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

doi:10.3969/j.issn.1673-8640.2015.02.011

摘要/Abstract

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(tP1NP)、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tP1NP、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。

关键词: 骨代谢, 25-羟基维生素D, 慢性肾功能衰竭

Abstract: 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 (tP1NP), 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, tP1NP, 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.

Key words: Bone metabolism, 25-hydroxy vitamin D, Chronic renal failure

中图分类号:

R446.1

王瑛, 沈建雄, 徐旻, 薛志忠. 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[J]. 检验医学, 2015, 30(2): 149-151.

WANG Ying, SHEN Jianxiong, XU Min, XUE Zhizhong. Analysis of bone metabolism balance in chronic renal failure patients with 25-hydroxy vitamin D deficiency[J]. Laboratory Medicine, 2015, 30(2): 149-151.

图/表 1

参考文献 14

[1]	BANSAL B,BANSAL S,MITHAL A,et al.Vitamin D deficiency in hemodialysis patients[J]. Indian J Endocrinol Metab,2012,16(2):270-273.
[2]	National Kidney Foundation.K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease[J]. Am J Kidney Dis,2003,42(4 Suppl 3):S1-S201.
[3]	中华中医药学会肾病分会. 慢性肾衰竭的诊断、辩证分型及疗效评定(试行方案)[J]. 上海中医药杂志,2006,40(8):8-9.
[4]	QUERFELD U, MAK RH.Vitamin D deficiency and toxicity in chronic kidney disease: in search of the therapeutic window[J].Pediatr Nephrol,2010,25(12):2413-2430.
[5]	WANG AY,LAM CW, SANDERSON JE, et al.Serum 25-hydroxyvitamin D status and cardiovascular outcomes in chronic peritoneal dialysis patients: a 3-y prospective cohort study[J]. Am J Clin Nutr,2008,87(6):1631-1638.
[6]	张春华,申珅,王世相.维持性血液透析患者25-羟维生素D水平及其影响因素[J].中华医学杂志,2012,92(24):1690-1693.
[7]	SINGER RF.Vitamin D in dialysis: defining deficiency and rationale for supplementation[J]. Semin Dial,2013, 26(1):40-46.
[8]	BRANDI L.1alpha(OH)D3 one-alpha-hydroxy-cholecalciferol-an active vitamin D analog. Clinical studies on prophylaxis and treatment of secondary hyperparathyroidism in uremic patients on chronic dialysis[J]. Dan Med Bull,2008,55(4):186-210.
[9]	张军芳,蒋飞霞,徐裔婷. 骨代谢生化标志物与骨质疏松研究进展[J]. 中国热带医学,2009,9(3):569-570.
[10]	JAMALI Z, ARABABADI MK, ASADIKARAM G.Serum levels of IL-6, IL-10, IL-12, IL-17 and IFN-γ and their association with markers of bone metabolism in vitamin D-deficient female students[J]. Inflammation,2013,36(1):164-168.
[11]	童明宏,肖国平,丁慧.骨质疏松症与骨转换标志物的相关性研究[J].检验医学,2013,28(2):111-113.
[12]	PÉREZ-GARCÍA R,ALBATATE M,DE SEQUERA P,et al. On-line haemodiafiltration improves response to calcifediol treatment[J].Nefrologia,2012,32(4):459-466.
[13]	JEAN G,CHARRA B,CHAZOT C.Vitamin D deficiency and associated factors in hemodialysis patients[J]. J Ren Nutr,2008,18(5):395-399.
[14]	PECOVNIK-BALON B,JAKOPIN E,BEVC S,et al.Vitamin D as a novel nontraditional risk factor for mortality in hemodialysis patients[J]. Ther Apher Dial,2009,13(4):268-272.

组别	例数	25-羟维生素D(nmol/L)	tP1NP(ng/mL)	骨钙素(ng/mL)	β-CTx(pg/mL)	PTH(pg/mL)
慢性肾衰组	80	13.65±3.82^*	187.41±85.46^*	79.03±33.23^*	960.43±184.73^*	75.39±23.26^*
正常对照组	52	87.08±10.78	81.89±23.14	16.41±5.84	219.37±68.62	25.17±9.72
组别	例数	钙(mmol/L)	磷(mmol/L)	镁(mmol/L)	铁(μmol/L)	BAP(μg/L)
慢性肾衰组	80	2.25±0.48	1.68±0.56^*	1.15±0.26	13.01±8.52	16.22±6.76
正常对照组	52	1.19±0.12	1.19±0.12	1.08±0.07	16.36±5.05	17.90±7.64

