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

王　瑛，　沈建雄，　徐　旻，　薛志忠

(上海中医药大学附属岳阳中西医结合医院，上海 200437)

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

王瑛，沈建雄，徐旻，薛志忠

(上海中医药大学附属岳阳中西医结合医院，上海 200437)

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

中图分类号：

文章编号：1673-8640(2015)02-0149-03R446.1

文献标志码：码：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.

作者简介：王瑛，女，1982年生，硕士，主管技师，主要从事免疫学检验工作。

通讯作者：沈建雄，联系电话：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

慢性肾功能衰竭(简称慢性肾衰)是由多种慢性肾脏疾病所导致的肾功能减退，会出现不同程度的骨代谢异常。BANSAL等[1]在测定45名血液透析患者的维生素D水平时发现，维生素D缺乏在慢性肾衰患者中普遍存在，且2/3为重度缺乏。我们在临床工作中发现，虽然大量慢性肾衰患者均有25-羟基维生素D降低甚至缺乏的表现，但血清钙水平则维持在正常水平。为此，我们通过测定25-羟基维生素D缺乏的慢性肾衰患者9项骨代谢指标,包括骨钙素、总Ⅰ型前胶原氨基末端肽(total procollagen type Ⅰ amino terminal peptide, tP1NP)、β-异构化的C-端肽(C-end peptide beta isomerization,β-CTx)、甲状旁腺素(parathyroid hormone, PTH)、骨碱性磷酸酶(bone alkaline phosphatase, BAP)、钙、镁、磷和铁，探讨慢性肾衰患者骨代谢平衡的特征及其与25-羟基维生素D之间的关系。