原发性肾病综合征患者血清胰岛素样生长因子1的变化及其与骨代谢的关系

目的 探讨原发性肾病综合征（PNS）患者血清胰岛素样生长因子1（IGF-1）的变化及其与骨代谢指标之间的关系。评价IGF-1在PNS患者骨代谢异常机制中的临床价值。方法 随机选取2008年1月至2009年5月临床资料完整的慢性肾脏病（CKD）1、2期PNS患者30例为对象;健康体检者61例为健康对照组。测定血清IGF-1、钙、磷、PTH、25羟基维生素D3[25-（OH）D3]、骨钙素（BGP）、I型胶原吡啶交联C终端肽（CTx）及尿钙/尿肌酐（UCa/Cr）。双能X线骨密度仪检测患者骨密度（BMD）。 结果 与健康对照组比较,PNS组血Ca、25-（OH）D3及BGP水平显著降低;血CTx水平及UCa/Cr比值显著增高（均P < 0.05）;BMD水平降低[（1.078±0.090） g/cm2 比（1.090±0.062） g/cm2,P > 0.05],但差异无统计学意义。PNS组血清IGF-1水平显著低于健康对照组,差异有统计学意义[（155.75±17.48） μg/L比（223.17± 16.44） μg/L,P < 0.05],且与24 h尿蛋白量及CTx呈负相关（r = -0.757和r = -0.786,均 P < 0.05）;与血BGP和BMD呈正相关（r = 0.861和r = 0.584,均P < 0.05）。 结论 PNS患者（CKD 1、2期）存在骨代谢异常,表现为骨形成减少、骨吸收增加。血清IGF-1与血BGP、CTx及BMD相关,可作为反映PNS患者骨代谢改变的临床指标之一。     

糖皮质激素诱导胰岛素样生长因子1降低对原发性肾病综合征患者骨代谢的影响

目的 观察糖皮质激素（GC）治疗的原发性肾病综合征（PNS）患者胰岛素样生长因子1（IGF-1）变化,探讨其水平改变对PNS患者骨代谢的影响及意义。 方法 以本院2008年1月至2009年8月临床资料完整的PNS患者39例为对象。口服泼尼松0.8~1.0 mg&#8226;kg-1&#8226;d-1,完全缓解2周后,以每2周减去原剂量的5％～10％的方式减量。最终每日或隔日5～10 mg维持（总疗程>24周）。测定应用激素前、治疗第4、8、12、24周末血白蛋白、24 h尿蛋白量、血清钙、磷、甲状旁腺激素（PTH）、25羟基维生素D3（25-（OH）D3）、骨钙素（BGP）、I型胶原吡啶交联C终端肽（CTx）及尿钙/肌酐;双能X线骨密度仪检测患者骨密度（BMD）;酶联免疫法测定血清IGF-1水平。使用Pearson 相关分析探讨IGF-1与骨代谢改变的关系。 结果 36例完成随访,并具备完整临床数据。治疗第4、8、12和24周与治疗前比较,患者血钙、25-（OH）D3水平均呈时间依赖性升高（P < 0.05）,相关分析提示,与尿蛋白量呈负相关 （r=-0.749,r=-0.831,P < 0.05）。骨形成指标血BGP、IGF-1水平呈时间依赖性降低（P < 0.05）,骨吸收指标CTx逐渐升高,至第12周起差异有统计学意义（P < 0.05）。第4周各部位BMD与治疗前差异均无统计学意义;第8周起腰椎（L1~L4）BMD值较治疗前显著下降（P < 0.05）;第 24 周,股骨颈和股骨干的BMD与治疗前差异有统计学意义（P < 0.05）。PNS患者经糖皮质激素治疗后,IGF-1与BMD和BGP呈正相关（r=0.495和r=0.896,均P < 0.05）,与血CTx呈负相关（r=-0.697,P < 0.05）。 结论 糖皮质激素呈时间依赖性导致PNS患者血清IGF-1水平降低。IGF-1下降与患者早期骨形成指标降低、骨吸收指标增高及后期骨密度下降相关。IGF-1途径可能参与GC 引起的PNS患者骨代谢改变。IGF-1有望成为反映或预测糖皮质激素诱导的骨质疏松的新型生化指标。     

