Aris R M, Neuringer I P, Weiner M A, Egan T M, Ontjes D
Department of Medicine, University of North Carolina at Chapel Hill 27599, USA.
Chest. 1996 May;109(5):1176-83. doi: 10.1378/chest.109.5.1176.
Osteoporosis and/or fractures have been reported as a complication of kidney, heart, liver, bone marrow, and, most recently, lung transplantation (LTx). We measured bone mineral density (BMD) before and after LTx to determine the frequency and severity of preoperative and postoperative osteoporosis.
We conducted a cross-sectional study of BMD in 100 patients with various diagnoses before (n = 55) and after (n = 45) LTx.
Age-matched mean spine and femoral BMDs were severely depressed before and after LTx placing 45% of the pre-LTx and 73% of the post-LTx patients at or below the fracture threshold (2 SDs below the mean). As expected, patients with cystic fibrosis had lower (p < 0.05) mean spine and femoral BMD than patients with COPD or other lung diseases both before and after LTx. Nevertheless, considerable osteoporosis was present in the patients with COPD and other lung diseases before and after LTx. The best predictors of pre- and post-LTxZ scores were body mass index (r = 0.56 to 0.59, p < 0.001) and cumulative steroid dose/per kilogram (r = 0.49-0.51, p < 0.001), respectively. Osteoporosis has resulted in 3 symptomatic fractures before and 12 after LTx.
Osteoporosis appears to be widespread in patients with end-stage respiratory failure before LTx and LTx, while often life-saving, has an adverse impact on BMD. As patients live longer after LTx, osteoporosis-related fractures may compromise quality of life by causing pain and debilitation.
骨质疏松和/或骨折已被报道为肾、心脏、肝脏、骨髓移植的并发症，最近还成为肺移植（LTx）的并发症。我们测量了肺移植前后的骨矿物质密度（BMD），以确定术前和术后骨质疏松的发生率和严重程度。
我们对100例接受不同诊断的患者进行了一项关于骨矿物质密度的横断面研究，其中55例为肺移植术前患者，45例为肺移植术后患者。
年龄匹配的脊柱和股骨平均骨密度在肺移植前后均严重降低，使45%的肺移植术前患者和73%的肺移植术后患者处于或低于骨折阈值（低于平均值2个标准差）。正如预期的那样，囊性纤维化患者在肺移植前后的脊柱和股骨平均骨密度均低于慢性阻塞性肺疾病（COPD）或其他肺部疾病患者（p<0.05）。然而，COPD和其他肺部疾病患者在肺移植前后均存在相当程度的骨质疏松。肺移植前后Z评分的最佳预测指标分别是体重指数（r = 0.56至0.59，p<0.001）和每千克累积类固醇剂量（r = 0.49 - 0.51，p<0.001）。骨质疏松导致肺移植术前3例出现症状性骨折，术后12例出现症状性骨折。
骨质疏松似乎在肺移植术前和肺移植的终末期呼吸衰竭患者中普遍存在，肺移植虽然通常能挽救生命，但对骨密度有不利影响。随着肺移植患者存活时间延长，骨质疏松相关骨折可能会因疼痛和虚弱而影响生活质量。
