铁过载对绝经后骨质疏松患者骨密度和骨代谢的影响

目的 观察铁过载对绝经后骨质疏松患者骨密度和骨代谢的影响。方法 将234名绝经后妇女按照骨密度（bone mineral density, BMD）分为正常组、骨量减少组和骨质疏松组。分析铁过载对年龄、绝经年数、血钙(Ca)、磷(P)、体质量指数（bone mass index,BMI）、肝肾功能、葡萄糖代谢、脂质代谢、炎症反应、BMD、抗酒石酸酸性磷酸酶5b(TRACP-5b)、ALP、Ⅰ型胶原交联C端肽(β-CTX)和Ⅰ型胶原交联N端肽(PINP)的影响。结果 与正常组相比,骨量减少组和骨质疏松组血清铁蛋白(Fer)显著升高(P<0.05)。Fer水平与BMD呈负相关(P<0.05)。TRACP-5b水平在骨质疏松组明显高于正常组(P<0.05)。与正常组相比,骨质疏松症组的ALP水平显著升高(P<0.05)。与骨量减少组相比,骨质疏松组血清β-CTX水平明显升高(P<0.05);且骨质疏松组的PINP水平显著高于正常组(P<0.05)。更重要的是,血清Fer和PINP之间存在正相关(P<0.05);血清Fer和β-CTX之间呈正相关(P<0.05)。结论 铁过载对绝经后骨质疏松患者骨密度和骨代谢均有显著影响。     

合并不同疾病的男性骨量异常患者骨代谢、骨密度及骨折情况研究

目的了解合并不同疾病的男性骨量异常患者骨代谢指标、骨密度(bone mineral density,BMD)及骨折的情况。方法对2006年1月至2017年12月在上海市第一人民医院内分泌科骨质疏松亚专科就诊的928例男性骨量异常患者进行回顾性研究。根据研究目的不同,将患者分为有或无糖尿病组、有或无慢性肝病组、有或无慢性肾病组、有或无慢性胃病组、有或无心血管疾病组及骨量减低组和骨质疏松组。分别观察各组各项指标的差异。结果单因素回归分析提示受试者年龄、体重、L1~4BMD、股骨颈BMD、全髋BMD、β-CTX、慢性胃病、骨质疏松症是骨折史的影响因素,差异具有统计学意义(P<0.05);骨折史与受试者年龄、β-CTX、慢性胃病、骨质疏松症因素成正相关,与体重、L1~4BMD、股骨颈BMD、全髋BMD成负相关;多因素回归分析提示年龄、BALP、2型糖尿病、骨质疏松是骨折的危险因素,而25OHD水平是骨折的保护性因素。结论对于男性骨量异常患者,需要重点关注年龄较大、β-CTX和BALP水平较高、合并慢性胃病以及2型糖尿病的患者,对这类患者应积极进行抗骨质疏松干预及治疗,以减少此类患者骨折的发生率。     

尿戊糖素水平与绝经后骨质疏松症患者骨密度相关性研究

目的 探讨尿戊糖素水平与绝经后骨质疏松症患者骨密度(bone mineral density,BMD)的相关性.方法 选择2016年4月至2019年5月在我院就诊的骨质疏松症患者80例为观察组,同期在我院体检的健康绝经后妇女80名为对照组.采用酶联免疫吸附法测定血清尿戊糖素和骨代谢指标水平.采用双能X线骨密度仪测量各研...     

骨质疏松症合并膝骨性关节炎患者骨密度及血清骨代谢指标、炎症因子水平研究

目的观察绝经后骨质疏松症(osteoporosis,OP)合并膝骨性关节炎患者骨密度、骨代谢相关指标以及细胞因子水平的特点。方法纳入78例绝经后骨质疏松症患者为OP组,75例绝经后骨质疏松症合并膝骨性关节炎患者为OPA组,76例膝骨性关节炎患者为KOA组。观察3组患者血清骨代谢指标骨钙素(BGP)、血清抗酒石酸酸性磷酸酶异体(TRACP-5b)、骨碱性磷酸酶(BAP)及I型胶原交联C末端肽(CTX-1)水平;炎症因子白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、转化生长因子-β1 (TGF-β1)及白细胞介素-10(IL-10)水平以及左髋、正位腰椎1-4(L1～4)的骨密度情况。结果 OPA组血清BGP、TRACP-5b、BAP、BGP、CTX-1水平高于OP组(P0. 05),而KOA组低于OP组(P0. 05)。KOA组血清TGF-β1水平高于OP组(P0. 05),而血清IL-6、TNF-α及IL-10水平显著低于OP组(P0. 05); KOA组血清IL-6、TNF-α及IL-10水平高于OP组(P0. 05),而TGF-β1水平低于OP组(P0. 05)。OP组及OPA组L1-4及左髋部骨密度显著低于KOA组(P0. 05)。结论绝经后骨质疏松症合并膝骨性关节炎患者的骨密度及骨代谢不同程度减低,而细胞因子水平升高,治疗时需要关注免疫异常。     

