血液透析患者血中骨質疏鬆標誌物與生化指數的相關性研究

Correlations of Osteoporosis Markers and Biochemical Parameters in Hemodialysis Patients

楊惠茹(Hui-Ru Yang)

指導教授 ： 黃友利

高雄醫學大學/健康科學院/醫學檢驗生物技術學系碩士班/碩士(2018年)

摘要

慢性腎臟病與礦物質代謝異常有著密切相關，現有研究顯示末期腎臟病患骨質密度較低，然而探討血液透析患者血中骨質疏鬆標誌物與生化指數間的相關性研究則較為闕如。本研究利用血液透析前的血液檢查探索病患血液中骨質疏鬆標誌物與生化指數間的相關性，期能協助評估骨質的病變。本研究的對象為181名血液透析患者，包括男性99位及女性82位。利用自動化儀器進行血液中骨質疏鬆標誌物及生化參數的檢測，並利用多變項線性回歸分析骨質疏鬆標誌物與參數間的相關性。研究結果顯示女性患者血色素數值顯著低於男性患者(p < 0.001)。第一型前膠原蛋白氮端前胜鏈(PINP)與年齡及白蛋白皆呈負相關(p < 0.05)，而與總鈣則呈正相關(p< 0.001)。β型的天門冬胺酸與鈣磷沉積物呈現負相關(p< 0.001)。骨質特異性鹼性磷酸酶與性別及白蛋白皆呈負相關(p < 0.05)，而與總鈣呈正相關(p < 0.05)。Dickkopf (DKK1)相關蛋白與白蛋白呈正相關(p< 0.001)。硬皮蛋白(SOST)與總鈣及25-羥基維他命D呈負相關(p < 0.05)。總括而言，本研究的骨質疏鬆標誌物DKK1及SOST皆高於正常參考值，SOST為骨質分解的指數，顯示因骨質大量分解增加骨鬆的可能性大幅提高。DKK1為天然的生長因子拮抗劑，血中數值升高不僅與骨頭病變有關，也可能是退化性關節炎的重要因子。此外，此二項與白蛋白及25-羥基維他命D之間皆呈現負相關，因此增加血中白蛋白與25-羥基維他命D應有助益。

關鍵字

慢性腎臟病 ； 血液透析 ； 骨質疏鬆 ； 生化指數 ； 標誌物

並列摘要

Chronic kidney disease is closely correlated with the abnormal mineral metabolism. Although many studies have shown that patients with chronic kidney disease have lower bone density, however few studies have included studies on biochemical osteoporosis markers in patients with hemodialysis. This study aimed to, based on hematological examination, early detect biochemical osteoporosis markers to evaluate bone lesions and prevent the risk of bone disease leading to fractures. A total of 181 patients (male 99, female 82) with hemodialysis were evaluated. The blood biochemical and immunological parameters were measured using automated instruments via routine examination of blood before hemodialysis. Multivariable linear regression analysis was used to explore the correlation between osteoporosis markers and other parameters. The laboratory reports showed that hemoglobin values of women were significantly lower than in men (p < 0.001). PINP was negatively correlated with age and albumin (p < 0.05) and was positively correlated with total calcium (p < 0.001). β-CTx was negatively correlated with calcium and phosphorus deposits (p<0.001). BAP was negatively correlated with gender and albumin (p < 0.05) and was positively correlated with total calcium (p < 0.05). DKK1 was positively correlated with albumin (p<0.001). There was a negative correlation between SOST and total calcium and 25-hydroxyvitamin D (p < 0.05). Both the levels of DKK-1 and SOST are higher than the reference value, which indicates the probability of bone looseness is greatly increased due to massive bone breakdown because SOST is the index of bone breakdown. DKK-1 is a natural growth factor antagonist. Elevated blood values are not only related to bone lesions, but may also be one of the culprits of degenerative arthritis. And these two items are negatively correlated with ALB and Vit-D, so it is helpful to increase ALB and Vit-D in blood.

並列關鍵字

chronic kidney disease ； hemodialysis ； osteoporosis ； biochemical parameter ； marker

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