慢性肝病患者血清VitD3水平与骨代谢的关系

检测了部分慢性乙型肝炎（下简称慢乙肝）及肝硬化患者的血清1，25（OH）2D3，骨钙素（BGP），甲状旁腺素（PTH），钙，磷及尺桡平均密度（BMD），并与对照组比较，结果两组患者血清1，25（OH）2D3，BGP及BMD值均明显下降，肝硬化组下降尤为显著，肝硬化组血清PTH显著升高，两组患者血钙明显降低，而血磷三组间无差异，1，5（OH）2D3水平与BGP，BMD呈显著正相关；PTH与血钙，BMD无相关性。提示慢性肝病患者存在以骨形成减少为主的骨代谢紊乱，其中血清1，25（OH）2D3减少为关键因素，PTH虽升高，但与肝病患者骨密度变化无相关。     

血浆维生素D与慢性肾脏病患者心血管疾病的相关性研究

目的了解慢性肾脏病(chronic kidney disease,CKD)患者维生素D状态及缺乏原因,并探讨血浆维生素D缺乏是否独立影响CKD患者心血管疾病(cardiovasculardisease,CVD)的发生。方法选取北京医院肾脏内科住院的CKD 1~5期非透析患者80例为研究对象,门诊健康查体人群10例为对照组,测定其血浆25-OH-D_3、1,25(OH)_2D_3水平并进行相关实验室检查。根据血浆25-OH-D_3水平将患者分为维生素D缺乏组和非维生素D缺乏组,比较组间临床和实验室检查资料以及心脏超声检查相关参数差异;根据超声心动图结果,将患者分为左室肥厚(1eft ventricular hypertrophy,LVH)组和非LVH组,比较组间患者相关临床资料差异,并采用多因素分析CKD患者LVH的独立危险因素。结果 CKD组及对照组25-OH-D3分别为(15.09±2.44)μg/L和(18.60±1.88)μg/L;2组维生素D水平均较低,但CKD组较对照组更低,组间有统计学差异(P0.05)。CKD患者维生素D水平普遍偏低,血浆25-OH-D_3波动于10.29~20.51μg/L,1,25(OH)2 D3波动于16.23~54.32 ng/L,两者之间存在线性相关,两者与CKD患者肾功能分期均无线性相关。CKD患者维生素D缺乏组(≤15μg/L)和非维生素D缺乏组(15μg/L)组间比较,发现2组血磷、左心室质量指数存在统计学差异(P0.05)。维生素D水平与左心室质量指数无线性相关;比较LVH组及非LVH组相关临床资料,单因素分析发现血肌酐、尿素氮、估算肾小球滤过率、脑钠肽、肌钙蛋白、血红蛋白、红细胞比容、24h尿蛋白定量、高密度脂蛋白均存在统计学差异(P0.05);多元逐步Logistic回归发现BNP升高(≥1 000 ng/L),24h尿蛋白定量(≥3.5 g),LDL升高(≥2.59 mmol/L)可进入方程(P0.05)。结论 CKD患者25-OH-D_3水平低于普通人群,但与CKD患者肾功能水平无线性相关;BNP升高、24h尿蛋白定量、高低密度脂蛋白血症是CKD患者左室肥厚的独立危险因素,目前尚不认为25-OH-D_3水平下降影响CKD患者左室肥厚的发生。     

