骨循环标记在慢性脏疾病中的临床用处
Praopilad Srisuwarn1,2, Richard Eastell1, Syazrah Salam1,3
1Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
Journal of bone metabolism
|December 19, 2024
概括
慢性病 (CKD) 矿物质和骨疾病 (CKD-MBD) 导致骨脆弱. 本综述检查了副甲状腺激素 (PTH) 和骨周转标记物,用于诊断骨缩症 (ROD) 和指导慢性病治疗.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 内分泌学 在内分泌学.
- 骨的新陈代谢 骨的新陈代谢
背景情况:
- 慢性病 (CKD) 经常与矿物质和骨疾病 (CKD-MBD) 相关,这种疾病在透析患者中几乎普遍存在.
- 慢性病-病包括酸代谢,血管和软组织化以及骨异常的障碍,它们被统称为骨质疏松症 (ROD).
- 慢性瘤患者的骨脆弱性源于骨质减少和骨质质量受损,导致骨折和死亡风险增加.
研究的目的:
- 审查甲状腺上腺激素 (PTH) 和特定骨周转标记在CKD患者ROD的诊断和管理中的实用性.
- 评估完整的公原类型N终端的I型原蛋白 (PINP),骨特异性性酸酶 (骨ALP) 和耐酸酸酸酶5b (TRAP-5b) 在评估骨周转的作用.
- 讨论这些标记物的应用,以预测骨折,并在CKD的背景下为ROD提供治疗策略.
主要方法:
- 关于CKD-MBD和ROD的现有文献和临床实践指南的审查.
- 对血清副甲状腺激素 (PTH) 水平的诊断和预后价值的分析.
- 关键骨转换标记物的评估:完整的公原类型N-终端 I型原蛋白 (PINP),骨特异性性酸酶 (骨ALP) 和耐酸酶5b (TRAP-5b).
主要成果:
- 骨组织形状测量,虽然是黄金标准,但由于其劳动密集和昂贵的性质,对于例行ROD诊断是不切实际的.
- 血清PTH和骨ALP是病改善全球结果 (KDIGO) 准则建议的,用于评估ROD中的骨周转率.
- 新出现的证据支持PINP和TRAP-5b在提供进一步了解骨周转动态方面的作用.
结论:
- 血清PTH和骨循环标记物,如骨ALP,PINP和TRAP-5b,为诊断CKD中的ROD提供了宝贵的,不那么侵入性的骨基因组学替代方案.
- 这些生化标志物有助于预测骨折风险,并可指导CKD-MBD患者的个性化治疗决策.
- 进一步的研究可能会巩固这些标记物在优化慢性病中骨病管理中的作用.
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