Nehme D, Rondeau E, Paillard F, Moreau J F, Nussaume O, Kanfer A, Sraer J D
Service de Néphrologie, Hôpital Tenon, Paris, France.
Nephrol Dial Transplant. 1989;4(2):123-8.
Bone status, calcium and phosphate metabolism were prospectively evaluated in 98 renal transplant recipients with stable renal function. Aseptic necrosis of bone was found in 30 patients, leading to arthroplasty in 12 patients. Plasma parathyroid hormone and nephrogenic cyclic adenosine monophosphate (cAMP) values were greater and the duration of pre-transplant chronic renal failure longer in patients with aseptic necrosis of bone than in those who were not affected. Cumulative oral corticosteroid doses and the number of acute rejection episodes treated by intravenous methylprednisolone pulses were similar in patients with or without aseptic necrosis of bone. Hyperparathyroidism was confirmed histologically in 14 patients, comprising 4 cases of adenoma and 10 of diffuse hyperplasia. Serum parathyroid hormone correlated positively with serum creatinine (r = 0.47; P less than 0.001) and with cumulative corticosteroid dose (r = 0.30; P less than 0.003). This study suggests that hyperparathyroidism is a factor in the pathogenesis of aseptic bone necrosis. The frequency and severity of bone necrosis may be decreased by early detection and treatment of post-transplant hyperparathyroidism.
对98例肾功能稳定的肾移植受者的骨状态、钙和磷代谢进行了前瞻性评估。30例患者发现骨无菌性坏死，其中12例行关节成形术。骨无菌性坏死患者的血浆甲状旁腺激素和肾源性环磷酸腺苷（cAMP）值更高，移植前慢性肾衰竭的持续时间比未受影响的患者更长。有或无骨无菌性坏死的患者，口服皮质类固醇的累积剂量以及静脉注射甲泼尼龙冲击治疗的急性排斥反应次数相似。14例患者经组织学证实为甲状旁腺功能亢进，其中4例为腺瘤，10例为弥漫性增生。血清甲状旁腺激素与血清肌酐呈正相关（r = 0.47；P < 0.001），与皮质类固醇累积剂量呈正相关（r = 0.30；P < 0.003）。本研究表明，甲状旁腺功能亢进是骨无菌性坏死发病机制中的一个因素。通过早期发现和治疗移植后甲状旁腺功能亢进，可降低骨坏死的发生率和严重程度。
