nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2007-11-2-50-54nefr-786Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSФАКТОРЫ, АССОЦИИРОВАННЫЕ СО СНИЖЕНИЕМ МИНЕРАЛЬНОЙ ПЛОТНОСТИ КОСТЕЙ РАЗЛИЧНЫХ ОТДЕЛОВ СКЕЛЕТА У БОЛЬНЫХ НА ГЕМОДИАЛИЗЕFACTORS ASSOCIATED WITH THE DECREASED MINERAL DENSITY OF BONES OF DIFFERENT PARTS OF THE SKELETON IN HEMODIALYSIS PATIENTSВолковМ. М.VolkovM. M.

кафедра пропедевтики внутренних болезней

ДобронравовВ. А.DobronravovV. A.

кафедра пропедевтики внутренних болезней

ЛарионоваВ. И.LarionovaV. I.

кафедра пропедевтики внутренних болезней

ГлазковП. В.GlazkovP. V.

кафедра пропедевтики внутренних болезней

Научно-исследовательский институт нефрологии Санкт-Петербургского государственного медицинского университета им. акад. И.П. ПавловаRussian Federation2007100220071125054Copyright © Волков М.М., Добронравов В.А., Ларионова В.И., Глазков П.В., 20072007Волков М.М., Добронравов В.А., Ларионова В.И., Глазков П.В.Volkov M.M., Dobronravov V.A., Larionova V.I., Glazkov P.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/786

ЦЕЛЬ ИССЛЕДОВАНИЯ. Определить факторы, связанные с развитием остеопении и остеопороза разных отделов скелета у пациентов на хроническом гемодиализе (ГД), помимо показателей фосфорно-кальциевого обмена. ПАЦИЕНТЫ И МЕТОДЫ. Двухэнергетическая рентгеновская абсорбциометрия (ДЭРА) 3 отделов скелета с оценкой минеральной плотности костей (МПК) по Z-критерию выполнена у 58 больных (м/ж - 29/29, средний возраст 49,8±13,3 (Х±SD) лет, получающих хронический бикарбонатный гемодиализ в среднем 74,3±70,1 мес. У 30 пациентов изучен генетический полиморфизм рецептора витамина D3. Оценивали длительность менопаузы у женщин, наличие вирусного гепатита В и С, интенсивность курения, злоупотребление алкоголем, физическую активность, терапию глюкокортикостероидами (ГКС) и цитостатиками (ЦС), наличие трансплантаций почек в анамнезе. РЕЗУЛЬТАТЫ. На МПК поясничных позвонков влияет генетический полиморфизм рецептора витамина D3 TAQI: при генотипе tt МПК была выше по сравнению с Tt и TT (F=3,39, Panova=0,049). Также определялась прямая связь МПК с количеством лейкоцитов крови (Rs=0,33; p=0,015). МПК проксимального отдела бедра была выше у пациентов с большей массой тела (Rs=0,57; p<0,001), большим числом лейкоцитов крови (Rs=0,35; p=0,012). МПК предплечья зависело от множества факторов. Выявлена обратная связь с длительностью ГД (Rs=-0,49; p<0,001), длительностью терапии ГКС (Rs=-0,34; p=0,028), и ЦС (Rs=-0,54; p<0,001), аллотрансплантациями почек в анамнезе (Рэ=-0,41; р=0,002), наличием вирусного гепатита В, С или их сочетанием (Rs=-0,35; p=0,009), высоким уровнем АЛТ крови (Rs=-0,39; р=0,004) и позитивная: с уровнем холестерина (Rs=0,45; р<0,001) и альбумина крови (Rs=0,37; p=0,012). С длительностью ГД были связаны количество лейкоцитов крови (Rs=-0,30; p<0,001), наличие вирусного гепатита (Rs=0,54; p<0,001). ЗАКЛЮЧЕНИЕ. Выявлена связь МПК позвонков с генетическим полиморфизмом рецептора витамина D3. МПК предплечья коррелирует с большим числом факторов: длительностью лечения гемодиализом, проводимой терапией ГКС и ЦС, наличием трансплантаций почки в анамнезе, некоторыми лабораторными показателями нутриционного статуса.

THE AIM of the investigation was to determine factors associated with the development of osteopenia and osteoporosis of different parts of the skeleton in chronic hemodialysis patients besides the indices of phosphoro-calcium metabolism. PATIENTS AND METHODS. Dual X-ray absorptiometry of 3 parts of the skeleton with the estimation of the bone mineral density (BMD) by Z-criterion was fulfilled in 58 patients (m/w - 29/29, mean age 49.8 ± 13.3 years (X±SD) treated by chronic bicarbonate hemodialysis (HD) on average for 74.3±70.1 months. Genetic polymorphism of the vitamin D3 receptor was studied in 30 patients. Under estimation there were the duration of menopause in women, the presence of viral hepatitis В and C, intensity of smoking, alcohol abuse, physical activity, therapy with glucocorticosteroids (GCS) and cytostatics (CS), history of transplantation of the kidneys. RESULTS. BMD of the lumbar vertebra is influenced by genetic polymorphism of the vitamin D3 receptor TAQI: in tt genotype BMD was higher as compared with Tt and TT (F=3.39, Panova =0.049). In addition, a direct correlation between BMD and the number of blood leukocytes (Rs=0.33; p= 0.015) was also determined. BMD of the proximal part of the femur was higher in patients with greater body mass (Rs=0.57; p<0.001), greater number of leukocytes (Rs=0.35; p=0.012). BMD of the forearm wasdependent on many factors. The negative feedback was found with the duration of HD(Rs=-0.49; p<0.001), duration of GCS therapy (Rs=-034; p=0.028), and CS therapy (Rs=-0.54; p<0.001), allotransplantations of the kidneys in anamnesis (Rs=0.41; p=0.002), the presence of viral hepatitis В and С or their combination (Rs=-0,35; p=0.009), high level of blood ALT (Rs=-0.39; p=0.004) and positive: with the cholesterol level (Rs+0.45; p<0.001) and blood albumin (Rs=0.37; p<0.012). The number of blood leukocytes and the presence of viral hepatitis (Rs=0.54; p<0.001) were associated with the duration of HD. CONCLUSION. A relationship was revealed between BMD of the vertebra and the genetic polymorphism of the vitamin D3 receptor. BMD oftheforearm correlated with a great number of factors: duration of hemodialysis treatment, GCS and CS therapy, the presence of allotransplantations of the kidneys in anamnesis, certain laboratory indices of the nutritional status.

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The authors declare that there are no conflicts of interest present.