Bone aluminum and histomorphometric features of renal osteodystrophy.
Bone aluminum and histomorphometric features of renal osteodystrophy.
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DOI：
10.1210/jcem-54-3-539
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发表时间：
1982-03
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影响因子：
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通讯作者：
A. Hodsman;D. Sherrard;A. Alfrey;S. Ott;A. Brickman;N. Miller;N. Maloney;J. Coburn
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文献类型：
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作者：
A. Hodsman;D. Sherrard;A. Alfrey;S. Ott;A. Brickman;N. Miller;N. Maloney;J. Coburn
为探讨铝与尿毒症骨病的关系，对59例尿毒症维持性血液透析患者的骨铝含量及骨组织形态计量学定量分析进行了研究。骨软化症(OM)23例，纤维性骨炎(OF)13例，混合性骨软化症7例，轻度骨软化症16例。两组间血钙、碱性磷酸酶水平无明显差异，但纤维性骨炎患者血磷水平稍高。OF和混合性皮损患者血清甲状旁腺激素免疫反应性水平高于OM和轻度皮损患者(P<0.01)。骨铝均高于正常(P<0.01)，OM组为175+/-18 mg/kg，干重为46+/-7，混合组为81+/-29，轻度组为67+/-7。OM组骨铝显著高于其他组(P<0.001.0 1)，骨铝与OM中未矿化类骨质定量指标呈正相关(r=0.6 7，P<0.0 1)，其余各组间无相关性。骨铝与血清甲状旁腺激素免疫反应性(r=-0.35，P<0.001)和活检骨吸收面积(r=-0.44，P<0.05)呈负相关。骨铝与血液透析时间呈正相关(r=0.49)，而在OM患者中未见相关关系，且透析期的骨铝含量较高，提示OM患者的骨铝蓄积速度可能更快。这些发现与铝在透析骨软化症中起致病作用的假设一致，但不能证明这一假设；铝积累的机制仍不清楚。
To evaluate the relationship between aluminum and the characteristics of bone disease in uremia, bone aluminum content and quantitative histomorphometric analysis of bone were evaluated in bone biopsies from 59 uremic patients undergoing maintenance hemodialysis. Biopsies were classified as showing 1) pure osteomalacia (OM) in 23 cases, 2) osteitis fibrosa (OF) in 13, 3) mixed in 7, and 4) mild lesions in 16. There were no significant differences in levels of serum calcium or alkaline phosphatase between the groups, but serum phosphorus levels were slightly higher in those with OF. Serum immunoreactive parathyroid hormone levels were greater in the patients with OF and mixed lesions than in patients with OM or mild lesions (P less than 0.01). Bone aluminum exceeded normal in all groups (P less than 0.01), with values of 175 +/- 18 mg/kg dry wt in OM patients, 46 +/- 7 of OF patients, 81 +/- 29 in mixed subjects, and 67 +/- 7 in patients with mild lesions. Bone aluminum was significantly higher in the OM patients than in any other group (P less than 0.01); also, bone aluminum correlated with the quantitative measure of unmineralized osteoid in OM (r = 0.67; P less than 0.001); no correlations existed for the other groups. There were inverse correlations between bone aluminum and the serum immunoreactive parathyroid hormone (r = -0.35; P less than 0.01) and resorbing surface on biopsy (r = -0.44; P less than 0.001). Bone aluminum correlated with the duration of hemodialysis in patients with OF with mixed and mild lesions (r = 0.49); no relation was seen in OM patients, and bone aluminum was higher for the duration of dialysis, suggesting that aluminum may accumulate more rapidly in OM subjects. These findings are consistent with but do not prove the hypothesis that aluminum plays a pathogenic role in dialysis osteomalacia; the mechanism by which aluminum accumulates remains unknown.