Ⅰ型神经纤维瘤病伴脊柱侧凸患者骨密度与血清骨钙素和骨代谢生化指标的相关性

【摘要】 目的：探讨Ⅰ型神经纤维瘤病（neurofibromatosis type 1,NF1） 伴脊柱侧凸患者骨密度（BMD）与血清骨钙素（BGP）及骨代谢生化指标的相关性。方法：选取2012年2月~2013年3月我院脊柱外科收治的17例NF1伴脊柱侧凸（NF1-S）患者为观察对象（病例组）,年龄8~18岁,Cobb角40°~143°;17例正常儿童及青少年作为对照组,年龄7~19岁。两组均采用双能X线骨密度吸收仪测量非优势侧的股骨近端和腰椎（L2~L4）的BMD,同时采用免疫分析仪检测BGP水平,血生化分析仪检测碱性磷酸酶（ALP）、血钙（血Ca）、血磷（血P）、尿钙/肌酐比值（尿Ca/Cr）和尿磷/肌酐比值（尿P/Cr）。应用SPSS 16.0软件进行统计分析,采用独立样本t检验分析两组BMD及各项骨代谢生化指标之间的差异;Pearson相关分析病例组患者腰椎BMD与对应各项骨代谢生化指标的相关关系。结果：两组受试者年龄、性别构成比无统计学差异（P>0.05）。病例组所测各部位BMD均明显低于正常对照组,差异有显著性（P<0.05）;BGP（135.6ng/ml）、血Ca（2.59mmol/L）、血P（1.75mmol/L）、尿Ca/Cr（0.10mg/mg）均高于正常对照组（79ng/ml、2.45mmol/l、1.47mmol/l、0.06mg/mg）,差异均具有显著性（P<0.05）,而ALP（141.6u/L vs 141.8u/l,t=3.611,P=0.991）和尿P/Cr（0.47mg/mg vs 0.46mg/mg,t=0.054,P=0.957）则无显著性差异（P>0.05）。NF1-S患者腰椎BMD与BGP（r=-0.916,P=0.000）、尿Ca/Cr（r=-0.968,P=0.000）存在显著性负相关。结论：NF1-S患者BMD明显低于正常人;BGP、血Ca、血P和尿Ca/Cr均高于正常人,测定BGP、尿Ca/Cr水平是监测NF1-S患者BMD变化较为敏感的方法之一。     

慢性肾脏病患者维生素D缺乏与动脉僵硬度的相关性

目的 探讨慢性肾脏病患者维生素D缺乏与动脉僵硬度的相关性.方法 选取慢性肾脏病(CKD l～5期)患者300例,根据血25(OH)D3浓度分为维生素D缺乏组[25 (OH)D3＜20 μg/L]和维生素D非缺乏组[25(OH)D3≥20 μg/L].采集临床资料数据,测定动脉僵硬度指标肱踝脉搏波传导速度(baPWV).对血25(OH)D3水平与baPWV间的关系进行单因素相关分析及多元线性回归分析. 结果 维生素D缺乏组188例(62.7％),维生素D非缺乏组112例(37.3％).全部CKD患者25(OH)D3平均浓度为(17.62±8.54) μg/L,维生素D缺乏组和非缺乏组分别为(12.38±4.55) μg/L与(26.44±6.05) μg/L(P＜0.01).维生素D缺乏组baPWV值高于非缺乏组[(1 827.34±429.11) cm/s比(1 555.31±353.14) cm/s,P＜0.01].单因素相关分析显示全体CKD患者(r=-0.38,P＜0.01)以及CKD 2～5期患者[r=-0.30,P＜0.05;r=-0.26,P＜0.05;r=-0.46,P＜0.01;r=-0.57,P＜0.01]血25(OH)D3浓度与baPWV均呈负相关.多元线性回归分析显示血25 (OH)D3浓度下降与baPWV的增加独立相关(模型1:β=-0.18,P＜0.01;模型2:β=-0.17,P=0.01),回归模型1与模型2均可解释baPWV变化的50％.结论 CKD患者普遍存在维生素D缺乏,维生素D缺乏与动脉僵硬度增加相关.维生素D替代治疗可能影响CKD患者的心血管预后,但有待未来研究的进一步明确.     

