老年慢性肾功能不全患者的骨密度及骨代谢变化

摘要

目的 探讨老年慢性肾功能不全患者的骨密度及骨代谢,以及影响因素.方法 用DEXA骨密度仪测定120例70岁以上的老年患者(60例慢性肾功能不全者、60例肾功能正常者)的腰椎及股骨端骨密度,并检测生化及骨代谢指标.结果 慢性肾功能不全组的腰椎及股骨端各部位骨密度明显下降,骨代谢指标中血磷、甲状旁腺素、降钙素、Ⅰ型胶原吡啶交联终肽显著升高(P＜0.01),血钙明显下降,碱性磷酸酶、25羟维生素D3和骨钙素变化不大.血肌酐水平与甲状旁腺素、降钙素、Ⅰ型胶原吡啶交联终肽呈正相关,其中与Ⅰ型胶原吡啶交联终肽水平相关程度最高.结论 慢性肾功能不全者主要表现在骨吸收增加,骨密度下降,骨吸收活跃程度与血肌酐水平密切相关.%Objective To investigate the relationship between bone mineral density (BMD) and bone metabolic markers in patients with chronic renal failure ( CRF), and the influential factors.Methods Dual energy X-ray absorptiometry was used to measure BMD of the lumbar spine and the proximal femur in 120 elder persons over 70 years old (60 cases with CRF and 60 cases with normal renal function).Bone metabolic biochemical markers were examined.Results BMD of the lumbar and the proximal femur in patient in CRF group descended significantly.Serum phosphorus, parathyroid hormone (PTH), calcitonin (CT), and pyridinoline cross-linked carboxy-terminal telopeptiele of type Ⅰ collagen (ICTP) increased significantly ( P ＜ 0.01 ), Serum calcium decreased significantly.Alkaline phosphatase, 25 dihydroxyvitamin D3, and osteocalcin had no obvious change.Serum creatinine was positively correlated with PTH, CT, ICTP, and the level of the correlation between creatinine and ICTP was the highest.Conclusion Patients with CRF appeared with increased bone resorption and decreased BMD.Bone resorption activity level was closely related to the serum level of creatinine.