内科

目的探讨慢性肾脏病(CKD)患者骨质疏松和心血管钙化情况与骨代谢标志物的相关性。方法纳入412例CKD患者，根据CKD分期将其分至CKD 3期组（46例）、CKD 4期组（54例）和CKD 5期组（312例），另取60名同期健康体检者作为对照组。比较各组生化指标、骨代谢指标，骨质疏松、心血管钙化情况和血清炎症因子水平。应用Spearman秩相关分析不同分期CKD患者骨质疏松和心血管钙化情况与骨代谢标志物水平的相关性。结果CKD 3、4、5期组估算肾小球滤过率（eGFR）水平均低于对照组，且CKD患者eGFR水平随着CKD分期增加降低（均P＜0.05）。CKD 3、4、5期组血清磷、全段甲状旁腺激素（iPTH）、骨碱性磷酸酶（BALP）、1型前胶原氨基端肽（P1NP）、β-Ⅰ型胶原C-末端交联肽（β-CTX）水平均高于对照组；随着CKD分期增加，CKD患者血清磷、iPTH、BALP、P1NP、β-CTX水平均升高（均P＜0.05）。CKD 5期组骨质疏松发生率高于对照组、CKD 3期组和CKD 4期组；CKD 3、4、5期组心血管钙化发生率均高于对照组；CKD 5期组心脏瓣膜钙化发生率高于对照组、CKD 3期组和CKD 4期组（均P＜0.05）。Spearman秩相关分析结果显示：CKD患者骨质疏松、心血管钙化、心脏瓣膜钙化的发生与eGFR、血清钙水平均呈负相关，与血清磷、iPTH、BALP、P1NP、β-CTX水平均呈正相关（均P＜0.05）。随着CKD分期增加，CKD患者血清白细胞介素-6、肿瘤坏死因子-α、C反应蛋白水平均升高（均P＜0.05）。结论CKD患者骨质疏松和心血管钙化情况和eGFR与骨代谢指标水平密切相关。

ObjectiveTo investigate the correlations of osteoporosis and cardiovascular calcification with markers of bone metabolism in patients with chronic kidney disease (CKD). MethodsA total of 412 patients with CKD were included and divided into a CKD stage 3 group (46 cases), a CKD stage 4 group (54 cases), or a CKD stage 5 group (312 cases) according to their CKD stage, and 60 healthy individuals underwent physical examination were selected as the control group. The biochemical indexes, bone metabolism indexes, conditions of osteoporosis and cardiovascular calcification, and serum inflammatory factors levels were compared among groups. Spearman′s rank correlation was used to analyze the correlations of osteoporosis and cardiovascular calcification with markers of bone metabolism in patients with different CKD stages. ResultsThe estimated glomerular filtration rate (eGFR) levels of the CKD stage 3, 4, and 5 groups were lower than that of the control group, and the eGFR level of CKD patients decreased with CKD stage increasing(all P＜0.05). The serum levels of phosphorus, intact parathyroid hormone (iPTH), bone alkaline phosphatase (BALP), type 1 procollagen N-terminal peptide (P1NP), and β-crosslinked C-terminal telopeptide of type 1 collagen(β-CTX) in the CKD stage 3, 4, and 5 groups were higher than those in the control group; with CKD stage increasing, the serum levels of phosphorus, iPTH, BALP, P1NP, and β-CTX in CKD patients increased (all P＜0.05). The incidence of osteoporosis in the CKD stage 5 group was higher than that in the control group, CKD stage 3 group, and CKD stage 4 group; the incidences of cardiovascular calcification in the CKD stage 3, 4, and 5 groups were higher than that in the control group; the incidence of heart valve calcification in the CKD stage 5 group was higher than that in the control group, the CKD stage 3 group, and the CKD stage 4 group (all P＜0.05). The results of Spearman′s rank correlation analysis showed that the incidences of osteoporosis, cardiovascular calcification, and heart valve calcification were negatively correlated with eGFR and serum calcium level, and positively correlated with serum phosphorus, iPTH, BALP, P1NP, and β-CTX levels in CKD patients (all P＜0.05). With CKD stage increasing, the serum levels of interleukin-6, tumor necrosis factor-α, and C-reactive protein increased in CKD patients (all P＜0.05). ConclusionOsteoporosis and cardiovascular calcification are closely correlated to eGFR and the level of bone metabolism indexes in CKD patients.