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

(上海中醫藥大學附屬岳陽中西醫結合醫院，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

(上海中醫藥大學附屬岳陽中西醫結合醫院，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、鐵水平并對結果進行統計分析。結果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計學意義(P>0.05)。25-羥基維生素D水平和血鈣呈正相關[相關系數(r)=0.33，P<0.05]。結論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換代謝型，對此類患者進行骨轉換率的監測比單純的血鈣監測更有意義。

關鍵詞：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，主要從事免疫學檢驗工作。

通訊作者：沈建雄，聯系電話：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致的腎功能減退，會出現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水平時發現，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現，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，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,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之間的關系。