Changes of irisin in patients with end-stage renal disease before and after hemodialysis

Objective To observe the changes of irisin in patients before and after hemodialysis (HD), as well as the differentiation of irisin change in patients with diabetes mellitus and protein energy waste. Methods Clinical parameters of patients on maintenance hemodialysis (MHD) in Shanxi People's Hospital from September 2016 to November 2016 were collected. A total of 33 cases were enrolled——14 cases of diabetic MHD group and 19 cases of non-diabetic MHD group as divided according to etiology. Based on the presence of protein energy waste, patients were also grouped into 17 cases with and 16 cases without protein waste. Before and after HD, the non parametric test was used to compare the changes of irisin in each group. Results After HD, the irisin value of 33 patients with ERSD decreased, with the difference being statistically significant [0.666(0.218, 1.365) ng/L vs 0.977(0.202, 1.820) ng/L, P=0.01]. The difference was not statistically significant in the diabetes MHD group; statistically significant in the non diabetes group [0.666(0.178, 1.351) ng/L vs 0.913(0.100, 1.497) ng/L, P﹤0.05]; and not statistically significant in the protein energy group. The irisin of diabetic MHD group and non-diabetic MHD group were compared after HD: the difference was not statistically significant. Conclusions After HD, plasma irisin levels were reduced in patients with end-stage renal disease. Diabetes and protein wasting effects are not important for irisin at HD.     

探究围绝经期亚临床甲状腺功能减退症患者的糖脂代谢、骨密度的变化

目的探讨围绝经期亚临床甲状腺功能减退症(SCH)患者糖脂代谢、骨密度(BMD)的变化。方法选取2016年1月至2018年8月在医院内分泌专科就诊的围绝经期SCH患者120例为研究组,另选取同期至我院体检中心体检的围绝经期健康女性120名为对照组。采集2组受试人员空腹静脉血,检测并对比血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)水平;检测并对比2组受试者口服糖耐量及C肽(CP)释放试验中空腹血糖(FPG)、服糖1 h后血糖(PBG1h)、服糖2 h后血糖(PBG2h)水平及各时刻点C肽释放量(CP0h、CP1h、CP2h);检测并对比2组受试者腰椎L_(2-4)、髋部总体、左股骨颈、左股骨大转子骨密度(BMD)水平,采用Pearson相关性分析法评价TSH水平与糖脂代谢、BMD变化的关系。结果研究组TSH、TC、TG、LDL、CP0h、CP1h、CP2h、FPG、PBG1h、PBG2h水平均明显高于对照组,且差异有统计学意义(P0.05);研究组HDL、腰椎L_(2-4)、髋部总体、左股骨颈、左股骨大转子BMD水平均明显低于对照组,且差异有统计学意义(P0.05);研究组患者血清TSH水平与血清TC、TG、LDL、FPG、PBG1h、PBG2h、CP0h、CP1h、CP2h水平呈显著正相关(P0.05),研究组患者血清TSH水平与血清HDL、腰椎L_(2-4)、髋部总体、左股骨颈、左股骨大转子BMD水平呈显著负相关(P0.05)。结论围绝经期SCH患者糖脂代谢紊乱,BMD降低,且SCH水平与糖脂代谢、BMD有紧密关系。     

Survival in patients with end-stage renal disease

Based on age and medical condition at the time of treatment, 138 patients beginning dialysis for treatment of chronic renal failure between January 1, 1984 and December 31, 1988, were classified into low, average, and high risk of death. The survival in these three groups was shown to be significantly different after as little as 6 months. The classification scheme is simple, and can be performed at the bedside. Efforts to monitor quality assurance in the dialysis unit must account for the significant differences in expected survival that reflect the case-mix observed in a particular unit.     

Impact of ENPP1 genotype on arterial calcification in patients with end-stage renal failure.