慢性肝病患者血清VitD3水平与骨代谢的关系

检测了部分慢性乙型肝炎(下简称慢乙肝)及肝硬化患者的血清1,25(OH)2D3、骨钙素(BGP)、甲状旁腺素(PTH)、钙、磷及尺桡平均密度(BMD),并与对照组比较.结果两组患者血清1,25(OH)2D3、BGP及BMD值均明显下降,肝硬化组下降尤为显著.肝硬化组血清PTH显著升高.两组患者血钙明显降低,而血磷三组间无差异.1,25(OH)2D3水平与BGP、BMD呈显著正相关;PTH与血钙、BMD无相关性.提示慢性肝病患者存在以骨形成减少为主的骨代谢紊乱,其中血清1,25(OH)2D3减少为关键因素,PTH虽升高,但与肝病患者骨密度变化无相关.     

胶东半岛老年性骨质疏松症骨代谢生化指标 与骨密度相关性研究

目的 研究胶东半岛老年性骨质疏松症(OP)患者骨代谢生化指标与骨密度(BMD)的相关关系,探讨骨代谢生化指标对早期诊断OP的临床意义.方法 采用双能X线骨密度仪(DEXA)对胶东半岛沿海地区多中心多阶段整群抽样297名40～89岁居民进行腰椎(L2-4)BMD测量.采用酶联免疫法(ELISA)分别测定血抗酒石酸酸性磷酸酶(TRAP-5b)、I型胶原C端肽(CTX)、骨特异性碱性磷酸酶 (BALP)、骨钙素(BGP)、降钙素(CT)、25-羟基维生素D[25(OH)D]以及血钙(Ca)和磷(P)并进行比较,应用SPSS13.0软件进行统计分析.结果 OP患者各部位BMD明显低于正常组(均P<0.01).老年男性BMD与骨形成和骨吸收指标呈现降低趋势.其中,OP组较对照组BGP、TRAP-5b和25(OH)D明显下降(P<0.05),而血CTX和BALP较对照组升高.老年女性血TRAP-5b、CTX、BALP和 BGP在OP组显著升高(均P<0.01),而CT和25(OH)D明显降低.各组研究对象骨代谢生化标志物均有统计学意义.结论 骨代谢生物指标作为OP的监测指标,比BMD更加灵敏、特异.能够早期反映患者骨代谢水平,对指导OP的早期预防及治疗有重要意义.     

慢性肾脏病患者25-羟维生素D3水平的改变及其影响因素分析

目的检测慢性肾脏病(chronickidneydisease,CKD)患者不同进展阶段25-羟维生素D3[25(OH)D3]的浓度,25(OH)D3水平与CKD发生、发展的关系,进一步探讨活性维生素D在CKD患者中的合理应用。方法收集2014年11月至2015年11月中国医科大学附属第一医院肾脏内科住院的非血液净化的CKD患者885例及急性肾损伤患者11例,分别测定25(OH)D3及血红蛋白(hemoglobin,Hb)、血肌酐(SCr)、尿素氮(BUN)、血清胱抑素C(Cystatin C,Cys-C)、血钙、血磷、血碳酸氢根(HCO)3)、血尿酸(uric acid,UA)、血总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、血白蛋白(albumin,Alb)、血清碱性磷酸酶(alkaline phosphates,ALP)、C反应蛋白(C-reactive protein,CRP)、糖化血红蛋白(-HbAlC)及采用化学发光法测量血清全段甲状旁腺素(immunoreactive parathyroid hormone,讧TH)。统计CKD不同阶段25(OH)D3不足及缺乏的发生率,分析不同维生素D水平分组下各项生化指标的变化趋势并进行相关性分析。结果①随肾脏病的进展,维生素D严重缺乏的发生率呈升高趋势。急性肾损伤患者25(OH)D3水平为(15.8±9.16)ng/ml,明显高于CKD各期(P0.05)。随25(OH)D3水平下降,患者的血压(收缩压、舒张压)水平升高,尿蛋白的程度加重,血白蛋白水平下降,钙磷代谢紊乱(血钙下降,血磷升高)及血脂代谢异常加重,不同维生素D水平分组间差异有统计学意义(P0.05),而年龄、左室射血分数、肾功能相关指标、骨代谢指标、血尿酸、血红蛋白、C反应蛋白则无统计学差异(P0.05);②25(OH)D3水平与尿蛋白程度相关,中度尿蛋白组和大量尿蛋白组25(OH)D3浓度均明显低于正常尿蛋白组和低尿蛋白组(P0.05);且随着蛋白尿病情加重,维生素D严重缺乏的发生率升高,在各尿蛋白组间差异有统计学意义(χ~2=251.75,P=0.000)。③25(OH)D3水平与血白蛋白、血钙、血红蛋白水平呈正相关;与收缩压、舒张压、尿蛋白定量、磷、血脂水平呈负相关。血白蛋白、收缩压、尿蛋白定量、血红蛋白是25(OH)D3水平的独立危险因素。结论我国东北地区CKD患者维生素D缺乏更加严重。25(OH)D3水平与CKD临床重要指标相关。血白蛋白、收缩压、24 h尿蛋白定量、血红蛋白是25(OH)D3水平的独立危险因素。     

