通过定量超声测量肾移植后的骨骼状况。

Measurement of skeletal status after renal transplantation by quantitative ultrasound.

作者信息

Kosch M, Hausberg M, Link T, Kemkes M, Barenbrock M, Dietl K H, Matzkies F, Rahn K H, Kisters K

机构信息

Department of Internal Medicine D/Nephrology, University of Münster, Germany.

出版信息

Clin Nephrol. 2000 Jul;54(1):15-21.

PMID:10939752

Abstract

BACKGROUND

Osteoporosis remains a major problem following kidney transplantation. Radiographic measures of bone mass are of limited predictive value after transplantation and are complicated by preexisting renal osteopathy. Quantitative ultrasound (QUS) is a new and non-invasive method to assess skeletal status, however, no data exist on ultrasonic bone parameter after kidney transplantation. We evaluated the potential use of this novel method in renal allograft recipients and studied the accuracy compared to normal controls.

METHOD

Thirty patients (NTP, age 47.5 +/- 13.0 years) were studied 4.8 +/- 3.2 years after transplantation. Twenty-five healthy control persons (CON) were matched for age and sex. The left and right os calcis were studied by QUS and speed of sound (SOS) and broadband ultrasound attenuation (BUA) were measured. Bone stiffness (BS) was calculated from these parameters and corrected for age (CBS). Differences between right and left os calcis were compared to CON to assess the side variability.

RESULTS

Mean +/- SD BS was 75 +/- 22% compared to young adults, age-corrected CBS was decreased in NTP with 86 +/- 25% of normal, indicating a two-fold increased risk of fracture. SOS was 1525 +/- 47.7 m/s, BUA 105 +/- 22 dB/MHz. Mean difference between right and left os calcis was significantly higher in NTP than in CON (7.2 +/- 7.1% vs. 2.1 +/- 2.1%, p < 0.01). Limits of agreement of the measurements (MW of differences +/- 2 SD) according to a Bland-Altmann-type statistic were -16.9% and 20.7%. There was no correlation between CBS and age, cumulative steroid dose, parathyroid hormone concentrations or time after transplantation.

CONCLUSION

Our data show altered bone structure expressed by low bone stiffness values measured by quantitative ultrasound in kidney transplant patients. However, because of relatively high inter-feet variance of QUS results we suggest measurement of both ossa calcis to minimize measurement error after transplantation.

摘要

背景

骨质疏松仍然是肾移植后的一个主要问题。移植后骨量的影像学测量预测价值有限，且因先前存在的肾性骨病而变得复杂。定量超声（QUS）是一种评估骨骼状态的新的非侵入性方法，然而，关于肾移植后超声骨参数的数据尚不存在。我们评估了这种新方法在肾移植受者中的潜在应用，并与正常对照组比较研究了其准确性。

方法

对30例患者（肾移植组，年龄47.5±13.0岁）在移植后4.8±3.2年进行研究。25名健康对照者（对照组）按年龄和性别匹配。通过QUS研究左右跟骨，测量声速（SOS）和宽带超声衰减（BUA）。根据这些参数计算骨硬度（BS）并进行年龄校正（CBS）。将左右跟骨之间的差异与对照组进行比较，以评估双侧变异性。

结果

与年轻人相比，平均±标准差BS为75±22%，肾移植组年龄校正后的CBS降低，为正常的86±25%，表明骨折风险增加两倍。SOS为1525±47.7米/秒，BUA为105±22分贝/兆赫。肾移植组左右跟骨之间的平均差异显著高于对照组（7.2±7.1%对2.1±2.1%，p<0.01）。根据Bland-Altmann型统计，测量的一致性界限（差异的均值±2标准差）为-16.9%和20.7%。CBS与年龄、累积类固醇剂量、甲状旁腺激素浓度或移植后时间之间无相关性。