Pichette V, Bonnardeaux A, Prudhomme L, Gagné M, Cardinal J, Ouimet D
Medical Research Council of Canada, Montréal, Québec, Canada.
Am J Kidney Dis. 1996 Jul;28(1):105-14. doi: 10.1016/s0272-6386(96)90138-9.
Organ transplantation is associated with an early bone loss that subsequently increases the risk of osteopenia and bone fractures. It is not known whether bone loss continues in long-term survivors, but persistent bone demineralization could further jeopardize an already diminished bone mass. To better define long-term bone status of kidney transplant recipients (KTR), we conducted cross-sectional and longitudinal evaluations of bone mineral density (BMD) in 70 KTR with a mean posttransplantation time of 8.1 years. BMD was determined by dual-energy X-ray absorptiometry and was repeated in 55 of the patients after a mean follow-up period of 22 +/- 5 months. Lumbar and femoral osteopenia, defined as a BMD lower than 2 standard deviations from mean value of sex- and age-matched controls, was present in 28.6% and 10.5% of patients, respectively. There was a significant negative correlation between cumulative prednisone dose and adjusted lumbar as well as femoral BMD (R = 0.45, P < 0.001 and R = 0.29, P < 0.05, respectively). Five patients had a vertebral BMD below a fracture threshold of 0.777 g/cm2. Vertebral fractures (VF) were found in four men and were associated with higher prednisone dosage (P < 0.05), larger cumulative prednisone dose (P < 0.05), and significantly lower BMD values. According to World Health Organization recent criteria for women, prevalences of lumbar and femoral osteopenia and lumbar and femoral osteoporosis in female patients reach 75%, 65%, 33%, and 10%, respectively. The longitudinal part of the study showed a persistent pathological lumbar demineralization process. Over the study period, BMD, expressed as a percentage of that of controls, decreased from 89 +/- 14% to 86 +/- 14% (P < 0.001). Annual change of bone mass was -1.7 +/- 2.8% per year. Accelerated vertebral bone loss (defined as a decrease of BMD, expressed as a percentage of that of controls, of more than 1% per year) was present in 56% of patients and was associated with higher prednisone dosage (P < 0.01). In conclusion, although VF are relatively infrequent in long-term survivors of renal transplantation, osteopenia is a frequent finding, and a substantial proportion of women present lumbar osteoporosis. An ongoing demineralization process of the spine is also demonstrated and probably contributes to long-term spinal osteoporosis incidence. Prednisone dosage remains the most constantly isolated risk factor.
器官移植与早期骨质流失相关，这随后会增加骨质减少和骨折的风险。长期存活者的骨质流失是否会持续尚不清楚，但持续的骨质脱矿可能会进一步危及本就已减少的骨量。为了更好地明确肾移植受者（KTR）的长期骨骼状况，我们对70名平均移植后时间为8.1年的KTR进行了骨密度（BMD）的横断面和纵向评估。通过双能X线吸收法测定BMD，并在平均随访22±5个月后，对55名患者重复进行测定。腰椎和股骨骨质减少定义为BMD低于性别和年龄匹配对照组平均值2个标准差，分别在28.6%和10.5%的患者中出现。累积泼尼松剂量与调整后的腰椎和股骨BMD之间存在显著负相关（R = 0.45，P < 0.001和R = 0.29，P < 0.05）。5名患者的椎体BMD低于0.777 g/cm²的骨折阈值。在4名男性中发现椎体骨折（VF），且与更高的泼尼松剂量（P < 0.05）、更大的累积泼尼松剂量（P < 0.05）以及显著更低的BMD值相关。根据世界卫生组织最近针对女性的标准，女性患者中腰椎和股骨骨质减少以及腰椎和股骨骨质疏松的患病率分别达到75%、65%、33%和10%。研究的纵向部分显示腰椎存在持续的病理性脱矿过程。在研究期间，以对照组BMD的百分比表示的BMD从89±14%降至86±14%（P < 0.001）。骨量的年变化为每年-1.7±2.8%。56%的患者存在加速椎体骨质流失（定义为以对照组BMD百分比表示的BMD每年下降超过1%），且与更高的泼尼松剂量相关（P < 0.01）。总之，尽管肾移植长期存活者中椎体骨折相对少见，但骨质减少很常见，且相当比例的女性存在腰椎骨质疏松。还证实了脊柱存在持续的脱矿过程，这可能导致长期脊柱骨质疏松的发生率增加。泼尼松剂量仍然是最持续存在的危险因素。
