Christ E, Linka A, Junga G, Odermatt M, Steinert H, Kiowski W, Schmid C
Departement für Innere Medizin, Universitätsspital Zürich.
Schweiz Med Wochenschr. 1996 Sep 14;126(37):1553-9.
The purpose of this study was to assess bone mineral density (BMD) and parameters for bone metabolism in patients with end-stage heart disease awaiting heart transplantation to determine whether these patients are at increased risk of bone disease.
39 adult men (mean age 52.3, range 21-65 years) with ischemic (41%), idiopathic (43.5%), valvular (2.5%) and diverse (13%) end-stage heart disease were studied prior to heart transplantation. BMD was measured using dual-energy x-ray absorptiometry at the lumbar spine (L2-L4) and at the upper femur (Ward's triangle and femoral neck). Renal and bone biochemical profiles, parathyroid hormone (PTH), 25-OH-vitamin D3, testosterone, alkaline bone phosphatase, osteocalcin, and deoxypyridinoline and calcium excretion were measured.
No fractures were found. Mean z-scores were -1.06 +/- 2.02 (mean +/- SD) at the lumbar spine, -1.12 +/- 2.03 at the femoral neck and -0.25 +/- 1.06 at Ward's triangle. Significantly decreased values were seen at the lumbar spine and at the femoral neck compared to age matched healthy controls. Mean values of serum creatinine and parathyroid hormone were elevated (114.4 +/- 29.5 mumol/l and 84.3 +/- 67.8 ng/l, respectively). 7 (18%), 10 (26%) and 22 (56%) of the 39 patients had values beneath the normal range of 25-OH-vitamin D3, testosterone and osteocalcin respectively. Mean urinary deoxypyridinoline/creatinine ratios were elevated (9.46 +/- 8.52 nmol/mmol, normal range 2.5-5). No correlation existed between osteocalcin and urinary deoxypyridinoline/creatinine ratio. Using a multiple linear regression model, serum PTH and cardiac ejection fraction (EF) weakly predicted BMD at the femoral neck (r2 = 0.26).
(1.) Lumbar spine and femoral neck BMD are low in patients awaiting heart transplantation. (2.) A low EF and a high PTH weakly correlate with a decrease in BMD at the femoral neck. (3.) In patients with end-stage heart failure the coupling of bone formation to bone resorption is frequently disturbed. (4.) Testosterone and 25-OH-vitamin D3 levels are low in a number of patients and in such cases replacement therapy may be appropriate.
本研究旨在评估等待心脏移植的终末期心脏病患者的骨矿物质密度（BMD）及骨代谢参数，以确定这些患者是否存在骨病风险增加的情况。
对39名成年男性（平均年龄52.3岁，范围21 - 65岁）进行了研究，这些患者患有缺血性（41%）、特发性（43.5%）、瓣膜性（2.5%）和多种病因（13%）的终末期心脏病，均在心脏移植前接受了检查。采用双能X线吸收法测量腰椎（L2 - L4）和股骨上段（沃德三角区和股骨颈）的骨密度。检测了肾脏和骨生化指标、甲状旁腺激素（PTH）、25 - 羟基维生素D3、睾酮、碱性磷酸酶、骨钙素、脱氧吡啶啉以及钙排泄量。
未发现骨折情况。腰椎的平均z值为 -1.06 ± 2.02（均值 ± 标准差），股骨颈为 -1.12 ± 2.03，沃德三角区为 -0.25 ± 1.06。与年龄匹配的健康对照组相比，腰椎和股骨颈的数值显著降低。血清肌酐和甲状旁腺激素的均值升高（分别为114.4 ± 29.5 μmol/l和84.3 ± 67.8 ng/l）。39名患者中，分别有7名（18%）、10名（26%）和22名（56%）患者的25 - 羟基维生素D3、睾酮和骨钙素值低于正常范围。尿脱氧吡啶啉/肌酐比值的均值升高（9.46 ± 8.52 nmol/mmol，正常范围2.5 - 5）。骨钙素与尿脱氧吡啶啉/肌酐比值之间无相关性。使用多元线性回归模型，血清PTH和心脏射血分数（EF）对股骨颈骨密度的预测作用较弱（r2 = 0.26）。
（1）等待心脏移植的患者腰椎和股骨颈的骨密度较低。（2）低EF和高PTH与股骨颈骨密度降低存在较弱的相关性。（3）在终末期心力衰竭患者中，骨形成与骨吸收的耦联经常受到干扰。（4）许多患者的睾酮和25 - 羟基维生素D3水平较低，在这种情况下替代治疗可能是合适的。
