Goffin E, Devogelaer J P, Depresseux G, Squifflet J P, Pirson Y, van Yperselede de Strihou C
Department of Nephrology, Hôpital St. Luc, Université Catholique de Louvain, Brussels, Belgium.
Clin Nephrol. 2003 Mar;59(3):190-5. doi: 10.5414/cnp59190.
Progressive bone loss consistently complicates renal transplantation (TP) in patients given an immunosuppression including prednisolone. The adjunction of cyclosporine in the immunosuppressive regimen does not reverse the negative impact of renal TP on the skeleton. The post-transplant effect of tacrolimus on bone mass is still unknown.
We evaluated the evolution of bone mineral density (BMD) and various biochemical markers over the first 12 months following renal TP in 23 patients given an immunosuppression combining tacrolimus and low-dose prednisolone. BMD of lumbar spine, total hip and hip subregions was measured by dual-energy X-ray absorptiometry within the first 15 days and 1 year after TP.
At the time of TP, the average BMD was low in both the lumbar spine and the hip. After TP, a normalization of serum creatinine and a decrease in serum phosphate and iPTH levels occurs. Serum alkaline phosphatase level significantly rose transiently within the first 6 months and decreased thereafter. At 1 year post TP, BMD remained unchanged in the lumbar and in the trochanter subregions and rose in the other sites. BMD increased by at least 2% in 8, 13, 10 and 10 out of the 23 patients in the lumbar, neck, trochanter and total hip subregions, respectively. No correlation was found between evolution in BMD and age, sex, dialysis duration, level of hyperparathyroidism, prednisolone and tacrolimus cumulative intake and prescription of calcium, vitamin D or hormone replacement therapy.
An immunosuppression combining tacrolimus and low-dose prednisolone might avoid the usual post-TP bone loss. Further randomized double-blind studies evaluating a larger cohort of patients should be undertaken to compare the effect of cyclosporine and tacrolimus on bone mass.
在接受包括泼尼松龙在内的免疫抑制治疗的患者中，进行性骨质流失一直是肾移植（TP）的并发症。免疫抑制方案中添加环孢素并不能逆转肾移植对骨骼的负面影响。他克莫司对移植后骨量的影响尚不清楚。
我们评估了23例接受他克莫司和低剂量泼尼松龙联合免疫抑制治疗的患者在肾移植后前12个月内骨矿物质密度（BMD）和各种生化标志物的变化情况。在移植后前15天和1年时，采用双能X线吸收法测量腰椎、全髋及髋部各亚区域的BMD。
肾移植时，腰椎和髋部的平均BMD均较低。肾移植后，血清肌酐恢复正常，血清磷酸盐和iPTH水平下降。血清碱性磷酸酶水平在最初6个月内显著短暂升高，此后下降。肾移植后1年，腰椎和转子亚区域的BMD保持不变，其他部位则升高。23例患者中，腰椎、颈部、转子和全髋亚区域分别有8例、13例、10例和10例患者的BMD至少增加了2%。未发现BMD变化与年龄、性别、透析时间、甲状旁腺功能亢进程度、泼尼松龙和他克莫司累积摄入量以及钙、维生素D或激素替代疗法的处方之间存在相关性。
他克莫司和低剂量泼尼松龙联合免疫抑制可能避免肾移植后常见的骨质流失。应开展进一步的随机双盲研究，评估更大规模的患者队列，以比较环孢素和他克莫司对骨量的影响。