慢性肾脏病患者血清1,25（OH）2D水平与蛋白尿及尿炎症细胞因子相关性研究

目的：探讨慢性肾脏病（CKD）1～4期患者血清1,25（OH）2D水平与蛋白尿、尿炎症细胞因子的关系。方法：对我科115例CKD1～4期患者及20例健康对照者进行血清1,25（OH）2D、血CRP,尿TGF-β1、MCP-1、TNF、IL-6,24h尿蛋白定量检测;分析血清1,25（OH）2D水平与以上指标相关性。结果：（1）CKD组患者血清1,25（OH）2D水平低于对照组（P〈0.05）;血CRP,尿MCP-1、TGF-β1、IL-6、TNF水平,24h尿蛋白定量高于对照组（P〈0.05）。（2）与GFR≥60ml·min^-1·1.73m^-2患者比较：GFR〈44ml·min^-1·1.73m^-2患者CRP,尿MCP-1、TGF-β1、IL-6、TNF水平、24h尿蛋白定量升高（P〈0.05）;血清1,25（OH）2D水平降低（P〈0.05）;而GFR45～59ml·min^-1·1.73m^-2患者与GFR≥60ml·min^-1·1.73m^-2患者比较,两组间差异无统计学意义（P〉0.05）;（3）单因素相关分析显示CKD患者血清1,25（OH）2D与年龄（r=-0.442）、收缩压（r=-0.464）、舒张压（r=-0.399）、GFR（r=0.902）、Scr（r=-0.430）、PTH（r=-0.341）、UA（r=0.237）、24h尿蛋白定量（r=-0.372）及尿TGF-β1（r=-0.894）、MCP-1（r=-0867）、TNF（r=-0.899）、IL-6（r=-0.934）水平相关（P〈0.05）。多元回归分析显示血清1,25（OH）2D与GFR呈正相关;与24h尿蛋白定量,尿MCP-1、IL-6,血Scr、PTH呈负相关。结论：CKD1～4期患者存在1,25（OH）2D水平降低,并与蛋白尿及尿炎症细胞因子水平密切相关。     

Effect of etidronate disodium on bone turnover following surgical menopause

Summary A longitudinal study was performed to document the effect of surgical menopause and postmenopausal etidronate disodium therapy on several nonhistomorphometric indices of bone turnover. Twenty healthy, premenopausal women undergoing oophorectomy for nonmalignant conditions were studied preoperatively and at 3 monthly intervals postoperatively. Sequential measurements of serum calcium (Ca), alkaline phosphatase (AP), bone Gla protein (BGP), and urinary calcium and hydroxyproline excretion, expressed as a ratio of urinary creatinine (UCa/Cr and UOHp/Cr, respectively) were obtained. Twenty-four-hour whole body retention of diphosphonate (WBR) and radial bone density were also measured. When a postoperative increase in bone turnover was observed, patients were randomized to receive either 400 mg etidronate disodium daily or placebo for 3 months. Oophorectomy was associated with a significant increase in WBR, Ca, AP, and BGP and an insignificant rise in UCa/Cr. A variable pattern of UOHp/Cr was seen. Patients on placebo maintained these elevated levels of Ca, BGP, and UCa/Cr. WBR and AP continued to rise. Etidronate disodium therapy resulted in a fall towards premenopausal levels in WBR, Ca, and UCa/Cr. AP and BGP were unchanged. Three months after stopping etidronate, BGP fell significantly and the decrease in Ca was maintained; however, WBR and UCa/Cr had returned towards pretreatment values. Bone density measurements did not change significantly. An increase in several of the indices of bone turnover was seen following oophorectomy. Etidronate disodium suppressed this increase, affecting indices of both resorption and formation. This effect on formation may be an unavoidable consequence of normal resorption-formation coupling. The ability of etidronate alone to maintain postmenopausal bone mass has yet to be established. However, the suppressive effect of this diphosphonate on the accelerated bone turnover found after oophorectomy suggests that etidronate may have a potentially useful role as an inhibitor of resorption in a pulsed regimen.     

