Raman M, Aghdassi E, Baun M, Yeung M, Fairholm L, Saqui O, Allard J P
University Health Network, Toronto, Canada.
JPEN J Parenter Enteral Nutr. 2006 Nov-Dec;30(6):492-6. doi: 10.1177/0148607106030006492.
Metabolic bone disease (MBD) is a significant complication in patients receiving long-term home parenteral nutrition (HPN). Pamidronate has been poorly studied in this population. We examine the prevalence and risk factors for MBD and examine changes in bone mineral density (BMD) after pamidronate administration.
First, a chart review of patients receiving HPN for >1 year was performed, and Pearson correlations were used to assess associations between MBD (defined as t score<-1) and risk factors. Second, the effect of IV pamidronate on BMD was studied prospectively in 11 HPN patients. Results were compared using a t-test.
Charts were reviewed in 25 patients (15 F, 10 M): age, 56.9+/-3.1 years; body mass index (BMI), 21.2+/-0.57 kg/m2; months receiving HPN, 113.2+/-0.09; and days per week receiving HPN, 5.08+/-0.39. MBD was present in 33% of patients for the spine and hip and in 50% for the femoral neck; 24% had previous fractures. There was a significant negative correlation between the duration of HPN and BMD (r=-0.40) for all measurements. From those patients, 11 received IV pamidronate for a mean of 22.2+/-5.4 months. At baseline, their mean HPN treatment duration was 10.6+/-6.3 years. Overall, BMD results showed a trend toward improvement in the mean t score of the spine and hip postpamidronate therapy (pre, -3.1+/-0.75; post, -2.9+/-0.69; p=.07). After excluding 2 patients receiving corticosteroids, the mean t score of the spine showed significant improvement (prepamidronate -3.4+/-0.57 vs post-pamidronate -3.1+/-0.65, p=.036).
In our HPN population, 76% had MBD and 24% had previous fractures. The results suggest that these patients may benefit from pamidronate. More studies are needed to assess the efficacy of pamidronate.
代谢性骨病（MBD）是长期接受家庭肠外营养（HPN）患者的一种重要并发症。帕米膦酸在该人群中的研究较少。我们研究了MBD的患病率和危险因素，并观察了帕米膦酸治疗后骨矿物质密度（BMD）的变化。
首先，对接受HPN超过1年的患者进行病历回顾，并使用Pearson相关性分析评估MBD（定义为t值＜-1）与危险因素之间的关联。其次，对11例HPN患者前瞻性研究静脉注射帕米膦酸对BMD的影响。使用t检验比较结果。
回顾了25例患者（15例女性，10例男性）的病历：年龄56.9±3.1岁；体重指数（BMI）21.2±0.57kg/m²；接受HPN的月数113.2±0.09；每周接受HPN的天数5.08±0.39。33%的患者脊柱和髋部存在MBD，50%的患者股骨颈存在MBD；24%的患者既往有骨折史。所有测量中，HPN持续时间与BMD之间存在显著负相关（r=-0.40）。在这些患者中，11例接受静脉注射帕米膦酸，平均治疗时间为22.2±5.4个月。基线时，他们的平均HPN治疗时间为10.6±6.3年。总体而言，BMD结果显示，帕米膦酸治疗后脊柱和髋部的平均t值有改善趋势（治疗前，-3.1±0.75；治疗后，-2.9±0.69；p=0.07）。排除2例接受皮质类固醇治疗的患者后，脊柱的平均t值有显著改善（帕米膦酸治疗前-3.4±0.57 vs治疗后-3.1±0.65，p=0.036）。
在我们的HPN人群中，76%患有MBD，24%既往有骨折史。结果表明这些患者可能从帕米膦酸治疗中获益。需要更多研究来评估帕米膦酸的疗效。
