肾移植后矿物质和骨代谢紊乱：单中心队列研究。

Mineral and bone disorder after kidney transplantation: a single-center cohort study.

机构信息

Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.

出版信息

Ren Fail. 2023 Dec;45(1):2210231. doi: 10.1080/0886022X.2023.2210231.

DOI:10.1080/0886022X.2023.2210231

PMID:37183797

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10187110/

Abstract

BACKGROUND

The assessment and prevention of mineral and bone disorder (MBD) in kidney transplant recipients (KTRs) have not been standardized. This study aimed to evaluate MBD one year after kidney transplantation (KT) and identify the influencing factors of MBD.

METHODS

A total of 95 KTRs in our center were enrolled. The changes in bone mineral density (BMD) and bone metabolism biochemical markers, including serum calcium (Ca), phosphorus(P), 25-hydroxyvitamin D(25(OH)vitD), intact parathyroid hormone (iPTH), bone alkaline phosphatase, osteocalcin (OC), type I collagen N-terminal peptide and type I collagen C-terminal peptide (CTx), over one year after KT were assessed. The possible influencing factors of BMD were analyzed. The relationships between bone metabolism biochemical markers were evaluated. The indicators between groups with or without iPTH normalization were also compared.

RESULTS

MBD after KT was manifested as an increased prevalence of hypophosphatemia and bone loss, persistent 25(OH)vitD deficiency, and partially decreased PTH and bone turnover markers (BTMs). Femoral neck BMD was positively correlated with body mass index (BMI) and postoperative 25(OH)vitD, and negatively correlated with postoperative PTH. Lumbar spine BMD was positively correlated with BMI and preoperative TG, and negatively correlated with preoperative OC and CTx. BMD loss was positively associated with glucocorticoid accumulation. Preoperative and postoperative iPTH was negatively correlated with postoperative serum P and 25(OH)vitD, and positively correlated with postoperative Ca and BTMs. The recipients without iPTH normalization, who accounted for 41.0% of all KTRs, presented with higher Ca, lower P, higher BTMs, advanced age, and a higher prevalence of preoperative parathyroid hyperplasia.

CONCLUSIONS

MBD persisted after KT, showing a close relationship with hyperparathyroidism, high bone turnover, and glucocorticoid accumulation.

摘要

背景

肾移植受者（KTR）的矿物质和骨代谢紊乱（MBD）的评估和预防尚未标准化。本研究旨在评估肾移植（KT）后 1 年的 MBD，并确定 MBD 的影响因素。

方法

纳入本中心 95 例 KTR。评估 KT 后 1 年的骨密度（BMD）和骨代谢生化标志物的变化，包括血清钙（Ca）、磷（P）、25-羟维生素 D（25（OH）vitD）、全段甲状旁腺激素（iPTH）、骨碱性磷酸酶、骨钙素（OC）、I 型胶原 N 端肽和 I 型胶原 C 端肽（CTX）。分析 BMD 的可能影响因素。评估骨代谢生化标志物之间的关系。比较 iPTH 正常与未正常组的各项指标。

结果

KT 后 MBD 表现为低磷血症和骨丢失的患病率增加，25（OH）vitD 持续缺乏，部分 PTH 和骨转换标志物（BTMs）降低。股骨颈 BMD 与体重指数（BMI）和术后 25（OH）vitD 呈正相关，与术后 PTH 呈负相关。腰椎 BMD 与 BMI 和术前甘油三酯（TG）呈正相关，与术前 OC 和 CTx 呈负相关。BMD 丢失与糖皮质激素累积呈正相关。术前和术后 iPTH 与术后血清 P 和 25（OH）vitD 呈负相关，与术后 Ca 和 BTMs 呈正相关。iPTH 未正常的受者占所有 KTR 的 41.0%，其特点是 Ca 较高、P 较低、BTMs 较高、年龄较大，术前甲状旁腺增生的患病率较高。