BACKGROUND: Ectonucleotide pyrophosphatase/phosphodiesterase-1 (ENPP1) generates inorganic pyrophosphate, a solute that serves as an essential physiological inhibitor of calcification. Inactivating mutations of ENPP1 are associated with generalized arterial calcification of infancy. We hypothesized the ENPP1 K121Q variant to be associated with increased vascular calcification in patients with end-stage renal failure. SUBJECTS AND METHODS: We recruited 79 patients with end-stage renal failure undergoing dialysis treatment and genotyped them for the ENPP1 K121Q polymorphism. Next, we matched to each patient with ENPP1 121KQ genotype (n=15) a respective control with ENPP1 121KK genotype by gender, age, diabetes and duration of dialysis treatment. The matching ratio was 1:1. Severity of coronary calcification was quantified by computed tomography, and aortic stiffness was measured by pulse-wave analysis. RESULTS: Patients with ENPP1 121KQ genotype had a significantly higher coronary calcium score (1385 vs 94; n=30; P=0.033), and also a higher aortic pulse-wave velocity when compared to matched controls with ENPP1 121KK genotype (13.69 m/s vs 9.37 m/s; P=0.003). CONCLUSIONS: Taken together, our study suggests a potential role of the ENPP1 K121Q polymorphism in arterial calcification of patients with end-stage renal failure. Patients heterozygous for the ENPP1 K121Q polymorphism have higher coronary calcification scores and increased aortic stiffness, and may benefit from more intense treatment in order to prevent progression of arterial calcification.     

长期华法林治疗对骨代谢指标及骨密度的影响

目的 观察长期华法林治疗对患者骨代谢指标和骨密度（bone mineral density, BMD）的影响。方法 对长期服用华法林的42名患者和28名对照组人群进行横断面研究。使用酶联免疫吸附测定(ELISA)试剂盒测量骨钙素(osteocalcin ,OC),骨保护素(osteoprotegerin ,OPG)和核因子-κB配体(RANKL)总可溶性受体激活剂的血清水平,并通过双能X射线吸收测定法评估受试者股骨颈和腰椎BMD。结果 与对照组相比,华法林患者的OC浓度显著降低[(4.94±2.22) vs (10.68±4.5),P <0.001)]。OPG、sRANKL对数(log)、sRANKL/OPG对数比和BMD的水平相当。在女性华法林使用者中,发现OC和RANKL对数之间以及OC和RANKL/OPG对数比之间呈正相关(分别为P = 0.017;P = 0.005)、OC和OPG之间呈负相关(P= 0.027)。结论 长期华法林抗凝治疗可显著降低OC水平,但不影响其它骨代谢指标或BMD。此次研究结果还表明,长期使用华法林治疗可能会减轻绝经后妇女的骨吸收。     

Annual change in bone mineral density in predialysis patients with chronic renal failure: significance of a decrease in serum 1,25-dihydroxy-vitamin D

Bone disease occurs in the predialysis phase of chronic renal failure (CRF). The aim of this study was to examine how a decrease in renal function affects annual bone mineral density (BMD) changes in predialysis CRF patients and to examine the factors that affect BMD. The BMD of the distal radius in 53 predialysis CRF patients (age, 61.3 ± 10.8 years; serum creatinine 2.7 ± 1.2 mg/dl) was measured by peripheral quantitative computed tomography (pQCT) twice with a 1-year interval. The total BMD of the radius significantly decreased over a year (P < 0.001), and both trabecular and cortical BMD showed a significant decrease. Significant positive correlations with BMD changes were found for estimated creatinine clearance (r = 0.375, P < 0.01) and baseline serum 1,25(OH)₂D (r = 0.434, P < 0.005), indicating that BMD decreased to a greater extent with larger reductions in creatinine clearance and serum 1,25(OH)₂D. Of several bone metabolic markers examined, baseline serum osteocalcin was significantly positively correlated with annual BMD changes (r = −0.276, P < 0.05). Multiple regression analysis showed that baseline serum 1,25(OH)₂D (β = 0.434) was a significant predictor of decreases in total and trabecular BMD (R ² = 0.188, P < 0.01; and R ² = 0.207, P < 0.01), independent of other confounding factors. These results indicate that BMD decreases as renal function deteriorates in predialysis CRF patients, and that osteocalcin is a clinically useful marker associated with the decrease in BMD. The serum 1,25(OH)₂D level is the principal factor affecting BMD of the radius, suggesting that supplementation with an active form of vitamin D is of importance for predialysis CRF patients.     