甲状旁腺切除术对血液透析患者合并继发性甲状旁腺功能亢进骨代谢及骨密度的影响

目的 观察甲状旁腺切除术(parathyroidectomy,PTX)对继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的维持性血液透析患者骨代谢及骨密度(BMD)的影响.方法 26例SHPT患者行PTX.术前及术后1、3、6、12、18、24个月时常规检测血钙、血磷、血清碱性磷酸酶,化学发光法检测血清全段甲状旁腺素(intact parathyroid,iPTH)、骨钙素(OC)、Ⅰ型前胶原氨基末端前肽(PINP)、β胶原蛋白(β-C TX),术前及术后24个月时双能X线法测定腰椎、股骨颈、骨盆各部位骨密度,观察患者甲状旁腺切除术前、术后骨代谢指标及骨密度变化.结果 (1)与术前比较,血清OC水平[(104.49±25.42) μg/L比(695.46±355.62) μg/L,P＜ 0.01]、PINP水平[(248.36±159.38) μg/L比(809.28±283.50) μg/L,P＜0.01]于手术3个月后明显降低,β-CTX水平于手术1个月后明显降低[(1.60±0.64) μg/L比(3.37±1.34) μg/L,P＜0.01].(2)与术前比较,术后24个月时腰椎BMD[(0.88±0.23) g/cm2比(0.78±0.23) g/cm2,P＜0.01]、股骨颈BMD[(0.96±0.19) g/cm2比(0.84±0.24) g/cm2,P＜ 0.01]及腰椎Z评分[(-1.24±0.55)比(-1.66±0.24),P＜0.01]、股骨颈Z评分[(-1.51±0.72)比(-1.93±0.40),P＜0.01]均升高.(3)相关分析显示,术前血清iPTH水平与⊿腰椎Z评分(r=0.584,P=0.002)、⊿股骨颈Z评分(r=0.400,P=0.043)呈正相关,术前血清OC水平与⊿腰椎Z评分(r=0.651,P＜0.001)、⊿股骨颈Z评分(r=0.509,P=0.008)呈正相关.结论 PTX术可以降低患者升高的iPTH、OC、PINP及β-CTX水平,增加骨密度,同时改善多项生化指标,提高患者生活质量.     

Features of ambulatory blood pressure in 540 patients with chronic kidney disease

Objective To explore the features and influencing factors of ambulatory blood pressure in chronic kidney disease (CKD) patients. Methods A total of 540 CKD patients from May 2010 to May 2012 in our department were enrolled in this study. Ambulatory blood pressure monitoring was carried out. Blood pressure (BP), proteinuria and other clinical parameters were measured regularly. Ultrasonography was used to evaluate cardiac structure and function, carotid intima-media thickness and plaque. Univariate and multivariate analysis were used to examine the association between BP and clinical parameters. Results 63.9% of CKD patients was non-dipper BP pattern, and 36.1% was dipper BP pattern. As compared to dipper BP patients, those with non--dipper BP had higher ratio of nighttime/daytime proteinuria (0.51±0.29 vs 0.42±0.21, P＜0.01), lower estimated glomerular filtration rate (eGFR) [(56.2±48.2) vs (75.5±56.5) ml•min-1•（1.73 m2）-1, P＜0.01], higher serum cystatin C[(2.8±2.0) mg/L vs (2.1±2.0) mg/L, P＜0.01], higher left ventricular mass index [(53.7±23.2) vs (45.1±16.3) g/m2, P＜0.01] and severely damaged left ventricular diastolic function and higher carotid intima-media thickness [(0.7±0.3) vs (0.6±0.2) mm, P＜0.01]. Nighttime blood pressure was independent predictor for proteinuria, eGFR and left ventricular mass index. Conclusions Non-dipper blood pressure pattern is very common in CKD patients. Nighttime pressure is closely associated to renal damage and cardiovascular injuries.     

