Chiu M Y, Sprague S M, Bruce D S, Woodle E S, Thistlethwaite J R, Josephson M A
Department of Medicine, University of Chicago, IL 60637, USA.
J Am Soc Nephrol. 1998 Apr;9(4):677-83. doi: 10.1681/ASN.V94677.
Fractures occur in 11 to 26% of renal allograft recipients after transplantation despite improvements in bone and mineral disorders. This high fracture rate is likely a consequence of accelerated osteopenia. The cause of posttransplant bone loss is multifactorial, and patients with insulin-dependent diabetes mellitus and renal failure may have additional fracture risks such as low turnover bone disease. This retrospective cohort study was undertaken to determine the long-term incidence and the potential risk factors of posttransplant fractures in patients with insulin-dependent diabetes mellitus undergoing combined kidney-pancreas allograft transplantation. Thirty-five patients with insulin-dependent diabetes mellitus who received a combined kidney-pancreas allograft between 1987 and 1992 were evaluated. Thirty-five kidney allograft recipients matched for age, gender, and the date of transplant were also reviewed. The fracture incidence in the kidney-pancreas group was 49% after transplantation. The rate of first fracture after kidney-pancreas transplantation was 12.1% per patient year, resulting in a 5-yr fracture-free rate of 48%. The initial fracture occurred at a mean of 31.06 +/- 19.9 mo. Steroid exposure was found to increase the risk of fracture, and analysis by means of a Cox regression model estimated that an increase in cumulative steroid exposure of 10 mg/kg at any given month increased the hazard of sustaining a fracture by 9% (95% confidence interval for hazard ratio, 1.01 to 1.18; P = 0.031). This analysis suggests that kidney-pancreas recipients are at significant risk of sustaining a fracture within a few years after transplantation.
尽管骨与矿物质紊乱问题有所改善，但肾移植受者中仍有11%至26%会在移植后发生骨折。这种高骨折率可能是骨质减少加速的结果。移植后骨质流失的原因是多方面的，胰岛素依赖型糖尿病和肾衰竭患者可能有额外的骨折风险，如低转换型骨病。本回顾性队列研究旨在确定接受肾胰腺联合移植的胰岛素依赖型糖尿病患者移植后骨折的长期发生率及潜在风险因素。对1987年至1992年间接受肾胰腺联合移植的35例胰岛素依赖型糖尿病患者进行了评估。还对35例年龄、性别和移植日期相匹配的肾移植受者进行了回顾。肾胰腺组移植后的骨折发生率为49%。肾胰腺移植后每位患者每年首次骨折发生率为12.1%，5年无骨折率为48%。首次骨折发生的平均时间为31.06±19.9个月。发现类固醇暴露会增加骨折风险，通过Cox回归模型分析估计，在任何给定月份累积类固醇暴露量增加10 mg/kg会使发生骨折的风险增加9%（风险比的95%置信区间为1.01至1.18；P = 0.031）。该分析表明，肾胰腺移植受者在移植后几年内有发生骨折的显著风险。
