49例维持性血液透析患者肾性骨病的相关因素分析

目的研究维持性血液透析患者肾性骨病的类型、临床特点并分析相关因素。方法49例血液透析患者,口服四环素标记后行骨活检,同时检测相关生化参数。结果49例患者均有肾性骨病的临床表现,其中高转化型24例(49.0%),低转化型19例(38.8%),混合型6例(12.2%)。3组患者年龄和性别构成无差异,4例糖尿病患者均为低转化型;透析时间超过10年者高转化型骨病发生率显著高于透析5～10年和≤5年者。骨铝染色阳性率为63.3%,低转化型高于高转化型及混合型组,高通量组和普通透析组骨病类型和骨铝染色无差异,高通量透析组透析前血钙水平显著高于普通透析组(P<0.05),iPTH水平低于普通组,但无统计学差异。低转化型骨病组服用活性维生素D3制剂的比例显著高于其它组。骨铝阳性组透析前血磷和iPTH水平显著低于阴性组,服用铝制剂的患者比例也高于骨铝阴性组。结论本组患者高转化型骨病与长时间透析、维生素D3不足等因素相关,低转化型骨病可能与维生素D3制剂使用不当、糖尿病等因素相关,而骨铝沉积则与服用铝制剂等因素相关,与透析时间长短无关。     

骨保护素及其配体检测在高转换型肾性骨病中的临床意义

目的:观察高转换型肾性骨病中骨保护素(OPG)及其配体(RANKL)的表达,对骨病理进行骨形态计量学分析,并与外周血各项反映骨代谢的生化指标进行相关分析。方法:选择24例慢性肾衰竭尿毒症患者和3名正常人进行髂骨活检术,获得骨标本。采用免疫组化方法检测OPG和RANKL蛋白质表达,用全自动图像分析系统进行骨组织形态计量学测定,用酶联免疫吸附测定(ELISA)法检测外周血OPG、可溶性RANKL(sRANKL)水平,并对慢性肾衰竭尿毒症患者及对照者的检测结果进行对比分析。结果:24例慢性肾衰尿毒症患者经骨病理学检查证实均为高转换型骨病,以破骨细胞活化形成骨吸收陷窝伴或不伴骨矿化不全为特点。免疫组化显示,尿毒症患者骨组织中以RANKL阳性表达为主。成骨细胞面积与碱性磷酸酶水平(AKP)呈显著正相关,而类骨质厚度与白蛋白水平呈显著负相关。结论:高转换型肾性骨病中,甲状旁腺激素(PTH)的溶骨作用可能是通过OPG/RANKL系统介导的,但外周血的OPG/sRANKL水平并不能预测该类骨病。     

高通量血液透析治疗肾性骨病的效果

目的观察高通量血液透析治疗肾性骨病的效果。方法将我院收治的72例肾性骨病患者按照治疗方法不同分为观察组与对照组,各36例。观察组采取高通量血液透析治疗,对照组采取常规维持性血液透析治疗。比较两组的治疗效果。结果治疗后,两组患者的骨痛评分均低于治疗前,且观察组低于对照组(P<0.05)。观察组的并发症总发生率为5.56%,低于对照组的22.22%(P<0.05)。治疗后,两组血钙水平较治疗前升高,血磷、血PTH水平较治疗前降低,且观察组优于对照组(P<0.05)。结论采取高通量血液透析治疗肾性骨病,可减轻骨痛,减少并发症的发生,改善血磷、血钙、血PTH水平。     

组合型人工肾治疗肾性骨病的前瞻性研究

目的 探讨组合型人工肾对尿毒症患者肾性骨病的治疗作用.方法 我院于2008年6月至2009年2月采用血液透析(HD)+血液灌流(HP)方法 治疗30例尿毒症患者(HD+HP组),并与单纯HD治疗尿毒症患者31例(HD组)进行对比研究,通过比较治疗前与治疗后3个月时2组患者的骨痛、皮肤瘙痒、血压、食欲、睡眠等临床症状及尿素氮(BUN)、肌酐(SXr)、血红蛋白(Hb)、血小板(BPC)、钙(Ca)、磷(P)、全段甲状旁腺素(iPTH)等生化指标的变化,客观评价两种方法 治疗尿毒症患者肾性骨病的疗效.结果 HD组、HD+HP组治疗后骨痛的缓解率分别为67.7%(21/31)、96.7%(29/30),皮肤瘙痒的缓解率分别为71.0%(22/31)、96.7%(29/30),HD+HP在缓解维持性透析患者的骨痛与皮肤瘙痒中显著优于单纯HD(P均＜0.01);HD组治疗前后iPTH分别为(65.5±34.4)pmol/L和(57.1±21.4)pmol/L,HD+HP组治疗前后iPTH分别为(73.5±44.4)pmol/L和(19.1±17.4)pmol/L,单纯HD未能很好地清除iPTH(P＞0.05),而HD+HP则可(P＜0.05).结论 对于iPTH水平较高的维持性HD患者,可通过增加HP,达到更好地清除这些患者血中大、中、小分子毒素物质,从而降低肾性骨病发生率,提高其生存质量.     

