中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (01): 48-53.doi: 10.3969/j.issn.1671-4091.2017.01.012

• 基础研究 • 上一篇    下一篇

维持性血液透析患者不同骨转换类型下松质骨微观结构的研究

常安瑾1,钱莹1,陈晓农1,张文1,王伟铭1,任红1,陈楠1   

  1. 1上海交通大学医学院附属瑞金医院肾脏内科
  • 收稿日期:2016-07-07 修回日期:2016-11-07 出版日期:2017-01-12 发布日期:2017-01-12
  • 通讯作者: 钱莹 qiany69@126.com E-mail:qiany69@163.com
  • 基金资助:

    国家自然科学基金(81170655)；十二五国家科技支撑计划项目(2011BAI10B06)；上海市自然科学基金(14ZR1425400)

The microstructure of cancellous bone in hemodialysis patients of different bone turnover

  • Received:2016-07-07 Revised:2016-11-07 Online:2017-01-12 Published:2017-01-12

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摘要： 目的分析不同骨转换状态下维持性血液透析(maintenance hemodialysis, MHD)患者松质骨微结构的差异。方法选取血液透析中心收治的年满18 周岁且同意接受骨活检的MHD 患者。对所有入组患者行骨活检获取髂前上棘松质骨标本，采用全自动图象数字化分析仪，对骨组织切片进行二维组织形态计量学参数测量。根据测量结果，将骨标本分为高、低、混合骨转换组。使用Micro-CT 技术(我院伤骨科研究所，SKYSCAN 1172，SKYSCAN 公司，比利时)，对所有标本进行三维形态计量学测量，空间分辨率10μm 体素，主要测量参数包括，骨小梁体积骨密度(volume bone mineral density,vBMD)、骨小梁体积分数(bone volume/tissue volume, BV/TV)、骨小梁厚度(trabecular thickness,Tb.Th)、骨小梁数量(trabecular number,Tb.N)、骨小梁分离度(trabecular seperation, Tb.Sp)、结构模型指数(structure
model index, SMI)以及各项异性程度(degree of anisotropy, DA)。采用方差检验，比较各组骨标本间松质骨微观结构的差异。使用Pearson 相关，分析高骨转换组中二维结构参数(骨活检测量)与三维结构参数(Micro-CT 扫描)之间的相关性。结果本研究共入组9 例骨活检标本，其中高骨转换、低骨转换以及混合骨转换各3 例。方差分析结果显示，3 组间三维结构参数(vBMD、BV/TV、Tb.N、Tb.Th、Tb.Sp、SMI 以及DA)比较无统计学差异(F=1.859，P=0.235；F=2.040，P= 0.211; F=0.509，P=0.625；F=0.126，P=0.883；F =0.436，P=0.666；F=3.311，P=0.107；F=0.304，P=0.749)。进一步比较高骨转换组中二维结构参数(骨小梁面积分数trabecular area,Tb.Ar；骨小梁宽度trabecular width, Tb.Wi)与三维结构参数(BV/TV、Tb.Th)之间的相关性，发现相同意义的两项指标(Tb.Ar 与BV/TV；Tb.Wi 与Tb.Th)用骨活检检测与用Micro-CT 检测，其结果无明显相关性(r=-0.848，P=0.355，r=-0.263，P=0.830)。结论在MHD 患者骨微结构的研究中，虽然我们并未发现不同骨转换状态下松质骨间存在显著的微结构差异，但通过Micro-CT 技术的应用我们能更全面细致的分析MHD 患者松质骨的空间构向，弥补组织形态计量学的不足，对研究肾性骨病病理生理，评估骨质量的改变具有十分重要的意义。

关键词: 终末期肾脏病, 骨转换, 骨活检, 骨微结构, Micro-CT

Abstract: Objective To investigate the characteristics of cancellous bone microstructure in maintenance hemodialysis (MHD) patients of different bone turnover. Methods The MHD patients were enrolled if they were 18 years of age or older and agreed to have a bone biopsy in our hemodialysis center. Bone biopsy was performed at iliac crest to obtain cancellous bone samples. The bone sections were analyzed histomorphometrically using computer aided planimetry. According to bone turnover status, the specimens were divided into three groups: high, low, and mixed bone turnover groups. Each specimen was measured by micro-CT(SKYSCAN 1172, Belguim) with a high spatial resolution of 10μm. The main measurement parameters included volume BMD, bone volume/tissue volume (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb.Sp), structure model index (SMI) and degree of anisotropy (DA). The differences of trabecular microstructure among the three groups were analyzed by ANOVA. The correlation between two dimensional structure parameters measured by histomorphometry and three dimensional structure parameters measured by micro-CT in high bone turnover group was analyzed by Pearson correlation method. Results Nine cancellous bone samples were included in this study, including 3 in high bone turnover group, 3 in low bone turnover group, and 3 in mixed bone turnover group. No differences in vBMD, BV/TV, Tb.N, Tb.Th, Tb. Sp, SMI and DA were found among the three groups (F= 1.859, P=0.235; F=2.040, P=0.211; F=0.509, P= 0.625; F=0.126, P=0.883; F=0.436, P=0.666; F=3.311, P=0.107; F=0.304, P=0.749). Bone histomorphometric measurements of trabecular area (Tb.Ar) and trabecular width (Tb.Wi) did not correlate with micro-CT measurements of BV/TV and Tb.Th (P=0.355, P=0.830). Conclusion Despite no differences in trabecular microstructure among the three bone turnover group, the measurement by micro-CT enables us to analyze the spatial conformation of cancellous bone more precisely and covers the shortage of histomorphometry. It has also great significance for us to study the pathophysiology of renal osteodystrophy and evaluate the bone quality.

Key words: End-stage renal disease, Bone turnover, Bone biopsy, Bone microstructure, Micro-CT