高转换型肾性骨病中骨保护素及其配体的表达和形态计量学观察

目的 观察高转换型肾性骨病中骨保护素及其配体 (OPG，RANKL)的表达，并与骨形态计量学指标进行相关分析。 方法 选择10例慢性肾衰尿毒症患者和3例正常人进行髂骨活检术，获得骨组织标本。采用免疫组化方法检测OPG和RANKL蛋白质的表达。采用全自动图像分析系统进行骨组织形态计量学测定。结果 10例慢性肾衰尿毒症患者经骨病理学检查证实均为高转换型骨病，以破骨细胞活化形成骨吸收陷窝伴或不伴骨矿化不全为特点。免疫组化显示尿毒症患者骨组织中以RANKL阳性表达为主。与正常对照相比，RANKL阳性表达细胞数目显著增加，OPG阳性表达细胞数目显著减少。尿毒症患者RANKL的阳性表达细胞数目与骨吸收面积和破骨细胞数目呈显著正相关。结论 高转换型肾性骨病中，PTH的溶骨作用可能是通过OPG/RANKL/RANK系统介导的。

Expression of osteoprotegerin and osteoprotegerin ligand in high turnover bone disease and histomorphometric analysis of bone tissue

Objective To investigate the expression of osteoprotegerin(OPG)and osteoprotegerin ligand (RANKL) in high turnover renal bone disease and study the correlation between immunohistochemistry and histomorphometric measurements of bone. Methods Bone biopsy was performed on ten chronic renal failure (CRF) patients and three normal persons. Bone tissues were studied for OPC and RANKL expression by immunohistochemistry and histomorphometric measurement using an automatic image analysis system. Results Ten uremic patients were found to have high turnover bone disease according to the bone histology. A significantly increasing tendency of RANKL-positive cells and a significantly reducing tendency of OPG-positive cells were observed in CRF patients compared with control subjects. Histomorphometric analysis showing that the number of RANKL-positive cells was significantly correlated with histologically increasing bone resorbtion (both bone resorbtion surface and number of osteoclasts) in uremic patients. Conclusion OPG/RANKL/ RANK system is involved in high turnover renal bone disease by parathyroid hormone.