王　瑛，　沈建雄，　徐　旻，　薛志忠

(上海中醫(yī)藥大學(xué)附屬岳陽中西醫(yī)結(jié)合醫(yī)院，上海 200437)

25-羥基維生素D缺乏的慢性腎功能衰竭患者的骨代謝平衡分析

王瑛，沈建雄，徐旻，薛志忠

(上海中醫(yī)藥大學(xué)附屬岳陽中西醫(yī)結(jié)合醫(yī)院，上海 200437)

摘要：目的探討25-羥基維生素D缺乏的慢性腎功能衰竭(簡稱慢性腎衰)患者骨代謝平衡的特征及其相互關(guān)系。方法檢測80例25-羥基維生素D≤37.5 nmol/L的慢性腎衰患者及52名健康志愿者(正常對照組，25-羥基維生素D>75.0 nmol/L)外周血骨鈣素、總Ⅰ型前膠原氨基末端肽(tP1NP)、β-異構(gòu)化的C-端肽(β-CTx)、甲狀旁腺素(PTH)、骨堿性磷酸酶(BAP)、鈣、鎂、磷、鐵水平并對結(jié)果進行統(tǒng)計分析。結(jié)果25-羥基維生素D缺乏的慢性腎衰組tP1NP、骨鈣素、β-CTx、PTH、磷明顯高于正常對照組(P<0.01)，其余項目兩組間差異無統(tǒng)計學(xué)意義(P>0.05)。25-羥基維生素D水平和血鈣呈正相關(guān)[相關(guān)系數(shù)(r)=0.33，P<0.05]。結(jié)論25-羥基維生素D缺乏的慢性腎衰患者的骨代謝特征是以破骨和成骨同時增強的高轉(zhuǎn)換代謝型，對此類患者進行骨轉(zhuǎn)換率的監(jiān)測比單純的血鈣監(jiān)測更有意義。

關(guān)鍵詞：骨代謝；25-羥基維生素D；慢性腎功能衰竭

中圖分類號：

文章編號：1673-8640(2015)02-0149-03R446.1

文獻標(biāo)志碼：碼：A

DOI：10.3969/j.issn.1673-8640.2015.02.011

Abstract:ObjectiveTo investigate the characteristics and relationship of bone metabolism in chronic renal failure patients with 25-hydroxy vitamin D deficiency. MethodsA 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. ResultsCompared 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]. ConclusionsThe 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.

作者簡介：王瑛，女，1982年生，碩士，主管技師，主要從事免疫學(xué)檢驗工作。

通訊作者：沈建雄，聯(lián)系電話：021-65161782-2601。

Analysis of bone metabolism balance in chronic renal failure patients with 25-hydroxy vitamin D deficiencyWANGYing，SHENJianxiong，XUMin，XUEZhizhong.(YueyangHospitalofIntegratedTraditionalChineseandWesternMedicine，ShanghaiUniversityofTraditionalChineseMedicine，Shanghai200437，China)

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

慢性腎功能衰竭(簡稱慢性腎衰)是由多種慢性腎臟疾病所導(dǎo)致的腎功能減退，會出現(xiàn)不同程度的骨代謝異常。BANSAL等[1]在測定45名血液透析患者的維生素D水平時發(fā)現(xiàn)，維生素D缺乏在慢性腎衰患者中普遍存在，且2/3為重度缺乏。我們在臨床工作中發(fā)現(xiàn)，雖然大量慢性腎衰患者均有25-羥基維生素D降低甚至缺乏的表現(xiàn)，但血清鈣水平則維持在正常水平。為此，我們通過測定25-羥基維生素D缺乏的慢性腎衰患者9項骨代謝指標(biāo),包括骨鈣素、總Ⅰ型前膠原氨基末端肽(total procollagen type Ⅰ amino terminal peptide, tP1NP)、β-異構(gòu)化的C-端肽(C-end peptide beta isomerization,β-CTx)、甲狀旁腺素(parathyroid hormone, PTH)、骨堿性磷酸酶(bone alkaline phosphatase, BAP)、鈣、鎂、磷和鐵，探討慢性腎衰患者骨代謝平衡的特征及其與25-羥基維生素D之間的關(guān)系。