50例肾性骨病的护理

肾性骨病是慢性肾功能衰竭治疗中所面临的一个问题。通过对５０例肾性骨病患者的护理观察，我们认识到：心理护理、高钙低磷饮食、钙剂的选择及活性维生素Ｄ的应用与适当的户外活动等措施是肾性骨病康复的关键。     

血液透析串联血液灌流对肾性骨病的影响

血液灌流是应用吸附剂清除患者体内内源性和外源性的毒物[1].作者试图应用HA型树脂灌流器进行吸附治疗,观察对慢性肾衰竭维持血液透析患者肾性骨病的影响.     

血液透析串联血液灌流对肾性骨病的影响

血液灌流是应用吸附剂清除患者体内内源性和外源性的毒物。作者试图应用HA型树脂灌流器进行吸附治疗，观察对慢性肾衰竭维持血液透析患者肾性骨病的影响。     

血液透析患者肾性骨病单中心横断面研究

目的了解慢性肾衰竭血液透析患者骨代谢及骨病控制情况,并进行相关影响因素分析。方法对青岛大学医学院附属医院血液净化中心血液透析的113例患者肾性骨病指标进行调查,并与美国肾脏病基金会慢性透析患者骨代谢和骨病控制指南(简称"指南")进行比较,以观测其达标水平。分析其与年龄、性别、尿素清除指数(Kt/V)、体重指数(body mass index,BMI)、透析时间、肾功能、血压、血红蛋白(Hb)、超敏C反应蛋白(highsen sitivity C-reactive protein,hs-CRP)的相关性。结果113例患者中,有61例(54.0%)血清钙浓度、45例(39.8%)磷浓度、72例(63.7%)钙磷乘积、35例(31.0%)全段甲状旁腺素(iPTH)达到指南所要求的目标;但所有指标均达到要求目标仅有20例(17.7%)。钙磷代谢紊乱及继发性甲状旁腺功能亢进与年龄、性别、hs-CRP、Kt/V、透析时间不相关;血肌酐(Scr)、血红蛋白(Hb)、BMI、高血压≥140/90mmHg(1mmHg=0.133kPa)为其发生的危险因素,其中血肌酐、血红蛋白、高血压为其独立危险因素。结论多数血液透析患者骨代谢及骨病控制不佳,不能达到指南要求的目标。其发生与肌酐、血红蛋白、血压水平密切相关。     

鲑鱼降钙素对改善血液透析患者肾性骨病的效果观察及护理

目的 观察鲑鱼降钙素对于维持性血液透析(MHD)并发肾性骨病患者的临床治疗效果,探讨科学合理的护理措施.方法 选取血液透析室维持性血液透析并发肾性骨病患者40例,给予患者鲑鱼降钙素(50 U皮下注射,2次/周,透析后使用)同时服用碳酸钙和活性维生素D3,疗程为3个月,同时给予患者多项护理措施,观察治疗前后患者肾性骨病症状以及血磷、血钙、甲状旁腺激素水平的变化,并对所得结果进行统计分析.结果 所有患者经给予治疗及护理措施后,骨关节痛、皮肤瘙痒、肌无力等症状得到明显缓解,其血钙、血磷、甲状旁腺激素水平较治疗前均明显下降.结论 维持性血液透析并发肾性骨病患者在给予鲑鱼降钙素同时服用碳酸钙和活性维生素D3疗效显著,能够迅速减轻骨关节疼痛等症状,降低骨外软组织钙化风险,同时给予患者包括健康教育、预防并发症及血液透析后护理等措施有助于保证治疗顺利进行,提高患者的治疗效果.     

