vestimИзвестия Национальной академии наук Беларуси. Серия медицинских наукProceedings of the National Academy of Sciences of Belarus, Medical series1814-60232524-2350The Republican Unitary Enterprise Publishing House "Belaruskaya Navuka"10.29235/1814-6023-2022-19-3-263-277vestim-861Research ArticleКЛИНИЧЕСКАЯ И ЭКСПЕРИМЕНТАЛЬНАЯ МЕДИЦИНАCLINICAL AND EXPERIMENTAL MEDICINEБиохимические маркеры костного метаболизма в диагностике минеральных и костных нарушений, ассоциированных с хронической болезнью почекBiochemical markers of bone metabolism in the diagnosis of mineral and bone disorders associated with chronic kidney diseaseКарловичН. В.KarlovichN. V.

Карлович Наталия Викторовна ‒ кандидат медицинских наук, доцент.

Пр-т Независимости, 64, 220040, Минск

Natalia V. Karlovich ‒ Ph. D. (Med.), Associate Professor.

83, Dzerzhinski Ave., 220116, Minsk

natkarlovich@gmail.comСпиридоноваО. С.SpiridonovaO. S.

Спиридонова Ольга Сергеевна ‒ младший научный сотрудник.

Пр-т Независимости, 64, 220040, Минск

Olga S. Spiridonova ‒ Junior Researcher.

83, Dzerzhinski Ave., 220116, Minsk

spiry87@mail.ruМохортТ. В.MokhortT. V.

Мохорт Татьяна Вячеславовна ‒ доктор медицинских наук, профессор, главный научный сотрудник, заведующий кафедрой.

Пр. Дзержинского, 83, 220116, Минск

Tatiana V. Mokhort ‒ D. Sc. (Med.), Professor, Chief Researcher, Head of the Department.

83, Dzerzhinski Ave., 220116, Minsk

tatsianamokhort@gmail.comВасильеваН. А.VasilyevaN. A.

Васильева Наталья Анатольевна ‒ врач-рентгенолог.

Ул. Макаенка, 17, 220017, Минск

Natalya A. Vasilyeva ‒ Radiologist.

17, Makayonok Str., 220017, Minsk

СнапковВ. С.SnapkovV. S.

Снапков Виталий Степанович ‒ врач лабораторной диагностики.

Ул. Макаенка, 17, 220017, Минск

Vitaliy S. Snapkov – Doctor of Laboratory Diagnostics.

17, Makayonok Str., 220017, Minsk

СердюченкоН. С.SerdyuchenkoN. S.

Сердюченко Николай Сергеевич – член-корреспондент, доктор медицинских наук, профессор.

Пр-т Независимости, 66, 220012, Минск

Nikolay S. Serdyuchenko – Corresponding Member, D. Sc. (Med.), Professor.

66, Nezavisimosti Ave., 220012, Minsk

Белорусский государственный медицинский университетBelarusian State Medical UniversityРеспубликанский центр медицинской реабилитации и бальнеолеченияBelarusian State Medical UniversityНациональная академия наук БеларусиNational Academy of Sciences of Belarus202208092022193263277Copyright © Карлович Н.В., Спиридонова О.С., Мохорт Т.В., Васильева Н.А., Снапков В.С., Сердюченко Н.С., 20222022Карлович Н.В., Спиридонова О.С., Мохорт Т.В., Васильева Н.А., Снапков В.С., Сердюченко Н.С.Karlovich N.V., Spiridonova O.S., Mokhort T.V., Vasilyeva N.A., Snapkov V.S., Serdyuchenko N.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestimed.belnauka.by/jour/article/view/861

Диагностические возможности применения биохимических маркеров костного метаболизма у пациентов с вторичным гиперпаратиреозом (ВГПТ) и хронической болезнью почек (ХБП) в настоящее время не получили должной оценки.

Нами проанализированы показатели минеральной плотности кости по данным двойной рентгеновской абсорбциометрии, а также биохимические маркеры костного метаболизма остеокальцин (ОС), С-терминальный телопептид коллагена первого типа (СТх), щелочная фосфатаза (ЩФ), в том числе с применением нейросетевого алгоритма, у 452 пациентов с различными стадиями ХБП и у 60 лиц группы сравнения (контроль).

Установлено, что уровни биохимических маркеров костного метаболизма у пациентов с ХБП прогрессивно возрастают при усугублении почечной недостаточности и зависят от содержания паратгормона, наличия ВГПТ и остеопороза. Оценка ОС, СТх, ЩФ может использоваться как источник дополнительной информации о состоянии костного обмена у пациентов с ВГПТ и ХБП. Следует учитывать, что у пациентов с ХБП 4‒5-й стадии уровни ОС, СТх значительно превышают показатели в здоровой популяции, что обусловлено как повышением метаболизма кости, так и замедлением процессов деградации и элиминации данных маркеров.

С помощью нейросетевого алгоритма изучены референтные интервалы данных показателей в зависимости от стадии ХБП. Полученные данные являются основой для разработки рекомендаций по диагностике остеопатии при ВГПТ и ХБП, а также по многофакторной профилактике и коррекции данной патологии. Только комплексная оценка состояния кости позволяет объективно оценить ее состояние и выбрать эффективный и безопасный способ коррекции выявленных нарушений.

The diagnostic possibilities of using biochemical markers of bone metabolism in patients with secondary hyperparathyroidism (SHPT) and chronic kidney disease (CKD) have not yet been properly evaluated.

We analyzed indicators of bone mineral density according to double X-ray absorptiometry, as well as biochemical markers of bone metabolism (OC, CTx, ALP), incl. using a neural network algorithm, in 452 patients with various stages of CKD and in 60 persons of the comparison group (control).

It has been established that the levels of biochemical markers of bone metabolism in patients with CKD progressively increase with aggravation of renal failure, and are interrelated with PTH and the presence of SHPT, as well as with the presence of osteoporosis. Estimation of OC, CTx, ALP can be used as a source of additional information about the state of bone metabolism in patients with SHPT and CKD. It should be taken into account that in patients with CKD 4–5, the levels of OC, CTx significantly exceed those in a healthy population, due to both an increase in bone metabolism and a slowdown in the process of degradation and elimination of these markers.

Using a neural network algorithm, we proposed reference intervals for these indicators depending on the stage of CKD. The data obtained are the basis for the development of recommendations for the diagnosis of osteopathy in SHPT and CKD, as well as multifactorial prevention and correction of this pathology. Only a comprehensive assessment of the state of the bone will make it possible to objectively assess its condition and choose an effective and safe way to correct the identified violations.

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