内科理论与实践 ›› 2021, Vol. 16 ›› Issue (01): 45-48.doi: 10.16138/j.1673-6087.2021.01.010
收稿日期:
2020-10-21
出版日期:
2021-02-25
发布日期:
2022-07-26
通讯作者:
张凌
E-mail:zhangling5@medmail.com.cn
Received:
2020-10-21
Online:
2021-02-25
Published:
2022-07-26
中图分类号:
占志朋, 谢席胜, 张凌. 维持性血液透析合并难治性继发性甲状旁腺功能亢进患者甲状旁腺激素水平与骨密度的关系[J]. 内科理论与实践, 2021, 16(01): 45-48.
表1
研究人群的一般特征、实验室参数及不同部位的BMD[$\bar{x}\pm s$/n(%)/M(Q1,Q3)]
项目 | 数值 |
---|---|
男性/女性(n) | 77/82 |
年龄(岁) | 49.4±10.8 |
透析龄(月) | 89.3 (61.8,119.8) |
体质量指数(kg/m2) | 23.0±4.1 |
血钙(mmol/L) | 2.6±0.2 |
血磷(mmol/L) | 2.3±0.6 |
iPTH (ng/L) | 1 727.8 (1 170.8,2 470.8) |
ALP(U/L) | 200.0 (145.0,459.0) |
25羟维生素D (nmol/L) | 40.0 (29.0,47.5) |
Alb(g/L) | 44.2±4.1 |
腰椎L1~L4 BMD(g/cm2) | 1.1±0.2 |
股骨颈BMD (g/cm2) | 0.8±0.1 |
全髋BMD (g/cm2) | 0.8±0.2 |
表2
血iPTH水平与不同部位BMD的关系
项目 | 腰椎L1-L4 | 股骨颈 | 全髋 | |||||||
---|---|---|---|---|---|---|---|---|---|---|
β(95%CI) | P | β(95%CI) | P | β(95%CI) | P | |||||
iPTH/100 | -0.008(-0.012~-0.004) | <0.001 | -0.004(-0.007~-0.002) | 0.002 | -0.006(-0.010~-0.003) | <0.001 | ||||
分组 | ||||||||||
Q1 | 1.000 | 1.000 | 1.000 | |||||||
Q2 | -0.005(-0.088~0.078) | 0.900 | 0.027(-0.029~0.083) | 0.342 | 0.011(-0.055~0.077) | 0.743 | ||||
Q3 | -0.006(-0.089~0.077) | 0.890 | 0.018(-0.040~0.077) | 0.543 | 0.003(-0.064~0.070) | 0.923 | ||||
Q4 | -0.149(-0.232~-0.066) | <0.001 | -0.063(-0.119~-0.006) | 0.030 | -0.118(-0.184~-0.051) | <0.001 |
表3
血iPTH水平与不同部位BMD的阈值效应
变量 | β | 95%CI | P |
---|---|---|---|
腰椎BMD | |||
iPTH/100≤23.344 | -0.002 | -0.008~0.004 | 0.557 |
iPTH/100>23.344 | -0.022 | -0.033~-0.010 | <0.001 |
股骨颈BMD | |||
iPTH/100≤18.25 | 0.003 | -0.004~0.009 | 0.472 |
iPTH/100>18.25 | -0.009 | -0.014~-0.004 | <0.001 |
全髋BMD | |||
iPTH/100≤18.973 | 0.002 | -0.006~0.009 | 0.622 |
iPTH/100>18.973 | -0.013 | -0.019~-0.007 | <0.001 |
表4
血iPTH水平与不同部位BMD的多元线性回归
模型1 | 模型2 | |||||
---|---|---|---|---|---|---|
β(95%CI) | P | β(95%CI) | P | |||
腰椎BMD | ||||||
iPTH/100 | -0.007(-0.011, -0.002) | 0.004 | -0.008(-0.013, -0.002) | 0.007 | ||
iPTH/100≤18 | 0.005(-0.007, 0.017) | 0.394 | 0.001(-0.013, 0.015) | 0.868 | ||
iPTH/100>18 | -0.014(-0.021, -0.006) | <0.001 | -0.013(-0.022, -0.004) | 0.008 | ||
股骨颈BMD | ||||||
iPTH/100 | -0.003(-0.006, -0.000) | 0.041 | -0.005(-0.009, -0.001) | 0.021 | ||
iPTH/100≤18 | 0.005(-0.002, 0.013) | 0.184 | 0.004(-0.005, 0.014) | 0.376 | ||
iPTH/100>18 | -0.008(-0.013, -0.003) | 0.003 | -0.010(-0.016, -0.003) | 0.003 | ||
全髋BMD | ||||||
iPTH/100 | -0.005(-0.008, -0.002) | 0.006 | -0.007(-0.011, -0.003) | 0.001 | ||
iPTH/100≤18 | 0.006(-0.003, 0.015) | 0.221 | 0.002 (-0.008, 0.012) | 0.713 | ||
iPTH/100>18 | -0.017(-0.030, -0.004) | 0.014 | -0.013 (-0.020, -0.006) | <0.001 |
[1] |
Cozzolino M, Shilov E, Li Z, et al. Pattern of laboratory parameters and management of secondary hyperparathyroidism in countries of Europe, Asia, the Middle East, and North America[J]. Adv Ther, 2020, 37(6): 2748-2762.
