University of Minnesota Medical School, Minneapolis, MN, USA.
Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
Pancreatology. 2021 Dec;21(8):1491-1497. doi: 10.1016/j.pan.2021.08.013. Epub 2021 Sep 4.
BACKGROUND/OBJECTIVES: The effect of total pancreatectomy with islet autotransplantation (TPIAT) on bone mineral density (BMD) in patients with CP is unknown. We aimed to assess bone health in patients with CP after TPIAT.
We measured BMD, BMD Z-score, and bone mineral content (BMC) for total body, lumbar spine, right and left hip in 78 patients before and after TPIAT using dual-energy X-ray absorptiometry (DXA, n = 78 pre-TPIAT, n = 65 paired pre- and 12 months post-TPIAT, n = 33 paired 12 and 18 months post-TPIAT), and tested for association with clinical history including age, smoking status, and medications using paired and two-sample t-tests, linear regression, and Fisher's exact test. Laboratory measures related to bone health were also assessed.
In the patients with pre-TPIAT DXA, 12% had low BMD (Z-score ≤ -2). BMD, BMD Z-score, and BMC all decreased from pre-to 12 months post-TPIAT. BMD declined by 1.7%-4.1% with the greatest change at the hips. Adjusted for change in lean and fat body mass, DXA changes remained significant for total body and hip. Serum carboxy-terminal collagen crosslinks telopeptide and alkaline phosphatase increased at 12 months post-TPIAT, suggesting possible increased bone remodeling. BMD, BMD Z-score, and BMC did not change between 12 months and 18 months in any of the four regions (p > 0.6).
TPIAT is associated with decreases in BMD in the body, lumbar, and hip regions of patients with CP in the first year after TPIAT but these appear to stabilize between 12 and 18 months after TPIAT.
背景/目的：全胰切除术伴胰岛自体移植（TPIAT）对 CP 患者骨密度（BMD）的影响尚不清楚。我们旨在评估 TPIAT 后 CP 患者的骨骼健康状况。
我们使用双能 X 射线吸收法（DXA，n=78 例术前，n=65 例术前和 12 个月配对，n=33 例术前和 18 个月配对）测量了 78 例患者 TPIAT 前后的全身、腰椎、右侧和左侧髋部的 BMD、BMD Z 评分和骨矿物质含量（BMC），并通过配对和两样本 t 检验、线性回归和 Fisher 确切检验，对包括年龄、吸烟状况和药物在内的临床病史进行了关联测试。还评估了与骨骼健康相关的实验室指标。
在接受 TPIAT 术前 DXA 的患者中，有 12%的患者存在低 BMD（Z 评分≤-2）。BMD、BMD Z 评分和 BMC 均从术前降至术后 12 个月。BMD 下降 1.7%-4.1%，髋关节变化最大。调整瘦体重和脂肪体重的变化后，DXA 变化对全身和髋关节仍具有显著意义。术后 12 个月时，血清羧基末端胶原交联肽和碱性磷酸酶增加，表明可能存在骨重塑增加。在四个区域中的任何一个区域，BMD、BMD Z 评分和 BMC 在 12 个月和 18 个月之间均未发生变化（p>0.6）。
TPIAT 与 CP 患者 TPIAT 后 1 年内全身、腰椎和髋部的 BMD 下降有关，但在 TPIAT 后 12 至 18 个月之间似乎趋于稳定。
