Canavese C, Barolo S, Gurioli L, Cadario A, Portigliatti M, Isaia G, Thea A, Marangella M, Bongiorno P, Cavagnino A, Peona C, Boero R, D'Amicone M, Cardelli R, Rossi P, Piccoli G
Department of Medical Sciences, University of Torino, Italy.
Int J Artif Organs. 1998 Aug;21(8):443-50.
To define which noninvasive investigations are of value in predicting bone histology, we analyzed transiliac bone specimens (66 biopsies, 14 autopsies) from 80 uremic patients on chronic dialysis. Results were compared with values of different measurements of parathyroid hormone (PTH), alkaline phosphatase (APH), osteocalcin, calcitonin, baseline and post-deferroxamine (DFO) aluminium (Al),--beta 2 microglobulin, ferritin and bone mineral density. Among histomorphometric parameters, woven osteoid, active osteoblastic surface and resorption surface showed the best correlations with dynamic and biochemical marks of active bone metabolism. Among biochemical parameters, intact PTH and APH were better related to histomorphometric and dynamic bone parameters than other PTH measurements as well as osteocalcin, while calcitonin was related to no parameters. Stainable Al alone, and not total bone Al content was related to bone histology. Baseline Al was related to lamellar osteoid, while post-DFO Al was related to stainable Al. beta 2 microglobulin was positively related to active osteoid surface and ferritin was inversely related to the mineral apposition rate, while bone mineral density was related only to total bone volume. We conclude that, though definite diagnosis requires the use of histological methods, few simple biochemical parameters may offer insight to the bone metabolic status, useful to the physician in day to day clinical practice.
为了确定哪些非侵入性检查在预测骨组织学方面具有价值，我们分析了80例慢性透析尿毒症患者的经髂骨标本（66例活检，14例尸检）。将结果与甲状旁腺激素（PTH）、碱性磷酸酶（APH）、骨钙素、降钙素、基线和去铁胺（DFO）后铝（Al）、β2微球蛋白、铁蛋白以及骨矿物质密度的不同测量值进行比较。在组织形态计量学参数中，编织类骨质、活跃成骨细胞表面和吸收表面与活跃骨代谢的动态和生化指标显示出最佳相关性。在生化参数中，完整PTH和APH与组织形态计量学和动态骨参数的相关性优于其他PTH测量值以及骨钙素，而降钙素与任何参数均无相关性。仅可染色的Al而非总骨Al含量与骨组织学相关。基线Al与板层类骨质相关，而去铁胺后Al与可染色Al相关。β2微球蛋白与活跃类骨质表面呈正相关，铁蛋白与矿物质沉积率呈负相关，而骨矿物质密度仅与总骨体积相关。我们得出结论，尽管明确诊断需要使用组织学方法，但少数简单的生化参数可能有助于了解骨代谢状态，对医生的日常临床实践有用。