老年慢性肾脏病患者生活质量评估及其危险因素分析

目的:了解65岁以上慢性肾脏病（chronic kidney disease,CKD）患者的老年综合评估评分情况,并分析患者生活质量的相关影响因素。方法:本研究为回顾性队列研究,入选2016年10月至2019年10月在山西省人民医院肾内科诊断为CKD且65岁以上的189例患者,依据患者是否透析分为透析组（ ...     

Relationship between serum 25-hydroxyvitamin D3 and heart valvular calcification in chronic kidney disease patients stage 3-5

Objective To detect the prevalence of heart valvular calcification (VC) and its related risk factors, and to investigate correlation between serum 25-hydroxyvitamin D3[25(OH)D3] and VC in chronic kidney disease (CKD) stage 3-5 patients. Methods A total of 294 CKD patients stage 3-5 were admitted in The Second Affiliated Hospital of Anhui Medical University. Their clinical and laboratory data were collected, patients were classified into two groups according echocardiography: patients with VC were defined as VC group while others were defined as non-VC group. The differences of 25(OH)D3 level and other data in two group were assessed, and related risk factors of VC were analyzed. Results Among 294 CKD patients, 82 were with VC (27.9%) while 212 were without VC (72.1%); serum 25(OH)D3 level was significantly higher in VC group than in non-VC group [(11.9±9.3) μg/L vs (9.6±7.2) μg/L, P＜0.05]. Age, cystatin C, hypersensitive C-reactive protein, pulmonary artery pressure, proportion of secondary hyperparathyroidism, incidence of abdominal aortic calcification and taking active vitamin D proportion were higher in VC group than in non-VC group (P＜0.05). Two classification logistic regression analyses showed that advanced age, high intact parathyroid hormone (iPTH) and 25(OH)D3, pulmonary arterial hypertension were risk factors for VC in CKD stage 3-5 patients. Conclusions The prevalence of VC is high in CKD stage 3-5 patients. Advanced age, bone metabolic disorder and pulmonary arterial hypertension are associated with VC.     

血清SM4D水平与绝经后骨质疏松症患者骨密度和骨代谢指标的相关性研究

目的 探讨绝经后骨质疏松症(postmenopausal osteoporosis,POP)患者血清4D同型二聚体(SM4D)水平与骨密度(bone mineral density,BMD)和骨转换指标的关系.方法 通过双能X线吸收测定法对257例POP患者和90例健康对照者进行BMD测量.通过酶联免疫吸附测定法测定受...     

Peritubular capillaries injury and its association with clinical characteristics and long term renal survival in primary malignant nephrosclerosis patients

