中文摘要：

目的：观察高转换型肾性骨病中骨保护素（OPG）及其配体（RANKL）的表达，对骨病理进行骨形态计量学分析，并与外周血各项反映骨代谢的生化指标进行相关分析。方法：选择24例慢性肾衰竭尿毒症患者和3名正常人进行髂骨活检术．获得骨标本。采用免疫组化方法检测OPG和RANKL蛋白质表达，用全自动图像分析系统进行骨组织形态计量学测定，用酶联免疫吸附测定（ELISA）法检测外周血OPG、可溶性RANKL（sRANKL）水平，并对慢性肾衰竭尿毒症患者及对照者的检测结果进行对比分析。结果：24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。成骨细胞面积与碱性磷酸酶水平（AKP）呈显著正相关．而类骨质厚度与白蛋白水平呈显著负相关。结论：高转换型肾性骨病中，甲状旁腺激素（PTH）的溶骨作用可能是通过OPG／RANKL系统介导的，但外周血的OPG／sRANKL水平并不能预测该类骨病。

英文摘要：

Objective To investigate the expression of osteopotegerin （OPG） and osteoprotegerin ligand （RANKL） in nephrogenic high-turnover bone disease and analyze their correlation with histomorphometric measurements of bone and blood biochemical parameters reflecting bone metabolism. Methods Iliac bone biopsy was performed in 24 chronic renal failure patients and 3 normal persons. OPG and RANKL expressions in bone tissue were measured by immunohistochemistry, and histomorphometrie measurement was performed by using an automatic image analysis system. Serum levels of OPG and sRANKL were measured by ELISA. Results All 24 uremic patients were found to have high- turnover bone disease by bone histology. An increase in RANKL-positive cells were observed in chronic renal failure patients. There was a positive correlation between alkaline phosphatase （AKP） and area of osteogenic cells , and a negative correlation between osteoid thickness and albumin level. Conclusions In nephrogenic high-turnover bone disease, the osteoclastic effect of parathyroid hormone may be mediated by the OPG/RANKL system . However, the serum OPG and RANKL level could not predict the high-turnover bone disease.