Guthery Stephen L, Pohl John F, Bucuvalas John C, Alonso Maria H, Ryckman Frederick C, Balistreri William F, Heubi James E
Pediatric Liver Care Center, Cincinnati Children's Hospital Medical Center, OH, USA.
Liver Transpl. 2003 Apr;9(4):365-70. doi: 10.1053/jlts.2003.50071.
We sought to estimate the prevalence of reduced bone mass, defined by lumbar spine bone mineral density (LS-BMD) (z-score < -2.0), and to determine the factors associated with LS-BMD after liver transplantation in children and adolescents. LS-BMD z-scores were measured in a sample of subjects who had undergone liver transplantation in childhood or adolescence using dual energy x-ray absorptiometry (DXA). One hundred nine patients underwent DXA. The mean age at transplantation was 4.3 years (median, 1.8 years), and mean duration since transplantation was 6.2 years (median, 5.8 years). The mean weight z-score was -0.130 (SD, 1.26). The mean LS-BMD z-score was -0.243 (SD, 1.27). Eight patients, or 7.3% (95% confidence interval [CI], 2.4% to 12.2%), had reduced bone mass. Compared with those without reduced bone mass, subjects with reduced bone mass were more likely to have been treated for rejection at least once (87.5% versus 51.5%; P =.07), and had greater cumulative exposure to prednisone during the year before DXA (92.3 versus 26.2 mg/kg/y; P =.001). Multiple linear regression determined that LS-BMD z-score was positively associated with time since transplantation and weight z-score and negatively associated with cumulative prednisone exposure. Serum 25-OH vitamin D was measured and reduced (< 15 ng/mL) in 5 of 87 patients, one of whom had reduced bone mass. In conclusion, the prevalence of reduced bone mass was 7.3% in our population. Only certain patients appear to be at risk for low BMD, including those with a history of rejection. Screening for reduced bone mass may be appropriate for these patients.
我们试图估算腰椎骨矿物质密度（LS-BMD）（z值＜-2.0）所定义的骨量减少的患病率，并确定儿童和青少年肝移植后与LS-BMD相关的因素。使用双能X线吸收法（DXA）对童年或青春期接受肝移植的受试者样本进行LS-BMD z值测量。109例患者接受了DXA检查。移植时的平均年龄为4.3岁（中位数为1.8岁），移植后的平均时间为6.2年（中位数为5.8年）。平均体重z值为-0.130（标准差为1.26）。平均LS-BMD z值为-0.243（标准差为1.27）。8例患者（7.3%，95%置信区间[CI]为2.4%至12.2%）骨量减少。与骨量未减少的患者相比，骨量减少的患者更有可能至少接受过一次抗排斥治疗（87.5%对51.5%；P = 0.07），并且在DXA检查前一年中泼尼松的累积暴露量更大（92.3对26.2 mg/kg/年；P = 0.001）。多元线性回归分析确定，LS-BMD z值与移植后的时间和体重z值呈正相关，与泼尼松的累积暴露量呈负相关。对87例患者中的5例进行了血清25-羟基维生素D检测，其中1例骨量减少。总之，我们研究人群中骨量减少的患病率为7.3%。似乎只有某些患者存在低骨密度风险，包括有抗排斥病史的患者。对这些患者进行骨量减少的筛查可能是合适的。
