肾移植受者骨密度评估及影响因素分析  

Prognosis of chronic active antibody-mediated rejection in kidney transplantation

作　　者：孙黎[1] 韩志坚[1] 居小兵[1] 陶俊[1] 陈浩[1] 黄正楷[1] 王子杰[1] 费爽[1] 顾民[1] 谭若芸 Sun Li;Han Zhijian;Ju Xiaobing;Tao Jun;Chen Hao;Huang Zhengkai;Wang Zijie;Fei Shuang;Gu Min;Tan Ruoyun(Department of Urology and Nephrology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院泌尿外科肾移植中心,南京210029

出　　处：《中华器官移植杂志》2020年第3期169-173,共5页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金面上项目(81870512,81770751,81570676,81470981,81100532);江苏省"333"工程项目(BRA2017532,BRA2016514);江苏省"科教兴卫"工程医学重点人才培养资助项目(RC2011055);江苏省"六大人才高峰"资助项目(2010WSN-56,2011-WS-033);江苏省卫生厅面上项目(H2009907)。

摘　　要：目的:评估肾移植受者骨密度,分析影响因素,为肾移植术后骨质疏松防治提出方向。方法:回顾性分析南京医科大学第一附属医院2017年1月至2019年5月收治的254例肾移植受者,年龄(40.5±9.8)岁,男性168例、绝经期女性15例。应用双能X线吸收测定法(DEXA)检测右股骨颈及腰椎骨密度,评估骨质疏松发生率,分析影响因素。结果:254例受者骨量减少/骨质疏松在右股骨颈的发生率为20.1%和2.8%,在腰椎的发生率为26.1%和3.6%。卡方检验示术后时间较长、高龄、绝经受者右股骨颈及腰椎骨量丢失发生率更高(P<0.05)。线性回归分析示右股骨颈骨密度与身体质量指数(BMI)、胆固醇、甘油三酯、术前甲状旁腺切除术史呈正相关,与急性排斥、绝经女性呈负相关;腰椎骨密度与BMI、胆固醇、术前甲状旁腺切除术史呈正相关,与甲状旁腺激素(PTH)呈负相关(P<0.05)。结论:肾移植受者骨量丢失发生率较高。监测骨密度,控制甲状旁腺亢进、维持良好营养状态、减少糖皮质激素用量等,对防治骨量丢失有积极作用。Objective To evaluate the values of bone mineral density(BMD)of renal transplant recipients and analyze the influencing factors so as to provide rationales for preventing and treating osteoporosis after renal transplantation.Methods A retrospective study was conducted for clinical data of 254 renal transplant recipients hospitalized from January 2017 to May 2019.The values of BMD of right femoral neck and lumbar vertebrae were detected by dual-energy X-ray absorptiometry(DEXA)and their relationships with other clinical parameters analyzed.Results The average age was(40.5±9.8)years.Males accounted for 66.1%,and menopausal women 5.9%.The prevalence of osteopenia/osteoporosis of right femoral neck bone mass and lumbar vertebrae was 20.1%,2.8%and 26.1%,3.6%respectively.Chi-square test showed that recipients with lower BMD of femoral neck and lumbar spine were elders,menopausal women and those with longer postoperative time(P<0.05).Multivariate linear regression analysis indicated that BMD of right femoral neck was positively correlated with BMI and negatively correlated with acute rejection(P<0.05).The BMD of lumbar vertebrae was positively correlated with BMI and negatively correlated with PTH level(P<0.05).Conclusions There is a high prevalence of bone loss in kidney transplant recipients.Regular monitoring of BMD,active control of hyperparathyroidism,maintaining an excellent nutritional status,tapering of glucocorticoid dose and using immunosuppressants with less effect on bone metabolism may prevent osteoporosis.

关 键 词：肾移植 骨密度 骨质疏松 骨量减少 

分 类 号：R699.2[医药卫生—泌尿科学]