肾性骨营养不良的骨病理,骨组织计量学及骨密度测量研究

肾性骨营养不良(简称肾性骨病)是由于长期慢性肾小球或肾小管病变引起肾功能减退或衰竭导致以钙磷代谢紊乱为主的一种代谢性骨病。刘,朱二氏在本世纪40年代即探讨了慢性肾衰钙磷代谢与骨病的关系,并首先提出肾性骨营养不良的概念。 广义的肾性骨病指一切和肾脏有关的骨病,如肾小管性酸中毒发生的软骨病,透析膜组织不相容发生的淀粉样骨病等;而通常所述的肾性骨病指慢性肾功能衰竭伴发的代谢性骨病,随着经济的发展和治疗水     

Biochemical markers of bone turnover and bone mineral density in patients with beta-thalassaemia major

In this study, bone formation markers (bone-specific alkaline phosphatase and osteocalcin) and bone resorption markers (pyridinoline and deoxypyridinoline) were analysed. Bone formation, as evidenced by the levels of serum alkaline phosphatase and osteocalcin, did not appear to be impaired, while bone resorption was grossly increased in all patient groups. The decrease of bone mineral density values was more prominent in the lumbar spine, thus making this site particularly interesting for such studies. The patients had significantly lower femoral neck and lumbar spine bone mineral density when compared with control (all p <0.001). Our conclusion is that, in spite of the severe bone destruction that occurs in thalassaemia major, the fact that bone formation remains intact calls for a more intensive treatment.     

骨转换生化标志物在骨质疏松症治疗中的临床应用

目的探讨并分析骨转换生化标志物在骨质疏松症治疗中的临床价值。方法将104例骨质疏松症患者随机分成观察组(54例)和对照组(50例)。观察组在治疗前后均进行Ⅰ型胶原蛋白氨基端前胶原肽(PINP)、Ⅰ型胶原分解片段C端肽β型(β-CTx)及骨钙素变化情况的监测,并根据监测结果调整治疗方案,及早预防骨折发生。对照组则根据常规治疗方法进行治疗,不进行骨转换生化标记物监测。治疗结束时通过骨密度检查判定并比较两组的临床治疗效果及骨折发生情况。结果观察组治愈率为88.89%;对照组治愈率66.00%。两组治愈率比较有显著性差异(P<0.05)。观察组治疗结束后骨转换生化指标均处于本地区临床标准范围内。研究期间观察组发生骨折患者3例,占5.56%;对照组发生骨折患者4例,占8.00%,两组比较骨折发生率无显著性差异(P>0.05)。结论骨转换生化指标能敏感反应患者骨形成与骨吸收情况,检测简便且廉价,在骨质疏松症的预防和治疗方面有显著的医疗效益、社会效益和经济效益。     

Quantitative ultrasound in monitoring of skeletal status in adults with end-stage renal disease

The aim of the longitudinal study was to assess skeletal status in 29 subjects (18 males and 11 females) with end-stage renal disease (ESRD) being on regular hemodialysis. Control group consisted of 494 healthy subjects (305 males and 189 females). Skeletal status was evaluated by quantitative ultrasound measurements at the hand phalanges using DBM Sonic 1200 (IGEA, Carpi, Italy), which measures amplitude-dependent speed of sound (Ad-SoS, in m/s), performed three times: at the baseline, six and 12 months later. A precision expressed in root mean square-CV% was 0.72% in males and 0.43% in females. The values of Ad-SoS, T-score and Z-score at the baseline were significantly lower than in controls (p < 0.05). The mean values of Ad-SoS decreased over a period of observation; in the whole group from 1979 +/- 106 m/s to 1928 +/- 105 m/s, p < 0.0001, in males from 2003 +/- 93 m/s to 1949 +/- 111 m/s, p < 0.001 and in females from 1940 +/- 121 m/s to 1894 +/- 108 m/s, p < 0.05. Ad-SoS Z-scores dropped significantly over a period of the study in whole group (-1.14 +/- 1.64 to -2.08 +/- 2.26, p < 0.01), in males (-0.63 +/- 1.44 to -1.74 +/- 2.29, p < 0.0001) and in females nonsignificant decrease was observed. Using the least significant change (LSC) values for skeletal measurement, a decrease in Ad-SoS was noted in 15 subjects (52%). The values of PTH were over a normal limit. In the whole group main factors negatively influencing current Ad-SoS values were duration of dialysis, age and PTH. The skeletal status in subjects with ESRD on hemodialysis was seriously affected, and longitudinal measurements showed its aggravation over a time of the study.     

