营养-炎症评分与现患肾移植受者随后发生自我报告骨折风险的关系。
Association between malnutrition-inflammation score and risk of subsequent self-reported bone fractures in prevalent kidney transplant recipients.
机构信息
Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA.
Department of Extracorporeal Hemocorrection, National Scientific Medical Center, Astana, Kazakhstan.
出版信息
Osteoporos Int. 2019 Mar;30(3):611-620. doi: 10.1007/s00198-018-4774-4. Epub 2018 Nov 19.
UNLABELLED
Chronic inflammation and protein energy wasting (PEW) syndrome are common in kidney transplant recipients (KTR). The presence of inflammation and PEW syndrome can directly affect bone resorption and bone formation, leading to bone loss and fractures. We showed PEW is independently associated with new clinically detected bone fractures in prevalent KTR.
INTRODUCTION
Kidney transplant recipients (KTR) have a 4-fold higher risk of fracture compared to the general population. Chronic inflammation and PEW syndrome are common in KTR and are associated with poor outcomes. We hypothesized that the Malnutrition-Inflammation Score (MIS), a validated measure of PEW, is associated with higher risk of bone fractures in KTR.
METHODS
This prospective cohort study included 839 prevalent KTR from a Central European academic center. MIS, a semiquantitative instrument of PEW, was calculated at the study entry. Self-reported history of fractures was recorded during the 2-year follow-up period. The association between MIS and bone fractures was examined in logistic regression analyses with adjustment for age, gender, eGFR, smoking habits, history of pre-transplant bone fractures, and acute rejection.
RESULTS
Mean age was 51 ± 13 years, and 56% of patients were males with median (interquartile range) transplant vintage 69 (38-112) months, estimated glomerular filtration rate 55 ± 21 ml/min/1.73 m, and calculated MIS 3 (2-4) at enrollment. Fifty-five (7%) patients experienced self-reported bone fractures during the 2-year follow-up period. Higher MIS score showed linear association with increased risk of fracture. Each one-point higher MIS was associated with 23% higher risk of bone fractures (odds ratio (OR) and 95% CI 1.23, 1.12-1.34), which remained significant after multivariable adjustments (OR 1.17, 95% CI 1.06-1.29).
CONCLUSION
The MIS is independently associated with new clinically detected bone fractures in prevalent KTR.
背景
慢性炎症和蛋白能量消耗（PEW）综合征在肾移植受者（KTR）中很常见。炎症和 PEW 综合征的存在会直接影响骨吸收和骨形成，导致骨质流失和骨折。我们发现 PEW 与现患 KTR 中新出现的临床确诊骨折独立相关。
目的
与普通人群相比，肾移植受者（KTR）发生骨折的风险高 4 倍。慢性炎症和 PEW 综合征在 KTR 中很常见，并且与不良结局相关。我们假设，营养不良-炎症评分（MIS）是一种经过验证的 PEW 测量方法，与 KTR 骨折风险增加相关。
方法
这项前瞻性队列研究纳入了来自中欧一家学术中心的 839 例现患 KTR。在研究入组时计算了 MIS，这是一种 PEW 的半定量工具。在 2 年的随访期间记录了自我报告的骨折史。使用逻辑回归分析，在校正了年龄、性别、eGFR、吸烟习惯、移植前骨折史和急性排斥反应后，研究了 MIS 与骨折之间的关系。
结果
平均年龄为 51±13 岁，56%的患者为男性，中位（四分位间距）移植年限为 69（38-112）个月，估算肾小球滤过率为 55±21ml/min/1.73m2，入组时计算的 MIS 为 3（2-4）。在 2 年的随访期间，55 例（7%）患者发生了自我报告的骨折。较高的 MIS 评分与骨折风险的增加呈线性相关。MIS 每增加 1 分，骨折风险增加 23%（比值比[OR]和 95%置信区间[CI]为 1.23，1.12-1.34），多变量调整后仍具有显著意义（OR 1.17，95% CI 1.06-1.29）。
结论
MIS 与现患 KTR 中新出现的临床确诊骨折独立相关。
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