组别	例数	25-羟维生素D(nmol/L)	tP1NP(ng/mL)	骨钙素(ng/mL)	β-CTx(pg/mL)	PTH(pg/mL)
慢性肾衰组	80	13.65±3.82^*	187.41±85.46^*	79.03±33.23^*	960.43±184.73^*	75.39±23.26^*
正常对照组	52	87.08±10.78	81.89±23.14	16.41±5.84	219.37±68.62	25.17±9.72
组别	例数	钙(mmol/L)	磷(mmol/L)	镁(mmol/L)	铁(μmol/L)	BAP(μg/L)
慢性肾衰组	80	2.25±0.48	1.68±0.56^*	1.15±0.26	13.01±8.52	16.22±6.76
正常对照组	52	1.19±0.12	1.19±0.12	1.08±0.07	16.36±5.05	17.90±7.64

[1]	努荣古丽·买买提, 衡燕, 张凯迪, 王新玲, 李慧, 杜丹阳, 董玲玲, 郭艳英. 乌鲁木齐地区成年男性骨代谢指标与代谢综合征的相关性分析[J]. 检验医学, 2023, 38(12): 1186-1190.
[2]	戴健敏, 陈诺, 魏坚. 慢性肾脏病不同阶段患者血清ProGRP、NSE、CYFRA21-1水平的变化[J]. 检验医学, 2022, 37(9): 811-814.
[3]	刘洋, 耿坤静, 栗红江, 石昊曦, 陈思思. 25（OH）D₃与肝脏炎症分期和抗病毒疗效的相关性分析[J]. 检验医学, 2022, 37(7): 628-631.
[4]	张志斌, 杨万勇, 阮富旺, 温庆辉. 总IgE、sIgE、25（OH）D在婴儿特应性皮炎病情评估中的价值[J]. 检验医学, 2022, 37(3): 217-220.
[5]	赵晓敏, 江晓宇, 单凯莉, 单铁英, 刘秀珍. 缺铁性贫血患儿Flt-3L、TF、25（OH）D检测的临床意义[J]. 检验医学, 2022, 37(11): 1039-1043.
[6]	李定富, 黄健, 蔡枚龄, 王丽珍, 简开乾, 杨飞飞. 过敏性鼻炎-哮喘综合征患儿血清25（OH）D与病情控制的相关性[J]. 检验医学, 2022, 37(1): 32-35.
[7]	赵学玲, 郑昕, 徐化梅, 施洪耀. 过敏性鼻炎患儿血清25（OH）D、特异性IgE水平与VAS评分的相关性[J]. 检验医学, 2021, 36(6): 615-617.
[8]	李冰玲, 程雅婷, 赵蓓蓓, 佘旭辉, 董衡, 余木俊. LC-MS/MS检测血清25-羟基维生素D替代校准品基质的选择与评价[J]. 检验医学, 2021, 36(2): 213-218.
[9]	方慧玲, 葛丹红, 朱宇清, 朱岭峰, 赵晓君, 陈子齐, 王梓蒙. 2015—2019年上海地区25-羟基维生素D室间质量评价结果分析[J]. 检验医学, 2021, 36(2): 219-224.
[10]	陈刚, 王晶, 邓蔷, 陈曦, 胡冬, 庄利东. 甲状腺癌患者术前血清25（OH）D水平与甲状腺指标的相关性及风险评估[J]. 检验医学, 2020, 35(9): 885-888.
[11]	张素洁, 居漪, 李卿, 孙贺伟, 冯雪晴, 金中淦, 李水军, 李玉杰, 李金蓉. 健康人群血清25-羟基维生素D水平分析[J]. 检验医学, 2020, 35(10): 1028-1031.
[12]	孙良波, 景海宁. 肾病综合征患者生物可利用1,25（OH）₂D水平与骨密度及骨代谢标志物的相关性分析[J]. 检验医学, 2019, 34(8): 717-721.
[13]	邢小平, 唐吉斌, 王传发, 孙芸, 李旭光, 吴道伟, 宋元明. 慢性肾脏病患者甲状旁腺激素水平与肾功能的关系[J]. 检验医学, 2019, 34(5): 405-407.
[14]	姜文佳. 骨关节炎患者血清1, 25（OH） ₂D₃、IL-17和IL-10水平的变化及临床意义[J]. 检验医学, 2019, 34(3): 202-205.
[15]	杨娟, 徐瑾. 绝经后骨质疏松症患者血清铁调素水平变化及临床意义[J]. 检验医学, 2019, 34(1): 23-27.