D'Antiga Lorenzo, Moniz Caje, Buxton-Thomas Muriel, Cheeseman Paul, Gray Beverly, Abraha Hagosa, Baker Alastair J, Heaton Nigel D, Rela Mohammed, Mieli-Vergani Giorgina, Dhawan Anil
Paediatric Liver Service, Child Health Department, King's College Hospital, SE5 9RS London, UK.
Transplantation. 2002 Jun 15;73(11):1788-93. doi: 10.1097/00007890-200206150-00015.
Osteodystrophy is a well-described complication of chronic liver disease. Previous reports in adults and children undergoing liver transplantation (LT) were discordant, with the former showing no improvement of bone disease in the first year after transplantation and the latter demonstrating remarkable benefit from it. Our aim was to perform a pilot study on osteodystrophy in children undergoing LT and evaluate the contribution of growth on bone mineral density (BMD) changes.
We studied six patients (two male), with a median age at transplantation of 8.8 (range 3.8-16.6) years. Indications for transplantation were biliary atresia and progressive familial intrahepatic cholestasis (three patients each). BMD was studied with dual-energy x-ray absorptiometry and biochemical markers of liver and bone function in patients before and at 3, 6, and 12 months after LT.
Median L2-L4 spinal BMD was 0.54 g/cm2 (range 0.29-0.87) before LT, and 0.58 g/cm2 (0.27-0.86) at 3 months, 0.66 g/cm2 (0.36-1.00) at 6 months, and 0.76 g/cm2 (0.44-1.02) at 12 months after LT (P=0.005). Median height was 133 (range 93-167) cm before LT, and 134 (93-167) at 3 months, 136 (97-167) at 6 months, and 139 (102-167) at 12 months after LT. There was direct correlation between height gain and total body BMD improvement (r=0.929, P=0.007).
BMD in children with chronic cholestatic liver disease improves remarkably by 12 months after LT. Catch-up growth in children can account for the different effect of LT on bone density between adult and pediatric populations in the first year after surgery.
骨营养不良是慢性肝病一种广为人知的并发症。先前关于接受肝移植（LT）的成人和儿童的报告存在分歧，前者显示移植后第一年骨病无改善，而后者则显示从中显著获益。我们的目的是对接受LT的儿童骨营养不良进行一项初步研究，并评估生长对骨密度（BMD）变化的影响。
我们研究了6例患者（2例男性），移植时的中位年龄为8.8岁（范围3.8 - 16.6岁）。移植指征为胆道闭锁和进行性家族性肝内胆汁淤积症（各3例）。在LT前以及LT后3、6和12个月，对患者进行双能X线吸收法骨密度测定以及肝脏和骨功能的生化指标检测。
LT前L2 - L4椎体的中位骨密度为0.54 g/cm²（范围0.29 - 0.87），LT后3个月为0.58 g/cm²（0.27 - 0.86），6个月为0.66 g/cm²（0.36 - 1.00），12个月为0.76 g/cm²（0.44 - 1.02）（P = 0.005）。LT前的中位身高为133 cm（范围93 - 167），LT后3个月为134 cm（93 - 167），6个月为136 cm（97 - 167），12个月为139 cm（102 - 167）。身高增加与全身骨密度改善之间存在直接相关性（r = 0.929，P = 0.007）。
慢性胆汁淤积性肝病儿童在LT后到12个月时骨密度显著改善。儿童的追赶生长可以解释LT对术后第一年成人和儿童人群骨密度的不同影响。
