Cheng Ben-Chung, Chen Ying-Chou
Department of Nephrology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 833, Taiwan.
Departments of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan.
Clin Rheumatol. 2017 Apr;36(4):929-932. doi: 10.1007/s10067-016-3447-y. Epub 2016 Oct 18.
This study investigated the effect of different severities of CKD on femoral neck bone mineral density (BMD) in patients treated with denosumab. This study was a retrospective case review of CKD patients treated with denosumab. Baseline age, sex, and body mass index (BMI) were recorded for all patients. All comorbidities such as diabetes, hypertension, liver, and estimated glomerular filtration rate (eGFR) serum collagen type 1 cross-linked C-telopeptide (CTX) were also recorded. All subjects underwent dual energy X-ray absorptiometry assay of the femoral neck to determine the BMD. Changes in femoral neck BMD between baseline and 1 year after denosumab administration were recorded. A total 108 patients with CKD who had received denosumab therapy were enrolled. The mean age was 71.04 ± 9.64 years, and 96 patients (88.9 %) were women. Baseline eGFR correlated negatively with changes in the BMD of femoral neck (Rho =40.6, P < 0.01). The lower the eGFR, the more was the improvement in BMD in the femoral neck after denosumab therapy. When changes in femoral neck BMD were assessed as outcome measures using linear regression, young patients (P = 0.001) and those with a low eGFR benefitted more from denosumab therapy (P = 0.029). Denosumab therapy is effective in cases of low eGFR and young age. Aggressive medical attention is needed in these patients.
本研究调查了不同严重程度的慢性肾脏病（CKD）对接受地诺单抗治疗患者股骨颈骨密度（BMD）的影响。本研究是一项关于接受地诺单抗治疗的CKD患者的回顾性病例分析。记录了所有患者的基线年龄、性别和体重指数（BMI）。还记录了所有合并症，如糖尿病、高血压、肝脏疾病以及估算肾小球滤过率（eGFR）、血清Ⅰ型胶原交联C末端肽（CTX）。所有受试者均接受了股骨颈双能X线吸收测定以确定骨密度。记录了地诺单抗给药基线至给药后1年期间股骨颈骨密度的变化。共有108例接受地诺单抗治疗的CKD患者入组。平均年龄为71.04±9.64岁，96例患者（88.9%）为女性。基线eGFR与股骨颈骨密度变化呈负相关（Rho =40.6，P<0.01）。eGFR越低，地诺单抗治疗后股骨颈骨密度改善越明显。当使用线性回归将股骨颈骨密度变化作为结局指标进行评估时，年轻患者（P =0.001）和eGFR低的患者从地诺单抗治疗中获益更多（P =0.029）。地诺单抗治疗在eGFR低和年轻患者中有效。这些患者需要积极的医疗关注。