Mineral bone disease in autosomal dominant polycystic kidney disease

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终末期肾脏病透析患者骨密度与冠脉钙化的相关性分析

目的探讨终末期肾脏病(end stage renal disease,ESRD)透析患者骨密度与冠状动脉钙化(coronary artery colcification,CAC)之间的相关性。方法本研究为横断面研究。纳入115例ESRD患者,收集相关人口学特征、原发病、实验室检查等资料,双能X射线评估腰椎、股骨颈及髋部骨密度,多层螺旋计算机断层扫描(MSCT)检查患者CAC发生情况。以钙化积分100为界,将患者分为高钙化组和低钙化组。结果高钙化组56例,占维持性透析患者48%,其中男性36例,占高钙化组人数64.3%。高钙化组年龄、透析龄及血清甲状旁腺激素、碱性磷酸酶、25(OH) D水平均明显高于低钙化组,而股骨颈骨密度、髋部骨密度、血清胆固醇水平明显低于低钙化组(P0.05);男性高钙化组股骨颈骨密度及髋部骨密度明显低于低钙化组,且其冠脉钙化积分与股骨颈骨密度(r=-0.34,P0.05)、髋部骨密度(r=-0.65,P0.01)呈负相关。多元线性回归分析校正了年龄、透析龄等因素后仍显示男性髋部骨密度与冠脉钙化积分呈负相关(β=-1870.47,P0.05)。但在女性患者中,高钙化组与低钙化组骨密度无明显差异。结论骨密度降低可能是男性维持性透析患者冠脉钙化风险增高的危险因素。     

Using vertebral bone densitometry to determine aortic calcification in patients with chronic kidney disease

Background: Vascular calcification (VC) is a major contributor to increased cardiovascular (CV) disease in chronic kidney disease (CKD) and an independent predictor of mortality. VC is inversely correlated with bone mineral density (BMD). Screening for VC may be useful to determine those at greater CV risk and dual‐energy X‐ray absorptiometry (DXA) may have a dual role in providing VC measurement as well as BMD. Methods: We report cross‐sectional data on 44 patients with CKD stages 3–4 and aim to determine and validate measurement of VC using DXA. Patients had computed tomography (CT) of abdominal aorta and DXA of lateral lumbar spine, to determine both aortic VC and BMD. Semi‐quantitative measurement of VC from DXA was determined (blinded) using previously validated 8‐ and 24‐point scales, and compared with VC from CT. BMD determination from L2 to L4 vertebrae on CT was compared with DXA‐reported BMD. Results: Patients 66% male, 57% diabetic, had mean age 63.4 years and mean estimated glomerular filtration rate 31.4 ± 12 mL/min. Aortic VC was present in 95% on CT, mean 564.9 ± 304 Hounsfield units (HU). Aortic VC was seen in 68% on lateral DXA, mean scores 5.1 ± 5.9 and 1.9 ± 1.9 using 24‐ and 8‐point scales, respectively. Strong correlation of VC measurement was present between CT and DXA (r 0.52, P < 0.001). For DXA VC 24‐point score, intraclass correlations for intra‐rater and inter‐rater agreement were 0.91 and 0.64, respectively (8‐point scale, intraclass correlations 0.90 and 0.69). Vertebral BMD measured by CT (mean 469.3 HU L2–4) also significantly correlated with lateral DXA‐reported BMD (mean spine T‐score –0.67 ± 1.6) (r 0.56, P < 0.001). Conclusion: Despite limitations in CKD, DXA may be useful as lateral DXA images provide concurrent assessment of aortic calcification as well as lumbar spine BMD, both correlating significantly with CT measurements. Lateral DXA may provide VC screening to determine patients at greater CV risk although more studies are needed to evaluate their potential role.     

Evaluation of bone loss and the serum markers of bone metabolism in patients with hyperparathyroidism

Bone loss and the serum markers of bone metabolism were studied in 22 patients with primary hyperparathyroidism and 108 patients with renal hyperparathyroidism. The parameters of bone loss were bone mineral density in the distal radius and lumbar vertebrae, measured by dual energy X-ray absorptiometry, and bone mass index (GS/D) and the metacarpal index, in the second metacarpal bone, measured by the digital image processing method. Alkaline phosphatase (AIP), intact osteocalcin (OC), and the carboxyterminal propeptide of type I procollagen (PICP) were measured as serum markers of bone formation, while tartrate-resistant acid phsophatase (TRACP) and the carboxyterminal pyridinoline cross-linked telopeptide of type I collagen (ICTP) were measured as serum markers of bone resorption. Bone loss and elevated markers of bone metabolism were observed both in patients with skeletal symptoms and in those without. Furthermore, the decrease in the cortical bone mass was more predominant than that of the trabecular bone. As markers of bone formation, AIP and OC seemed to be more sensitive than PICP, and as markers of bone resorption, ICTP appeared to be more sensitive than TRACP. Thus, a close correlation was observed between bone loss and the markers of bone formation and resorption.     

