Munoz S J, Nagelberg S B, Green P J, Angstadt J D, Yang S L, Jarrell B E, Maddrey W C
Department of Medicine, Jefferson Medical College, Philadelphia, Pennsylvania 19107.
Hepatology. 1988 May-Jun;8(3):476-83. doi: 10.1002/hep.1840080307.
We observed ectopic soft tissue calcification affecting seven patients following orthotopic liver transplantation. The cause of such calcification is unknown, but potential pathogenetic factors include hyperparathyroidism, calcium administered during and following surgery, renal failure, acid-base changes and citrate in fresh frozen plasma. To investigate some of the mechanisms underlying ectopic calcification following liver transplantation, we determined preoperative levels of ionized serum calcium, phosphate, magnesium, parathyroid hormone (midmolecule assay) and 1,25-(OH)2 vitamin D in 20 patients who underwent 24 liver transplants. In addition, these parameters were measured weekly in 15 patients during the first month after liver transplantation. Preoperatively, 5 of the 20 patients had elevated serum levels of parathyroid hormone, and 9 others had low levels of 1,25-(OH)2 vitamin D. After liver transplantation, ectopic calcification was found in seven patients (47%). The organs affected in order of frequency were lungs, liver graft, colon, vascular walls, kidneys, adrenal glands and gastric mucosa. One patient with ectopic calcification of both lungs had markedly restricted pulmonary function as well as radiologic evidence of osteopenia and pathologic fractures of three vertebrae. Postoperatively, increased parathyroid hormone levels were found in all patients who developed soft tissue calcification. Parathyroid hormone levels peaked during the second week after transplantation and were higher at all times compared to subjects without calcification. Five of the seven patients with ectopic calcification had associated renal failure. Individuals who developed calcification had received significantly more fresh frozen plasma, red blood cells and elemental calcium postoperatively, but showed no difference in serum levels of calcium, magnesium, vitamin D, total plasma CO2 or phosphate levels when compared to patients without calcification.(ABSTRACT TRUNCATED AT 250 WORDS)
我们观察到7例原位肝移植患者出现异位软组织钙化。这种钙化的原因尚不清楚，但潜在的致病因素包括甲状旁腺功能亢进、手术期间及术后给予的钙、肾衰竭、酸碱变化以及新鲜冰冻血浆中的柠檬酸盐。为了研究肝移植后异位钙化的一些潜在机制，我们测定了20例接受24次肝移植患者术前血清离子钙、磷、镁、甲状旁腺激素（中分子测定法）和1,25-(OH)₂维生素D的水平。此外，在15例患者肝移植后的第一个月每周测量这些参数。术前，20例患者中有5例甲状旁腺激素血清水平升高，另外9例1,25-(OH)₂维生素D水平较低。肝移植后，7例患者（47%）出现异位钙化。受影响器官的频率依次为肺、肝移植肝、结肠、血管壁、肾、肾上腺和胃黏膜。1例双肺异位钙化患者肺功能明显受限，并有骨质减少的影像学证据以及三个椎体的病理性骨折。术后，所有发生软组织钙化的患者甲状旁腺激素水平均升高。甲状旁腺激素水平在移植后第二周达到峰值，且在所有时间均高于未发生钙化的患者。7例异位钙化患者中有5例合并肾衰竭。发生钙化的患者术后接受的新鲜冰冻血浆、红细胞和元素钙明显更多，但与未发生钙化的患者相比，其血清钙、镁、维生素D、血浆总二氧化碳或磷水平无差异。（摘要截短于250字）
