Loria I, Albanese C, Giusto M, Galtieri P A, Giannelli V, Lucidi C, Di Menna S, Pirazzi C, Corradini S G, Mennini G, Rossi M, Berloco P, Merli M
Gastroenterologia, Dipartimento Di Medicina Clinica, Policlinico Umberto I, La Sapienza, Roma, Italy.
Transplant Proc. 2010 May;42(4):1191-3. doi: 10.1016/j.transproceed.2010.03.096.
An important complication of chronic liver disease is osteodystrophy, which includes osteoporosis and the much rarer osteomalacia. Both conditions are associated with significant morbidity through fractures resulting in pain, deformity, and immobility. Liver transplantation may further deteriorate bone metabolism. The aim of the present study was to investigate the frequency and severity of hepatic osteodystrophy among patients with liver cirrhosis who were referred for liver transplantation. We also evaluated modifications in bone metabolism after liver transplantation.
We recruited 35 consecutive patients with chronic liver disease who were undergoing assessment for transplantation over a 1-year period. Bone mass in the total skeleton and proximal hip was evaluated using a dual-energy X-ray absorptiometry device (Lunar Prodigy Advance, GE Healthcare, USA). According to World Health Organization recommendations, osteoporosis was defined as a T score < -2.5 and osteopenia as T score between -1 and -2.5.
We enrolled in the study 35 patients, including 8 females and 27 males of overall mean age of 57 +/- 7, who showed a viral etiology (57%) or alcohol etiology (28%), Child-Pugh 8.7 +/- 2.3. The overall prevalence of osteodystrophy was 40% (26% osteopenia and 14% osteoporosis). No difference was evident according to gender, severity of liver disease (Child-Pugh, Model for End-stage Liver Disease), or origin of liver disease. A subgroup of 10 transplanted patients reached 3-month follow-up, showing total body T score with a significant decrease after 3 months while femoral T scores tended to decrease insignificantly.
This study revealed a high prevalence of low bone mineral density among cirrhotic patients before liver transplantation. We suggest that both bone mineral density and biochemical examinations should be considered to be routine tests to identify the status of bone mass and bone metabolism among recipients prior to liver transplantation.
慢性肝病的一个重要并发症是骨营养不良，其中包括骨质疏松症以及更为罕见的骨软化症。这两种病症都会因骨折导致疼痛、畸形和活动不便，从而引发严重的发病情况。肝移植可能会使骨代谢进一步恶化。本研究的目的是调查因肝移植前来就诊的肝硬化患者中肝性骨营养不良的发生率及严重程度。我们还评估了肝移植后骨代谢的变化情况。
我们招募了35例连续的慢性肝病患者，这些患者在1年时间内接受了移植评估。使用双能X线吸收测定仪（美国通用电气医疗集团的Lunar Prodigy Advance）评估全身骨骼和近端髋部的骨量。根据世界卫生组织的建议，骨质疏松症定义为T值＜-2.5，骨量减少定义为T值在-1至-2.5之间。
我们纳入本研究的35例患者中，包括8名女性和27名男性，总体平均年龄为57±7岁，病因包括病毒感染（57%）或酒精性病因（28%），Child-Pugh评分为8.7±2.3。骨营养不良的总体患病率为40%（骨量减少26%，骨质疏松症14%）。根据性别、肝病严重程度（Child-Pugh评分、终末期肝病模型）或肝病病因，未发现明显差异。10例接受移植的患者亚组进行了3个月的随访，结果显示3个月后全身T值显著下降，而股骨T值虽有下降趋势，但不明显。
本研究表明，肝移植前肝硬化患者中低骨密度的患病率较高。我们建议，骨密度和生化检查均应被视为常规检查，以在肝移植前确定受者的骨量和骨代谢状况。
