Arterial calcifications and bone histomorphometry in end-stage renal disease
Arterial calcifications and bone histomorphometry in end-stage renal disease
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DOI：
10.1097/01.asn.0000129337.50739.48
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发表时间：
2004-07-01
影响因子：
13.6
通讯作者：
De Vernejoul, MC
中科院分区：
文献类型：
--
作者：
London, GM;Marty, C;De Vernejoul, MC
动脉钙化（AC）是终末期肾病（ESRD）的常见并发症。其机制很复杂，包括矿物质代谢紊乱和各种矿物质调节蛋白的活跃表达。在尿毒症患者中，AC 与骨密度之间存在负相关关系。在此介绍的研究中，包括 58 名接受血液透析 (HD) 的 ESRD 患者，将骨组织形态计量学特征与根据钙化动脉部位数量确定的 AC 评分（0 至 4）进行了比较。 AC评分为0（无钙化）或1或2（轻度钙化）的患者具有相似的血清甲状旁腺激素水平和骨组织形态学，具有较大的破骨细胞吸收、较高的破骨细胞数量以及较大的成骨细胞和双四环素标记的表面。相反，AC评分高（3和4）的患者的特点是血清甲状旁腺激素较低、破骨细胞数量和成骨细胞表面较低、双四环素标记表面较小或不存在、以及铝染色表面比例较高。根据多变量分析，AC评分与年龄（P < 0.0001）、含钙磷酸盐结合剂日剂量（P = 0.009）和骨铝染色表面（P = 0.037）呈正相关，与成骨细胞表面呈负相关（P = 0.001）。高 AC 评分与骨组织形态计量相关，提示骨活性低和动力性骨病。这些发现表明，与过度降低甲状旁腺活性相关的治疗干预措施（甲状旁腺切除术、过量的钙或铝负荷）有利于降低骨转换和动力性骨疾病，这可能会影响 AC 的发生和进展。
Arterial calcification (AC) is a common complication of end-stage renal disease (ESRD). The mechanisms responsible are complex, including disturbances of mineral metabolism and active expression of various mineral-regulating proteins. An inverse relationship between AC and bone density has been documented in uremic patients. In the study presented here, which included 58 patients with ESRD on hemodialysis (HD), bone-histomorphometry characteristics were compared with the AC scores (0 to 4) determined according to the number of arterial sites with calcifications. Patients with AC scores of 0 (no calcifications), or 1 or 2 (mild calcifications) had similar serum parathyroid hormone levels and bone histomorphometry, with larger osteoclast resorption, higher osteoclast numbers, and larger osteoblastic and double tertracycline-labeled surfaces. In contrast, patients with high AC scores (3 and 4) were characterized by lower serum parathyroid hormone, low osteoclast numbers and osteoblastic surfaces, smaller or absent double tetracycline-labeled surfaces, and high percentages of aluminum-stained surfaces. According to multivariate analysis, AC score was positively associated with age (P < 0.0001), daily dose of calcium-containing phosphate binders (P = 0.009), and bone aluminum-stained surfaces (P = 0.037), and an inverse correlation was observed with osteoblastic surfaces (P = 0.001). A high AC score is associated with bone histomorphometry suggestive of low bone activity and adynamic bone disease. These findings suggest that therapeutic interventions associated with excessive lowering of parathyroid activity (parathyroidectomy, excessive calcium or aluminum load) favor lower bone turnover and adynamic bone disease, which could influence the development and progression of AC.