Phosphate Binder Impact on Bone Remodeling and Coronary Calcification - Results from the BRiC Study
Phosphate Binder Impact on Bone Remodeling and Coronary Calcification - Results from the BRiC Study
复制标题
磷酸盐粘合剂对骨质重塑和冠状动脉钙化的影响--BRiC 研究的结果
DOI：
10.1159/000170783
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发表时间：
2008-01-01
影响因子：
--
通讯作者：
Fernandes Canziani, Maria Eugenia
中科院分区：
文献类型：
--
作者：
Barreto, Daniela Veit;Barreto, Fellype de Carvalho;Fernandes Canziani, Maria Eugenia
背景和目标：含钙磷结合剂已被证明会增加血液透析患者血管钙化的进展。这是一项比较醋酸钙和司维拉姆对冠状动脉钙化（CAC）和骨组织学影响的前瞻性研究。研究方法：101名血液透析患者被随机分配使用每种磷结合剂，并在入组和12个月时接受多层冠状动脉断层扫描和骨活检。结果：完成研究的71例患者具有相似的基线特征。在随访中，司维拉姆组的全段甲状旁腺激素水平较高（498 +/- 352 vs. 326 +/- 236 pg/ml，p = 0.017），骨碱性磷酸酶（38 +/- 24 vs. 28 +/- 15 U/l，p = 0.03）和脱氧吡啶啉（135 +/- 107 vs. 89 +/- 71 nmol/l，p = 0.03）和较低的LDL胆固醇（74 +/- 21 vs. 91 +/- 28 mg/dl，p = 0.015）。磷（5.8 +/- 1.0 vs. 6 +/- 1.0 mg/dl，p = 0.47）和钙（1.27 +/- 0.07 vs. 1.23 +/- 0.08 mmol/l，p = 0.68）水平在组间无差异。两组基线和12个月时的CAC进展（35 vs. 24%，p = 0.94）和骨组织学诊断相似。司维拉姆组基线时骨转换率高的患者骨吸收增加（侵蚀表面，ES/BS = 9.0 +/- 5.9 vs. 13.1 +/-9.5%，p = 0.05），而两组基线时骨转换率低的患者骨形成率均有所改善，（钙的BFR/BS = 0.015 +/- 0.016 vs. 0.062 +/- 0.078，p = 0.003;司维拉姆的BFR/BS = 0.017 +/- 0.016 vs. 0.071 +/- 0.084 mu m（3）/mu m（2）/天，p = 0.010）。结论：钙和司维拉姆组之间CAC进展或骨重建变化无差异。版权所有（C）2008 S. Karger AG，巴塞尔
Background and Aims: Calcium-containing phosphate binders have been shown to increase the progression of vascular calcification in hemodialysis patients. This is a prospective study that compares the effects of calcium acetate and sevelamer on coronary calcification (CAC) and bone histology. Methods: 101 hemodialysis patients were randomized for each phosphate binder and submitted to multislice coronary tomographies and bone biopsies at entry and 12 months. Results: The 71 patients who concluded the study had similar baseline characteristics. On follow-up, the sevelamer group had higher levels of intact parathyroid hormone (498 +/- 352 vs. 326 +/- 236 pg/ml, p = 0.017), bone alkaline phosphatase (38 +/- 24 vs. 28 +/- 15 U/l, p = 0.03) and deoxypyridinoline (135 +/- 107 vs. 89 +/- 71 nmol/l, p = 0.03) and lower LDL cholesterol (74 +/- 21 vs. 91 +/- 28 mg/dl, p = 0.015). Phosphorus (5.8 +/- 1.0 vs. 6 +/- 1.0 mg/dl, p = 0.47) and calcium (1.27 +/- 0.07 vs. 1.23 +/- 0.08 mmol/l, p = 0.68) levels did not differ between groups. CAC progression (35 vs. 24%, p = 0.94) and bone histological diagnosis at baseline and 12 months were similar in both groups. Patients of the sevelamer group with a high turnover at baseline had an increase in bone resorption (eroded surface, ES/BS = 9.0 +/- 5.9 vs. 13.1 +/- 9.5%, p = 0.05), whereas patients of both groups with low turnover at baseline had an improvement in bone formation rate (BFR/BS = 0.015 +/- 0.016 vs. 0.062 +/- 0.078, p = 0.003 for calcium and 0.017 +/- 0.016 vs. 0.071 +/- 0.084 mu m(3)/mu m(2)/day, p = 0.010 for sevelamer). Conclusions: There was no difference in CAC progression or changes in bone remodeling between the calcium and the sevelamer groups. Copyright (C) 2008 S. Karger AG, Basel