摘要
目的 研究调查移植肾受者骨密度并分析其主要影响因素。方法 选取移植肾功 能正常的受者140例,其中50例患者移植前检测血钙、磷、甲状旁腺激素、骨钙素、活性维生素D、 尿钙和尿吡啶啉,双能X线吸收法测定腰椎和股骨近端骨密度。结果 移植前患者钙、磷代谢异 常明显,移植后血钙、磷、甲状旁腺激素、骨钙素、活性维生素D等均有明显改善,但尿钙/肌酐和尿 吡啶啉/肌酐有增高趋势,股骨骨密度明显下降。平均每日激素用量为移植后尿钙/肌酐的主要预 测因素。每日环孢素用量、体重指数与移植受者各部位骨密度明显正相关。累计激素用量是肾移 植绝经女性病人腰椎和股骨颈骨密度的不良预测因素。结论 患者肾移植后骨量减少和骨质疏松 的发生率较高。骨质吸收增加可能是其主要原因。激素是移植肾受者尤其绝经女性骨质吸收增加 的主要因素之一。
Objective To observe bone loss and analyze its risk factors in kidney transplant recipients.Methods A cross-sectional study was conducted to investigate bone metabolism in 140 native kidney transplantation patients with normal renal function(serum creatinine≤2mg/dl).The following baseline data were obtained on each subject:age,sex,cause of renal failure,the duration of dialysis before transplantation,the immunosuppression regimen employed,cumulative prednisone and cyclosporine doses. Bone mineral density (BMD) in the lumbar vertebrae and hip was measured by dual-energy X-ray absorptiometry (DEXA).Serum parathyroid hormone (iPTH) was measured by immunoradiometic assay,serum level of 1,25 dihydroxy vitamin D[1,25(OH)2 vitamin D] was tested by RIA.Markers for bone formation (serum osteocalcin) and bone resorption[ratio of urinary calcium and creatinine (Uca/cr)] were also measured.Results Serum calcium, phosphorus and PTH were abnormal in patients before transplantation,most of them were improved after transplantation.Uca/cr and Upyd/cr increased and the BMD in the femur was decreased significantly after transplantation.Cyclosporine (CsA) doses and body mass index (BMI) were predictors for BMD at the lumbar spine.BMI and female were predictors for BMD in the femoral neck.Serum level of calcium and BMI were predictors for BMD in the femoral trochanter.BMD was not associated with prednisone doses,serum levels of PTH and BGP,but there were significant association between serum PTH and serum phosphorus,duration of dialysis,prednisone doses.Conclusion The prevalence of osteopenia and osteoporosis is high in renal transplant recipients.The use of prednisone contributes mainly to bone loss.The role of cyclosporine in bone metabolism is to be investigated.
出处
《临床内科杂志》
CAS
2005年第2期85-88,共4页
Journal of Clinical Internal Medicine
关键词
肾移植
骨质疏松
骨密度
Kidney transplantation
Osteoporosis
Bone mineral density
