范围内，但高钙尿症受试者的血清和尿酸水平较高（分别为p<0.03和p<0.005）；高钙尿症患者的血液pH值低于对照组（p<0.01）。在FH患者中，尿羟脯氨酸与脊柱和股骨密度呈负相关（分别为p<0.001和p<0.005），而血液pH值与脊柱密度呈正相关。
仅空腹高钙尿症患者存在骨代谢紊乱和骨质流失。过量的酸负荷，可能源于饮食，可能是一个致病因素。
