【摘要】目的 观察慢性肾脏病(chronic kidney disease,CKD) 3期开始纠正钙磷代谢紊乱对CKD患者桡动脉血管钙化的防治作用。方法 入选南方医科大学附属南海医院CKD 3、4和5期非透析患者106例，随机分为干预组及对照组，干预组进行钙磷代谢达标治疗。待进展到终末期肾病并行维持性血液透析治疗前作动静脉内瘘术并取部分桡动脉观察血管钙化程度及骨桥蛋白(osteopontin,OPN)、崞交〖《鞍(alpha smooth muscle actin,-SMA)的表达。结果 49例进入终末期肾病患者茜素红染色提示干预组血管钙化病例减少且程度明显减轻，免疫组化提示钙化病例较未钙化病例OPN表达增多、-SMA表达减少，干预组较对照组OPN表达相对减少、-SMA表达相对增多。结论 从 CKD 3和4期开始纠正钙磷代谢紊乱能有效减轻尿毒症患者桡动脉血管钙化。OPN、-SMA的表达变化先于明确钙化表现，OPN表达量与钙化正相关，-SMA表达量与钙化负相关。

【Abstract】 Objective To investigate the effects of early improving disorder of calcium and phosphorus metabolism on vascular calcification（VC） in stage 3 of chronic kidney disease (CKD). Methods 106 patients at stage 3, 4 and 5 of non-dialysis patients of CKD were divided into intervention group or control group randomly. Patients of intervention group were administered phosphate binding drugs or 1,25 dihydroxy vitamin D to ensure that their serum level calcium, intact phosphate or parathyroid hormone (iPTH) keep at the suitable extent of the K/DOQI guideline. The trial would be concluded if patients progressed to end-stage renal disease（ESRD）and needed hemodialysis or other replacement treatment. Segments of radial arteries were obtained during the operation of A-V fistula and observed by Alizarin red stain and immunohistochemical staining. Results 49 patients progressed to ESRD and needed replacement therapy finally. All subjects received A-V fistula operation in which some segments of radial arteries were obtained. Cases and severity of VC in intervention group were signi?cantly reduced compared with controls（P<0.05）. Osteopontin (OPN)抯 level was significantly increased and -smooth muscle actin(-SMA)抯 level was significantly decreased in VS cases compared with controls. Conclusion The intervention of calcium and phosphorus metabolism disorder earlier can effectively ameliorate VS in stage 3 or 4 CKD patients. Changes of OPN and -SMA are earlier than definite calcification. VC was positively correlated to OPN, and was negatively correlated to -SMA. OPN and -SMA may be earlier markers of VC in CKD patients.