PREDICTIVE VALUE OF SERUM PARATHYROID-HORMONE LEVELS FOR BONE TURNOVER IN PATIENTS ON CHRONIC MAINTENANCE DIALYSIS
PREDICTIVE VALUE OF SERUM PARATHYROID-HORMONE LEVELS FOR BONE TURNOVER IN PATIENTS ON CHRONIC MAINTENANCE DIALYSIS
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DOI：
10.1016/0272-6386(95)90599-5
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发表时间：
1995-10-01
影响因子：
13.2
通讯作者：
MALLUCHE, HH
中科院分区：
文献类型：
--
作者：
QI, QL;MONIERFAUGERE, MC;MALLUCHE, HH
随着粘连性骨病发生率的增加，在开始维生素D治疗之前，确定慢性透析患者的骨转换水平是必要的。为了评估血清甲状旁腺激素（PTH）水平预测骨转换的价值，我们确定了血清PTH单独或与其他变量联合的灵敏度、特异性和预测值阳性，在79名进行一次或两次骨活检的患者中，通过放射免疫测定法测定血清PTH水平，并在骨活检时获得。根据骨活化频率的值，将患者分为（1）低或正常和（2）高骨转换，血液透析患者57例，持续性非卧床腹膜透析（CAPD）患者39例，血清PTH水平在正常范围内或低于正常范围的患者均为低或正常骨转换，血清甲状旁腺激素高于450 pg/mL者，高甲状旁腺激素特异性为100%，高甲状旁腺激素特异性为95.5%。血清PTH在65 ~ 450 pg/mL之间对CAPD患者骨转换阳性预测值较低（48.6%至78.6%）比血液透析患者（67.3%~ 87.1%），当考虑到患者的其他特征时，仅血液透析患者的年龄和CAPD患者的血清离子钙提高了血清PTH的预测价值，所有年龄小于45岁且血清PTH水平高于65 pg/mL的血液透析患者（n = 15）均具有高骨转换，而骨转换低或正常的CAPD患者具有较高的血清离子钙，然而，总的来说，在30%的血液透析患者和51.3%的CAPD患者中，骨转换不能通过血清PTH测量来预测。数据表明，对于血清PTH水平在65和450 pg/mL之间的患者，骨活检适用于在开始维生素D治疗前精确评估骨转换。(C)1995年由国家肾脏基金会，公司。
With the increasing occurrence of adynamic bone disease, it is essential to determine the level of bone turnover in chronically dialyzed patients before instituting vitamin D therapy, To assess the value of serum parathyroid hormone (PTH) levels for prediction of bone turnover, we determined sensitivity, specificity, and predictive value positive of serum PTH, alone or in combination with other variables, in 79 patients who underwent one or two bone biopsies, Serum PTH levels were determined by a radioimmunometric assay and were obtained at the time of bone biopsies, Patients were classified into (1) low or normal and (2) high bone turnover according to the value of activation frequency of bone, There were 57 biopsy specimens taken from hemodialysis patients and 39 specimens from continuous ambulatory peritoneal dialysis patients (CAPD), All patients with serum PTH levels within or below the normal range had low or normal bone turnover, Values of serum PTH above 450 pg/mL were 100% and 95.5% specific for high. bone turnover in hemodialysis and CAPD patients, respectively, Values of serum PTH between 65 and 450 pg/mL had worse predictive value positive in CAPD patients (48.6% to 78.6%) than in hemodialysis patients (67.3% to 87.1%), When other characteristics of the patients were taken into consideration, only age in hemodialysis patients and serum ionized calcium in CAPD patients improved the predictive value of serum PTH, All hemodialysis patients younger than 45 years of age with serum PTH levels above 65 pg/mL (n = 15) had high bone turnover, and CAPD patients with low or normal bone turnover had higher serum ionized calcium, However, overall, bone turnover could not be predicted by serum PTH measurements in 30% of hemodialysis and 51.3% of CAPD patients, The data suggest that for patients with serum PTH levels between 65 and 450 pg/mL, bone biopsies are indicated to precisely assess bone turnover prior to initiation of vitamin D therapy. (C) 1995 by the National Kidney Foundation, Inc.