doi: 10.1007/s12325-020-01359-1 pmid: 32410164 |
[2] | Wang J, Bieber BA, Hou FF, et al. Mineral and bone disorder and management in the China dialysis outcomes and practice patterns study[J]. Chin Med J (Engl), 2019, 132(23): 2775-2782. |
[3] |
Pimentel A, Ureña-Torres P, Zillikens MC, et al. Fractures in patients with CKD-diagnosis, treatment, and prevention: a review by members of the European Calcified Tissue Society and the European Renal Association of nephrology dialysis and transplantation[J]. Kidney Int, 2017, 92(6): 1343-1355.
doi: S0085-2538(17)30567-7 pmid: 28964571 |
[4] |
Ketteler M, Block GA, Evenepoel P, et al. Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) guideline update: what’s changed and why it matters[J]. Kidney Int, 2017, 92(1): 26-36.
doi: S0085-2538(17)30249-1 pmid: 28646995 |
[5] |
West SL, Lok CE, Langsetmo L, et al. Bone mineral density predicts fractures in chronic kidney disease[J]. J Bone Miner Res, 2015, 30(5): 913-919.
doi: 10.1002/jbmr.2406 URL |
[6] |
Leder BZ. Parathyroid hormone and parathyroid hormone-related protein analogs in osteoporosis therapy[J]. Curr Osteoporos Rep, 2017, 15(2): 110-119.
doi: 10.1007/s11914-017-0353-4 URL |
[7] |
Iimori S, Mori Y, Akita W, et al. Diagnostic usefulness of bone mineral density and biochemical markers of bone turnover in predicting fracture in CKD stage 5D patients-a single-center cohort study[J]. Nephrol Dial Transplant, 2012, 27(1): 345-351.
doi: 10.1093/ndt/gfr317 URL |
[8] |
Kumar R, Thompson JR. The regulation of parathyroid hormone secretion and synthesis[J]. J Am Soc Nephrol, 2011, 22(2): 216-224.
doi: 10.1681/ASN.2010020186 URL |
[9] |
Wojda SJ, Donahue SW. Parathyroid hormone for bone regeneration[J]. J Orthop Res, 2018, 36(10): 2586-2594.
doi: 10.1002/jor.24075 URL |
[10] |
Murray TM, Rao LG, Divieti P, et al. Parathyroid hormone secretion and action: evidence for discrete receptors for the carboxyl-terminal region and related biological actions of carboxyl- terminal ligands[J]. Endocr Rev, 2005, 26(1): 78-113.
doi: 10.1210/er.2003-0024 URL |
[11] |
Malluche HH, Davenport DL, Cantor T, et al. Bone mineral density and serum biochemical predictors of bone loss in patients with CKD on dialysis[J]. Clin J Am Soc Nephrol, 2014, 9(7): 1254-1262.
doi: 10.2215/CJN.09470913 URL |
[12] |
Huang GS, Chu TS, Lou MF, et al. Factors associated with low bone mass in the hemodialysis patients-a cross-sectional correlation study[J]. BMC Musculoskelet Disord, 2009, 10: 60.
doi: 10.1186/1471-2474-10-60 URL |
[13] |
Jerome CP, Burr DB, Van Bibber T, et al. Treatment with human parathyroid hormone(1-34) for 18 months increases cancellous bone volume and improves trabecular architecture in ovariectomized cynomolgus monkeys (Macaca fascicularis)[J]. Bone, 2001, 28(2): 150-159.
pmid: 11182372 |
[14] | Lau WL, Obi Y, Kalantar-Zadeh K. Parathyroidectomy in the management of secondary hyperparathyroidism[J]. Clin J Am Soc Nephrol, 2018, 13(6): 952-961. |
[15] |
郑淑蓓, 郑育, 李占园, 等. 成纤维细胞生长因子23、Klotho蛋白与血液透析患者骨密度改变的关系[J]. 中华肾脏病杂志, 2016, 32(5): 321-326.
