Brandenburg Vincent M, Ketteler Markus, Fassbender Walter J, Heussen Nicole, Freuding Thomas, Floege Juergen, Ittel Thomas H
Department of Nephrology, University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.
Am J Kidney Dis. 2002 Nov;40(5):1066-74. doi: 10.1053/ajkd.2002.36345.
Rapid bone loss is a frequent finding early after kidney transplantation. Only limited data are available on the bone mineral density (BMD) in long-term kidney transplant recipients.
In 26 kidney transplant recipients (13 men and 13 women, age 45.3 +/- 12.3 years), serum biochemical markers of bone metabolism and BMD at the lumbar vertebrae L2-4 were evaluated prospectively in three serial examinations (E1, E2, E3; method: dual-energy X-ray absorptiometry). Examinations were performed at 47 +/- 2 months, 59 +/- 2 months, and 71 +/- 2 months after transplantation. All patients received standard dual or triple immunosuppression including prednisolone.
The mean BMD was significantly lower (P < 0.001) than in sex-matched young controls: T-score was -1.43 +/- 1.49 (E1), -1.39 +/- 1.40 (E2), and -1.44 +/- 1.30 (E3). The BMD did not change significantly (Delta BMD, -0.5 +/- 5.9%) from E1 to E3. Regression analysis did not show significant associations between Delta BMD and biochemical parameters or prednisolone dosage. No clinically apparent new lumbar vertebral fracture occurred. The mean intact parathyroid hormone was 110.1 +/- 97.5 pg/mL (E1), 121 +/- 102.7 pg/mL (E2), and 134.5 +/- 128.6 pg/mL (E3). Serum creatinine was 1.44 +/- 0.45 (128 +/- 40) mg/dL (micromol/L) (E1), 1.44 +/- 0.47 (127 +/- 42) mg/dL (micromol/L) (E2), and 1.45 +/- 0.70 (128 +/- 62) mg/dL (micromol/L) (E3). Ten patients (38.5%) showed an increase of BMD (+5.7 +/- 3.2%) and 15 patients (57.7%) showed a decrease of -4.7 +/- 3.2% (P < 0.0001). Both groups were different in T-scores at E1 (-2.29 +/- 1 versus -0.88 +/- 1.5); intact parathyroid hormone, creatinine, vitamin D levels, and prednisolone dosage were not significantly different.
This study shows that lumbar BMD is reduced in long-term kidney transplant recipients. During our 24-month observation period, overall lumbar BMD remained stable.
肾移植术后早期快速骨质流失是常见现象。关于长期肾移植受者的骨矿物质密度（BMD），仅有有限的数据。
对26例肾移植受者（13例男性和13例女性，年龄45.3±12.3岁）进行前瞻性研究，在三次连续检查（E1、E2、E3；方法：双能X线吸收法）中评估腰椎L2 - 4的骨代谢血清生化标志物和BMD。检查在移植后47±2个月、59±2个月和71±2个月进行。所有患者均接受包括泼尼松龙在内的标准二联或三联免疫抑制治疗。
平均BMD显著低于性别匹配的年轻对照组（P < 0.001）：T值在E1时为-1.43±1.49，E2时为-1.39±1.40，E3时为-1.44±1.30。从E1到E3，BMD无显著变化（BMD变化量，-0.5±5.9%）。回归分析未显示BMD变化量与生化参数或泼尼松龙剂量之间存在显著关联。未发生临床上明显的新的腰椎骨折。平均完整甲状旁腺激素在E1时为110.1±97.5 pg/mL，E2时为121±102.7 pg/mL，E3时为134.5±128.6 pg/mL。血清肌酐在E1时为1.44±0.45（128±40）mg/dL（微摩尔/升），E2时为1.44±0.47（127±42）mg/dL（微摩尔/升），E3时为1.45±0.70（128±62）mg/dL（微摩尔/升）。10例患者（38.5%）BMD升高（+5.7±3.2%），15例患者（57.7%）BMD降低-4.7±3.2%（P < 0.0001）。两组在E1时的T值不同（-2.29±1对-0.88±1.5）；完整甲状旁腺激素、肌酐、维生素D水平和泼尼松龙剂量无显著差异。
本研究表明长期肾移植受者腰椎BMD降低。在我们24个月的观察期内，总体腰椎BMD保持稳定。
