Serum immunoreactive parathyroid hormone and 25-hydroxyvitamin D in patients with uremic bone diseases.
Serum immunoreactive parathyroid hormone and 25-hydroxyvitamin D in patients with uremic bone diseases.
复制标题
尿毒症骨病患者血清免疫反应性甲状旁腺激素和 25-羟基维生素 D。
DOI：
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发表时间：
1975
影响因子：
5.8
通讯作者：
J. Wergedal
中科院分区：
文献类型：
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作者：
Shen F;D. Baylink;D. Sherrard;L. Shen;N. Maloney;J. Wergedal
对 20 名接受血液透析治疗的终末期肾衰竭患者进行了骨组织学参数以及血清 iPTH 和 25-OHD 的测量。根据骨组织学标准，患者被分为三组：轻度组、骨软化组和纤维化组。纤维化组血清 iPTH 的增加比轻度组或骨软化组高得多。在尿毒症患者群体中，血清 iPTH 与骨髓纤维化百分比和再吸收表面百分比之间存在显着相关性。在轻度组和纤维化组中，血清 iPTH 也与形成表面的百分比相关。这一发现和其他发现表明，轻度和纤维化组的大部分骨骼变化可以用过量的 PTH 来解释。轻度组和纤维化组之间骨变化和血清 iPTH 的差异可能与我们早期的发现有关，即纤维化组的肾病持续时间比轻度组长得多。骨软化组中血清 iPTH 的增量最低。在该组中，吸收表面百分比没有增加，并且骨髓纤维化仅略有增加。因此，在所有三组中，血清 iPTH 似乎反映了甲状旁腺状态。血清 iPTH 升高的原因以及组间差异并不明显，因为所有三组的血清钙均正常。骨软化组和纤维化组的血清 25-OHD 显着升高。由于我们的患者均未接受含有维生素 D 的制剂，因此骨软化组和纤维化组中血清 25-OHD 升高与这两组中维生素 D 代谢的改变一致。类固醇面积百分比与血清 25-OHD 之间存在直接关系。然而，尚无法确定维生素 D 代谢的改变是否会导致尿毒症骨病的矿化缺陷。
Bone histologic parameters and serum iPTH and 25-OHD were measured in 20 patients with end-stage renal failure treated with hemodialysis. By bone histologic criteria, the patients were divided into three groups: mild, osteomalacic, and fibrotic. The increase in serum iPTH was much greater in the fibrotic group than in the mild or osteomalacic groups. In the uremic patients as a group, there were significant correlations between serum iPTH and both percent marrow fibrosis and percent resorbing surface. In the mild and fibrotic groups together, serum iPTH was also correlated with percent forming surface. This and other findings suggested that most of the bone changes in the mild and fibrotic groups could be explained by excess PTH. The difference in bone changes and in serum iPTH between the mild and fibrotic groups could be related to our eariler findings that duration of renal disease was much greater in the fibrotic than in the mild group. The lowest increment in serum iPTH was found in the osteomalacic group. In this group, percent resorbing surface was not increased and there was only a slight increase in marrow fibrosis. Thus in all three groups, serum iPTH appeared to reflect parathyroid status. The cause of the elevated serum iPTH and for the intergroup differences was not apparent inasmuch as serum calcium was normal in all three groups. Serum 25-OHD was significantly elevated in the osteomalacic and fibrotic groups. Because none of our patients had received preparations containing vitamin D, the elevated serum 25-OHD in the osteomalacic and fibrotic groups is consistent with altered vitamin D metabolism in these two groups. There was a direct relationship between percent osteroid area and serum 25-OHD. However, whether or not altered vitamin D metabolism contributed to the mineralization defect in uremic bone disease could not be established.