doi: 10.3760/cma.j.issn.1001-7097.2016.05.001 |
[16] |
Chu X, Zhu Y, Wang O, et al. Bone mineral density and its serial changes are associated with PTH levels in pseudohypoparathyroidism type 1B patients[J]. J Bone Miner Res, 2018, 33(4): 743-752.
doi: 10.1002/jbmr.3360 URL |
[17] |
Gao C, Qiao J, Li SS, et al. The levels of bone turnover markers 25(OH)D and PTH and their relationship with bone mineral density in postmenopausal women in a suburban district in China[J]. Osteoporos Int, 2017, 28(1): 211-218.
doi: 10.1007/s00198-016-3692-6 pmid: 27468899 |
[18] |
Kazama JJ, Wakasugi M. Parathyroid hormone and bone in dialysis patients[J]. Ther Apher Dial, 2018, 22(3): 229-235.
doi: 10.1111/1744-9987.12678 URL |
[1] | 高健, 王德琴, 周永华, 缪娴静, 陈宇, 景鑫, 王艳. 血清生长刺激表达基因2蛋白和脂蛋白相关磷脂酶A2与维持性血液透析患者心血管事件的关系[J]. 内科理论与实践, 2022, 17(04): 295-300. |
[2] | 李荣国, 张伟军, 徐婷燕, 杜琪威. 甲状旁腺全切除联合自体前臂移植治疗继发性甲状旁腺功能亢进[J]. 外科理论与实践, 2022, 27(04): 346-350. |
[3] | 杜艳萍, 程群. 骨质疏松症使用甲状旁腺激素类似物和双膦酸盐序贯治疗的机制及策略[J]. 诊断学理论与实践, 2020, 19(03): 219-224. |
[4] | 王琳, 陈东, 朱峰, 辛明徽, 刘畅, 彭程, 刘强强,. 甲状旁腺次全切除术和西那卡塞口服对难治性甲状旁腺功能亢进患者骨代谢的影响[J]. 内科理论与实践, 2018, 13(06): 364-367. |
[5] | 赵雪, 陈丽萌,. 慢性肾脏病矿物质和骨异常患者骨折风险评估及临床意义[J]. 内科理论与实践, 2018, 13(04): 244-249. |
[6] | 赵东宝, 高颖, 贺玲玲,. 骨关节炎与骨质疏松症关系的再认识[J]. 诊断学理论与实践, 2014, 13(03): 237-239+241+240. |
[7] | 王筱婧, 陈瑛, 郁静嘉, 焦培林, 孙立昊, 陶蓓, 宣言, 刘建民, 王卫庆, 赵红燕,. 血清骨钙素水平与绝经后女性2型糖尿病患者骨密度的关系[J]. 诊断学理论与实践, 2014, 13(01): 68-71. |
[8] | 巩云霞, 庞小芬, 高丽红, 王颖,. 上海老年男性血清维生素D水平状况调查[J]. 诊断学理论与实践, 2012, 11(01): 34-37. |
[9] | 孟迅吾,. 原发性骨质疏松症的危险因素和风险评估[J]. 诊断学理论与实践, 2012, 11(01): 1-4. |
[10] | 李淼, 胡伟伟, 张增, 胡云秋, 章振林,. 410名绝经后健康妇女身体成分与骨密度相关性的研究[J]. 诊断学理论与实践, 2012, 11(01): 30-33. |
[11] | 王赎, 刘建民,. 骨质疏松症的全基因组关联分析进展[J]. 诊断学理论与实践, 2010, 9(05): 518-520. |
[12] | 张旻佳, 刘建民,. 骨质疏松症的最新基因学研究进展[J]. 内科理论与实践, 2009, 4(04): 349-352. |
[13] | 孙静, 庞小芬, 巩云霞, 王萍, 严美珠,. 血清性激素水平与老年男性骨代谢指标及骨密度的关系[J]. 内科理论与实践, 2008, 3(04): 272-275. |
[14] | 赵琳, 刘建民,. 正常血钙的原发性甲状旁腺功能亢进[J]. 内科理论与实践, 2008, 3(01): 64-66. |
[15] | 顾振辉, 付宏亮, 吴靖川, 王辉, 李佳宁,. 甲状腺癌术后碘-131治疗后腰椎骨密度检测分析[J]. 诊断学理论与实践, 2007, 6(05): 451-452. |
阅读次数 | ||||||
全文 |
|
|||||
摘要 |
|
|||||