骨质流失可能代表透析病患的心脏健康不佳


  【24drs.com】根据在线发表于4月2日美国肾脏病学会期刊的一篇研究,副甲状腺值高与骨质流失可以预测透析患者的冠状动脉钙化(coronary artery calcification,CAC)病程。
  
  肯塔基大学肾、骨骼和矿物质代谢科Hartmut H. Malluche医师在新闻稿中表示,我们发现,副甲状腺值高与后续的骨质流失,是血管钙化病程的主要风险因素。
  
  他指出,与传统的已知风险因素不同,这两个因素迄今尚未被探讨。
  
  作者们指出,副甲状腺素值升高导致钙质从骨骼释出,造成骨质流失与变薄;因为慢性肾脏病而接受透析的患者,大部分也患有冠状动脉钙化,冠状动脉钙化增加了心血管事件风险,最后成为大部份慢性肾病患者的死亡原因。
  
  因此,Malluche医师等人建议,接受透析的病患应监测副甲状腺素值或骨质密度(BMD),以预测他们的冠状动脉钙化病程。
  
  在2009年8月至2013年4月间,研究者从肯塔基州的38个透析中心招募了213名研究对象,这些研究对象在纳入时与一年时进行了例行检验、骨质代谢血清标记与冠状动脉钙化。在这两个时间点,研究者还使用了双能X光骨密度扫描和定量计算机断层评估骨质密度。他们使用心脏多切计算机断层以及冠状动脉钙化量的冠状动脉钙化平方根(针对扫描变异情况的分析技术)评估冠状动脉钙化。
  
  开始时,约80%的研究对象有冠状动脉钙化,其中约50%测量发现心血管事件风险高,三分之一研究对象患有骨质疏松。
  
  开始时的冠状动脉钙化独立正向预侧因子,包括冠状动脉疾病、糖尿病、接受透析的期间、年龄、纤维母细胞生长因子23(调节血清磷、帮助维持骨骼强度)的浓度。相对的,脊椎的骨质密度则是反比预测开始时的冠状动脉钙化。
  
  完成研究的122名病患中,约四分之三在一年时发生冠状动脉钙化病程。冠状动脉钙化病程的独立风险因素,包括年龄、骨质疏松(β = 4.6;95%信赖区间1.8 - 7.5;P = .002),校正年龄之后,开始时的荷尔蒙值或副甲状腺值是正常值9倍以上(β = 6.9;95%信赖区间2.4 - 11.4;P = .003)。
  
  研究者指出一些研究限制,包括受筛检的病患有将近20%因为严重共病症或心智状态不佳而被排除,此外,这篇研究的前瞻短期性质,无法确认疾病机转与长期关系。
  
  Malluche医师在新闻稿中指出,骨骼钙化与血管钙化之间存在有重要的关联;他强调,须进行研究以厘清预防骨质流失是否可以延缓血管钙化的病程。
  
  资料来源:http://www.24drs.com/
  
  Native link:Bone Loss May Indicate Poor Heart Health in Dialysis Patients

Bone Loss May Indicate Poor Heart Health in Dialysis Patients

By Veronica Hackethal, MD
Medscape Medical News

High parathyroid hormone levels and bone loss may predict progression of coronary artery calcification (CAC) in patients receiving dialysis, according to a study published online April 2 in the Journal of the American Society of Nephrology.

"We discovered that high parathyroid hormone and the consequential bone loss are major risk factors for progression of vascular calcifications," Hartmut H. Malluche, MD, from the Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, commented in a news release.

"These two factors were heretofore not appreciated and were independent from traditional known risk factors," he added.

Elevated parathyroid hormone levels cause the release of calcium from bone, leading to bone loss and thinning. Most patients receiving dialysis for chronic kidney disease have CAC. CAC increases the risk for cardiovascular events, which in turn cause the majority of deaths in patients with CKD, the authors note.

Therefore, Dr Malluche and colleagues recommend monitoring bone loss with measurements of parathyroid hormone or bone mineral density (BMD) as a way to predict progression of CAC in patients receiving dialysis.

Between August 2009 and April 2013, the researchers enrolled 213 participants from 38 dialysis centers in Kentucky. Participants underwent measurement of routine laboratory tests, serum markers of bone metabolism, and CAC at baseline and 1 year. The researchers also evaluated BMD at both points using dual-energy X-ray absorptiometry scans and quantitative computed tomography. They assessed CAC using multislide computed tomography of the heart and CAC square root of coronary artery calcification volume, an analytic technique that accounts for variability in scanning.

About 80% of participants had CAC at baseline, and almost 50% of these had measurements suggesting high risk for cardiovascular events. One third of participants had osteoporosis.

Independent positive predictors of baseline CAC included coronary artery disease, diabetes, length of time receiving dialysis, age, and concentration of fibroblast growth factor 23, which regulates serum phosphate levels and helps maintain bone strength. In contrast, BMD of the spine inversely predicted baseline CAC.

CAC progression at 1 year occurred among three quarters of the 122 patients who completed the study. Independent risk factors for CAC progression included age, osteoporosis (β = 4.6; 95% confidence interval, 1.8 - 7.5; P = .002), and baseline total or whole parathyroid hormone more than nine times the normal value, after adjusting for age (β = 6.9; 95% confidence interval, 2.4 - 11.4; P = .003).

The researchers note several limitations for the study, including exclusion of about 20% of screened patients because of severe comorbidities or impaired mental status. In addition, the prospective, short-term nature of the study precluded determination of disease mechanisms and long-term relationships.

Dr Malluche noted in the press release that important links may exist between the level of calcification in bones and calcifications in blood vessels.

"Studies need to be done to find out whether prevention of bone loss will reduce progression of vascular calcifications," he emphasized.

The authors have disclosed no relevant financial relationships.

J Am Soc Nephrol. Published online April 2, 2015.

    
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