25-羟基维生素 D 缺乏的慢性肾功能衰竭患者的骨代谢平衡分析

摘要

目的：探讨25-羟基维生素D缺乏的慢性肾功能衰竭（简称慢性肾衰）患者骨代谢平衡的特征及其相互关系。方法检测80例25-羟基维生素 D≤37．5 nmol／L 的慢性肾衰患者及52名健康志愿者（正常对照组，25-羟基维生素 D ＞75．0 nmol／L）外周血骨钙素、总Ⅰ型前胶原氨基末端肽（tP1 NP）、β-异构化的 C-端肽（β-CTx）、甲状旁腺素（PTH）、骨碱性磷酸酶（BAP）、钙、镁、磷、铁水平并对结果进行统计分析。结果25-羟基维生素 D 缺乏的慢性肾衰组 tP1 NP、骨钙素、β-CTx、PTH、磷明显高于正常对照组（P ＜0．01），其余项目两组间差异无统计学意义（P ＞0．05）。25-羟基维生素 D 水平和血钙呈正相关[相关系数（r）＝0．33，P ＜0．05]。结论25-羟基维生素 D 缺乏的慢性肾衰患者的骨代谢特征是以破骨和成骨同时增强的高转换代谢型，对此类患者进行骨转换率的监测比单纯的血钙监测更有意义。%Objective To investigate the characteristics and relationship of bone metabolism in chronic renal failure patients with 25-hydroxy vitamin D deficiency.Methods A total of 80 chronic renal failure patients with 25-hydroxy vitamin D≤37.5 nmol/L were enrolled as study group,and 52 healthy subjects with 25-hydroxy vitamin D>75.0 nmol/L were as enrolled as control group.Their peripheral blood osteocalcin,total procollagen type Ⅰ amino terminal peptide (tP1 NP),C-end peptide beta isomerization (β-CTx),parathyroid hormone (PTH),bone alkaline phosphatase (BAP),calcium,magnesium,phosphorus and ferrum were determined.The results were analyzed statistically.Results Compared to control group,tP1 NP,osteocalcin,β-CTx,PTH and phosphorus in study group were higher than those in control group (P <0.01 ).The other parameters had no statistical significance (P >0.05). 25-hydroxy vitamin D levels and calcium were positively correlated [correlation coefficient (r)=0.33,P <0.05 ]. Conclusions The characteristics of bone metabolism in chronic renal failure patients with 25-hydroxy vitamin D deficiency are enhancing the activity of osteoclasts and bone resorption significantly.It is more important to detect bone turnover rate than calcium in patients with chronic renal failure.