Objective To analyze the clinic-pathological data and peritubular capillary (PTC) injuries of malignant nephrosclerosis (MN) patients and their correlations with the long term renal survival. Methods This was a retrospective cohort study of 52 MN patients in Peking Union Medical College Hospital from January 2003 to March 2012. Their clinical data and renal biopsy samples were carefully studied. CD34 staining was performed to evaluate the PTC area, using Benign nephrosclerosis (BN, n=17) patients and glomerular minimal lesions (GML, n=19) patients as controls. Multivariate Cox proportional hazard model was used to identify the potential independent risk factors for long term renal survival. Results Fifty-two MN patients were enrolled. The sex ratio of male to female was 12∶1 and the average age was (34.0±8.2) years. The maximum blood pressure (SBP/DBP) was (230.4±25.0)/(156.4±20.6) mmHg, companied with significant loss of eGFR and proteinuria. Glomerular sclerosis index, tubular atrophy and interstitial fibrosis correlated with eGFR and proteinuria(P＜0.05). After aggressive treatment, BP control rate improved significantly (76.9% vs 3.7%, P＜0.01), Scr [(376.4±263.8) μmol/L vs (486.8±375.7) μmol/L, Wilcoxon test, P＜0.01] and proteinuria [(1.10±0.70) g/24 h vs (2.04±1.26) g/24 h, P＜0.01, n=21] also improved. PTC area in MN patients was significantly lower than those in BN patients and GML patients, and it correlated well with Scr (r=-0.553, P=0.001) and eGFR (r=0.476, P=0.004). The median follow-up time was 74 months, the cumulative renal survival rate at 1 year, 5 year and 10 year was 90%, 64% and 23%, respectively. Kaplan-Meier analysis showed that the patients with higher PTC area had longer renal survival time [(114.8±12.4) months vs (63.0±8.3) months, χ2=5.312, P＜0.05]. Univariate Cox proportional hazard model found that unsatisfied BP control, eGFR＜30 ml?min-1?(1.73 m2)-1 upon discharge, lower PTC area, severer tubular-interstitial damage and anemia were associated with poor renal outcome. Multivariate Cox model showed that unsatisfied BP control (RR=3.89, 95% CI 1.75-8.65, P=0.001), eGFR＜30 ml?min-1?(1.73 m2)-1 upon discharge (RR=4.27, 95%CI 1.40-13.09, P=0.011) were independent risk factors for long-term renal survival. Conclusions The correlation between PTC area and renal functions in MN patients are much better than that of classic vascular changes. Unsatisfied BP control and eGFR＜30 ml?min-1?(1.73 m2)-1 upon discharge are independent risk factors for long-term renal survival.     

各期慢性肾脏病患者骨代谢生化指标与骨密度的相关性

目的 观察各期慢性肾脏病（CKD）患者血清骨代谢生化指标与骨密度（BMD）的变化情况及其相关性,探讨这些指标在肾性骨营养不良（ROD）早期诊断中的意义。 方法 78例入选患者共分6组,其中Ccr≥15 ml/min者按CKD临床1~4期分期标准分为4组; Ccr <15 ml/min者按是否行规律血液透析而分为2组。ELISA法测定骨保护素(OPG)。放射免疫法测定血清骨钙素（OC）、降钙素(CT)。化学发光法测定甲状旁腺素(iPTH)。6组患者中共47例行腰椎及股骨不同部位BMD测定。分析各组患者以上指标的差异及其相关性。 结果 （1）血清OPG、iPTH及磷分别从CKD 3、4、5期开始显著上升（P < 0.01）,其中OPG在血液透析后达（5.10±1.34）ng/L,显著高于透析前的（3.35±0.76） ng/L,差异有统计学意义（P < 0.05）。各期CKD患者血清OC、CT、钙及碱性磷酸酶水平差异无统计学意义,而血液透析可使OC显著升高（P < 0.05）。股骨沃德三角BMD在 CKD 4期患者下降至0.77±0.09,显著低于CKD 1期患者的1.15±0.05,差异有统计学意义（P < 0.01）,而血液透析不影响其水平。（2）血清OPG与Ccr、磷、iPTH、OC呈负或正相关（r分别为-0.70、0.51、0.39、0.36,均P < 0.01）。股骨沃德三角BMD与血清iPTH、OC呈负相关（r分别为-0.59、-0.51,均P < 0.01）;与血清磷、OPG亦呈负相关（r分别为-0.45、-0.48,均P < 0.05）。 结论 CKD患者骨代谢生化指标与BMD均随Ccr下降而出现明显异常,这些变化之间存在一定的相关性。血清OPG改变早于iPTH及BMD,在ROD的早期诊断中意义最大。血液透析可使血清OPG、OC水平升高,但不影响BMD水平。