25例高转换型肾性骨病的骨组织学研究

目的通过对慢性肾脏病(chronic kidney disease,CKD)5期维持性血液透析(maintenance hemodialysis,MHD)患者行骨活检获得骨标本,对骨病理进行骨形态计量学分析,观察各型骨病尤其是高转换型肾性骨病的骨病理学特点并探讨临床各项常用无创性检查的意义。方法选择40例CKD5期MHD患者和3例正常人进行髂骨活检术,获得骨标本。采用全自动图像分析系统进行骨组织形态计量学测定。外周血各项检测指标和临床常用的骨密度和骨骼摄片与骨病理学指标行相关分析。结果25例CKD5期MHD患者经骨病理学检查证实为高转换型骨病,占同期骨活检的62.5%(25/40),骨病理学检查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。外周血钙、骨钙素水平与骨病理指标呈显著正相关。骨密度和骨骼摄片的阳性率低于骨活检。结论通过对CKD5期MHD患者行骨活检发现,高转换性肾性骨病的比例仍占大多数。在高转换型肾性骨病中,目前的各种无创性检查中血钙、骨钙素可能具有一定的预测价值。骨活检仍是诊断肾性骨病的金指标。

Bone histology in 25 end-stage renal disease patients with high turnover renal bone disease

Objective To investigate the characteristics of renal bone disease especially the high turnover bone disease and to evaluate the significance of various clinical biomarkers for renal bone disease by histological observation of bone biopsies from chronic kidney disease（CKD） patients at stage 5 and on maintenance hemodialysis.Methods Bone biopsy was performed in 40 CKD patients at stage 5 as well as 3 normal persons.Bone biopsies were studied by histomorphometric measurement using an automatic image analysis system.Serum level of biomarkers and bone pathological parameters were studied by correlation analysis.Results Twenty-five of the 40 uremic patients（62.5%） were found to have high turnover bone disease based on bone histological changes.High turnover bone disease was characterized by the hyperactivity of osteoclasts with or without bone mineral deposit impairment.There was a close relationship between serum levels of calcium and osteocalcin and histomorphometric parameters.Conclusions High turnover bone disease is the major type of bone disease in CKD patients at stage 5.Serum levels of calcium and osteocalcin may be predictive for high turnover bone disease in clinical practice.Bone biopsy is still the essential approach for the diagnosis.