2型糖尿病性骨质疏松患者骨转换标志物的改变

目的:观察2型糖尿病性骨质疏松症患者骨转换标志物的改变,为2型糖尿病患者骨质疏松症的诊断和治疗提供参考依据。方法:选取2014年1月～2017年12月本院收治的226例2型糖尿病患者作为糖尿病组,选择同期在我院体检的160例健康成年人作为对照组,比较分析糖尿病组和对照组的骨密度(BMD)、空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、血钙和骨转换标志物(Bone Turnover Markers,BTMs)的差异及相关性。结果:随着年龄增加,两组检测者的骨密度均呈下降趋势;糖尿病组的股骨颈及Ward's区骨密度明显低于对照组,且与年龄和糖尿病病程呈负相关;糖尿病组患者的骨转换标志物与骨密度测定结果有很好的相关性,尤其是与股骨颈和Ward's区的测定结果有很好的相关性。反映骨形成的标志物如骨钙素、骨碱性磷酸酶、Ⅰ型前胶原氨基末端前肽会随骨密度的降低而降低,反映骨吸收的标志物如Ⅰ型胶原蛋白C末端交联肽的含量,尿液中吡啶啉的含量会随骨密度的降低而升高。结论:在诊断2型糖尿病性骨质疏松症时,骨转换标志物与骨密度测量有很好的拟合性,可早期预测2型糖尿病患者的骨质疏松程度,并可用于监测骨质疏松症的治疗效果。     

Quantitative ultrasound measurements in diabetic and nondiabetic patients with end-stage renal disease

The aim of the study was to assess skeletal status in diabetic and nondiabetic subjects with end-stage renal disease (ESRD). One hundred twenty-three patients with ESRD (57 patients with diabetes: 9 type 1 and 48 type 2) and 66 nondiabetic patients were evaluated. Control group comprised 1541 subjects (614 males and 927 females). Diabetes and/or renal insufficiency was the only reason of bone disease and, in control group, no factors known to influence bone metabolism (chronic diseases or prolonged medications) were noted. Skeletal status was evaluated by quantitative ultrasound measurements at the hand phalanges using DBM 1200 (IGEA, Carpi, Italy), which measures amplitude-dependent speed of sound (Ad-SoS [m/s]). Because of some differences in mean age in subgroups of patients and controls, comparisons were performed using values of Z-score. In all diabetic patients, Z-score was significantly higher compared with nondiabetics (p < 0.05). In all type 1 diabetes patients, Z-score was significantly lower than in all nondiabetic patients (p < 0.05) and in patients with type 2 diabetes (p < 0.001). Z-score was also significantly lower in type 2 diabetics than in nondiabetic females (p < 0.00001) but did not differ in males. Comparisons between Z-scores in controls and patients showed that Z-score in nondiabetic females was significantly lower than in female controls (p < 0.000001), and in nondiabetic males--diabetic type 2 males as well as females--Z-score did not differ vs. results in adequate control group. Z-score was significantly lower in patients with diabetes type 1 vs. all controls (p < 0.001). Correlation analysis showed in all nondiabetic patients that Z-score was negatively affected by duration time of dialysis (r = -0.37, p < 0.01) and parathyroid hormone (PTH) serum level (r = -0.35, p < 0.01). In patients with type 1 diabetes, only PTH influenced significantly Z-score (r = -0.76, p < 0.05) and, in patients with type 2 diabetes, no significant correlations were obtained. Subjects with type 1 diabetes seemed to be sensitive for skeletal disturbances in a course of renal insufficiency, whereas subjects with type 2 diabetes did not show such skeletal pathology as shown by ultrasound measurements at hand phalanges.     

2型糖尿病患者骨转换标志物与骨密度的相关性研究

目的探讨骨转换标志物在2型糖尿病合并骨质疏松患者中的临床应用价值及与不同部位骨密度的相关关系。方法选择我院64例2型糖尿病成年男性患者为病例组,同期收集20例健康成年男性为对照组,用双能X线吸收测定仪检测受试者正位腰椎（L1-L4）、右侧髋部（股骨颈、大转子、ward’s三角）的骨密度,并依据WHO骨质疏松症诊断标准将病例组分为骨质疏松组、骨量减少组、骨量正常组。同时检测血清骨钙素（osteocalcin,OC）、总Ⅰ型前胶原氨基端延长肽（procollagen type Ⅰ N—terminal propeptide,PINP）、Ⅰ型胶原羧基端肽β特殊序列（β—carboxy—terminal collagen crosslinks,β—CTX）、血钙（calcium,Ca）、血磷（phosphorus,P）、甲状旁腺素（parathyroid hormone,PTH）、25羟维生素D3[25-hydroxy vitamin D3,25（OH）D3]、空腹血糖（fasting blood—glucose,FBG）、糖化血红蛋白（hemoglobin AlC,HbAlC）、碱性磷酸酶（alkaline phosphatase,ALP）以及血清肌酐（serum creatinine,SCr）等临床化学指标,对检测结果进行统计学分析。结果各组间年龄、体重指数差异均无统计学意义（P均〉0．05）。骨量减少组及骨质疏松组的脊椎骨密度值、髋部骨密度值均显著低于健康对照组,且差异均有统计学意义（P均〈0．05）;骨量减少组与健康对照组相比,SCr、FBG、HbAlC和β—CTX均升高,差异均有统计学意义（P均〈0．05）;骨质疏松组与健康对照组相比,SCr、ALP、FBG、HbAlC、PINP、β—CTX、PTH结果均升高,且差异具有统计学意义（P均〈0．05）;骨量减少组和骨质疏松组的25（OH）D,均明显降低,与健康对照组相比差异均有统计学意义（P均〈0．05）。相关性分析结果表明,PINP、β—CTX与大转子、股骨全部的骨密度均呈负相关（P均〈0．05）。结论骨转换标志物与骨密度联合检测能更早反映糖尿病患?     