慢性肾脏疾病患者骨密度异常的研究

慢性肾脏疾病(chronic kidney disease,CKD)是肾脏内科常见疾病,需要经过长时间的治疗干预,治疗期间常伴有不同程度骨代谢异常,出现骨代谢相关指标的异常变化。在众多的骨代谢指标中以骨密度水平降低最为常见,骨密度的降低会导致CKD患者出现骨质疏松甚至发生骨折的风险。CKD患者出现骨折后会增加治疗难度、治疗费用,并在一定程度上导致患者残疾,甚至死亡。因此对CKD患者治疗期间进行骨密度监测,判断骨折发生风险,对于CKD疾病的治疗进程和改善患者预后至关重要。为此,本文对CKD患者治疗期间骨密度变化情况的国内外相关研究进行综述,以期为降低CKD患者治疗期间的骨密度异常发生率提供参考。     

Spectrum of renal bone disease in end-stage renal failure patients not yet on dialysis.

BACKGROUND: During the last few years the spectrum of renal osteodystrophy (ROD) in dialysis patients has been studied thoroughly and the prevalence of the various types of ROD has changed considerably. Whereas until a decade ago most patients presented with secondary hyperparathyroidism (HPTH), adynamic bone (ABD) has become the most common lesion within the dialysis population over the last few years. Much less is known about the spectrum of ROD in end-stage renal failure (ESRF) patients not yet on dialysis. METHODS: Transiliac bone biopsies were taken in an unselected group of 84 ESRF patients (44 male, age 54+/-12 years) before enrolment in a dialysis programme. All patients were recruited within a time period of 10 months from various centres (n=18) in Macedonia. Calcium carbonate was the only prescribed medication in patients followed up by the outpatient clinic. RESULTS: HPTH was found in only 9% of the patients, whilst ABD appeared to be the most frequent renal bone disease as it was observed in 23% of the cases next to normal bone (38%). A relatively high number of patients (n=10; 12%) fulfilled the criteria of osteomalacia (OM). Mixed osteodystrophy (MX) was diagnosed in 18% of the subjects. There was no significant difference between groups in age, creatinine, or serum and bone strontium and aluminium levels. Patient characteristics associated with ABD included male gender and diabetes, whilst OM was associated with older age (>58 years). CONCLUSIONS: In an unselected population of ESRF patients already, 62% of them have an abnormal bone histology. ABD is the most prevalent type of ROD in this population. In the absence of aluminium or strontium accumulation the relatively high prevalence of a low bone turnover as expressed by either normal bone or ABD and OM is striking.     

Determinants of bone mass in end-stage renal failure patients at the time of kidney transplantation

Abstract: Background:  Patients with chronic renal failure (CRF) are at high risk of renal osteodystrophy. Our study aimed to identify predictors of bone mass and cumulative fracture rate at the time of renal transplantation (RTx). This is important since the patients experience further substantial bone loss the first month post-transplant.
Material and methods:  Altogether 133 renal transplant patients were examined for bone mineral density (BMD) using dual-energy X-ray absorptiometry shortly after RTx.
Results:  The patients' Z -scores were significantly lower at the time of RTx compared to the reference population (p < 0.05), 32% were osteopenic and 11% had osteoporosis. Independent predictors of low bone mass were age (p < 0.001), female sex (p < 0.001), intact parathyroid hormone (iPTH) level (p < 0.001), former transplantation (p = 0.001) and time on hemodialysis (HD) (p = 0.005). Body mass index (BMI) (p < 0.001) and physical activity (p = 0.027) were associated with high BMD. Cumulative fracture rate (29%) was associated with physical inactivity (p = 0.003), BMI (p = 0.036) and osteopenia (p < 0.001) at the time of RTx.
Conclusion:  In a representative CRF population, BMD was reduced. Independent predictors of BMD were as for the general population, and uremia associated predictors were time on HD, previous transplantation and serum iPTH level. Fracture rate was high, and physical inactivity had the strongest association with fractures.