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| 558例非透析慢性肾脏病患者骨代谢指标的分析 |
| Analysis of bone metabolic indexes in 558 patients with non-dialysis chronic kidney disease |
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| DOI：10.3969/j.issn.1006.7108.2013.11.006 |
| 中文关键词: 慢性肾脏病 甲状旁腺素 25经维生素D3 β-胶原特殊序列测定 骨钙素 |
| 英文关键词:CKD iPTH 25(OH) D3, β-CTX Osteocalcin |
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| 中文摘要: |
| 目的 调查我院非透析慢性肾脏病患者骨代谢指标，为早期监测慢性肾脏病的矿物质及骨代谢异常提供依据。方法 回顾性分析我科住院的非透析慢性肾脏病患者558例，检测血甲状旁腺素(iPTH) , β-胶原特殊序列测定(β-CTX )、骨钙素、25-羟基维生素D3[25(OH)D3]、钙、磷、碱性磷酸酶(AKP)、肌酐、白蛋白、血糖等指标，留取晨尿进行尿常规及24 h尿蛋白定量检查，并分析相关影响因素。结果558例CKD患者平均年龄(70.6±15. 6 )岁，其中男性51.1%，女性48.9%，骨代谢指标男女性别间差异无统计学意义(P > 0. 05)。iPTH , β-CTX、骨钙素、血磷在CKD1-3期患者间差异无统计学意义，但与CKD4、5期患者差异有统计学意义(P<0.001);AKP在CKD5期明显升高。25(OH)D3在CKD1-5期患者中差异无统计学意义，各期CKD患者均存在25(OH)D3的不足及缺乏，其患病率分别为24.7% ,70.1%。单因素相关分析显示，MDRD-eGFR与iPTH ( r=–0. 457 ) , β-CTX (r=–0. 501)、骨钙素(r=–0. 485 )、血磷(r=–0. 501) ,AKP( r=–0. 187 )、年龄(r=–0. 140 )水平相关，均P<0.01;与血钙(r =– 0. 084 )水平相关，P < 0. 05。结论 非透析CKD患者各骨代谢指标在CKD早期无明显差异，但随着肾功能的减退进行性升高，且其之间存在正相关关系。CKD患者普遍存在25(OH)D3的缺乏且在CKD早期即有。 |
| 英文摘要: |
| Objective To investigate the bone metabolic indexes in patients with non-dialysis chronic kidney disease(CKD) in our hospital，and to provide the basis for the early stage monitoring of the abnormality of mineral and bone metabolism in CKD .Methods The clinical data of 558 patients with non-dialysis CKD，who were hospitalized in our hospital，were analyzed. Serum iPTH，β-degradation products of C-terminal telopeptides of type I collagen(β-CTX )，osteocalcin，25(OH)D3，calcium(Ca)，phosphorus (P)，alkaline phosphatase(ALP )，albumin，and glucose were also detected .Morning urine was collected and urine regular test and 24-hour urinary protein excretion were also detected. Results The average age of 558 CKD patients(51.1% male and 48.9% female) was 70.6±15.6 years old. No significant difference of bone metabolic indexes was observed between men and women(P>0.05).The levels of iPTH，β-CTX，osteocalcin，and phosphorus showed significant difference in patients with stage 4-5 CKD (P<0.001)，while no significant difference was observed in patients with stage 1-3 CKD. The level of AKP was significant higher in patients with stage 5 CKD. While no significant difference of 25 ( OH ) D3 was observed in patients with stage 1-5 CKD，the insufficiency and deficiency of 25(OH)D3 in patients with each stage CKD existed，and the prevalence was 24.7% and 70.1%，respectively.Univariate correlation analysis showed that MDRD-eGFR was negatively correlated with iPTH(r=–0. 457，P<0.01)，β-CTX(r=–0. 501，P<0.01)，osteocalcin ( r=–0. 485，P<0.01)，phosphorus ( r=–0. 501，P<0.01)，AKP ( r=–0. 187 , P < 0. 01)，age(r=–0. 140，P<0. 001)，and Ca(r=–0. 084，P < 0. 05).Conclusion There is no significant difference of bone metabolic indexes at the early stage of CKD in patients with non-dialysis CKD. Along with the decrease of renal function，the scrum levels of iPTH, β-CTX,osteocalcin，and phosphorus Increase,showing a positive correlation .The deficiency of vitamin D is prevalent in patients with CKD，and it can be observed at the early stage of CKD. |
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