LDL and HDL subclass distribution in patients with end-stage renal diseases

OBJECTIVES: To examine the alterations in LDL and HDL subclass distribution in ESRD patients compared with a control group and to investigate the relationship of LDL particle size to the other plasma lipoproteins levels. DESIGN AND METHODS: Plasma lipids, LDL and HDL subclasses were determined in 63 hemodialysis patients (HD), 42 predialysis patients and 345 control subjects. Lipoprotein subclasses were separated by polyacrylamide 3 to 31% gradient gel electrophoresis. RESULTS: In predialysis group, 88% subjects had small LDL particles compared with 58.5% of hemodialysis patients and 16.5% of control subjects. Mean LDL size particle diameter was significantly smaller in HD and predialysis patients in comparison with controls (p < 0,0005, p < 0,0001; respectively). Significant inverse correlation between LDL particle size and triglyceride level was observed for both patient groups. Decreased levels of the largest HDL2b subclass was found in both predialysis (16.5%) and in HD patients (30%) as compared with controls (50%), and increased levels of the small HDL3a subclass was found only in predialysis group (21%) in comparison with controls (4.5%). CONCLUSIONS: Alterations in LDL and HDL subclass distribution toward smaller particles is the main lipid abnormality associated with atherogensis found in ESRD. ESRD is associated with reduced levels of HDL2b subclass and increased levels of HDL3c subclass, which occurs in coronary artery disease (CAD) as well.     

透析前慢性肾功能衰竭患者骨密度和髋部几何结构参数变化的研究

目的探讨透析前慢性肾衰患者骨密度和髋关节几何结构参数的变化。方法采用回顾性研究方法,选取2013年5月至2017年11月首都医科大学附属北京友谊医院收治的透析前慢性肾衰患者272例作为病例组。按照1:1的比例匹配健康病例作为对照组。采用双能X线骨密度仪(DXA)测量受试者的腰椎、股骨颈、股骨粗隆间及全髋的骨密度。并使用髋部结构分析(HAS)程序获得髋关节几何测量值。统计学分析髋关节几何参数与年龄、体重指数、估算肾小球滤过率(eGFR)和骨密度的关系。结果在股骨颈狭区、股骨粗隆间区和股骨干区病例组测量的皮质骨内宽度、横截面积、截面模量、皮质骨厚度和屈曲应力参数测量值与对照组的差异均具有统计学意义(P<0.05)。股骨粗隆间区横截面积与总腰椎骨密度(r=0.58)、股骨颈狭区CT与股骨颈骨密度(r=0.92)及股骨粗隆间区CT与总髋部骨密度(r=0.81)的相关性最高。结论髋关节几何结构改变与慢性肾衰高度相关,测量髋部几何结构可提高慢性肾衰患者骨强度评估的精确性。     

Effects of alendronate and risedronate on bone mineral density and bone turnover markers in late postmenopausal women with osteoporosis

This study was undertaken to compare the effects of alendronate and risedronate on bone mineral density (BMD) and bone turnover markers (BTMs) in late postmenopausal women with osteoporosis. Thirty women older than 60 y of age were randomly assigned to receive alendronate 10 mg (n=16) or risedronate 5 mg (n=14) on a daily basis. The patients were followed every 3 mo for 12 mo. BMD measurements were taken at baseline and at the end of the study, and BTMs were measured at 3-mo intervals. By the end of the study, there were statistically significant increases in BMD in both groups at all sites at which they were measured (P < .001). However, these differences were not statistically significant between groups. By the end of the study, all BTMs had decreased significantly and to a similar extent in both groups. The most significant change was observed in the third month of the study. A negative correlation was noted between percentage change in bonespecific alkaline phosphatase and femoral neck BMD (r=-0.467). This study reported no difference between the 2 drugs in their effects on BMD and BTMs.