成年男性肾移植受者10年内骨密度及骨生化指标的自然变化  

Natural changes in bone mineral density and bone biochemical markers in adult male kidney transplant recipients during ten years

作　　者：王晨秀[1] 霍亚南[1] 林安华[1] 熊昌辉 朱文怡 邓颖[1] 张娜[1] 黄水金 李新长[4] 沈群[1] WANG Chen-xiu;HUO Ya-nan;LIN An-hua;XIONG Chang-hui;ZHU Wen-yi;DENG Ying;ZHANG Na;HUANG Shui-jin;LI Xin-chang;SHEN Qun(Department qf Endocrinology and Osteoporosis,Jiangxi Provincial People's Hospital Affiliated to Nanchang University,Nanchang 330000,China;Department of Science and Education,Jiangxi Provincial People's Hospital Affiliated to Nanchang University,Nanchang 330000,China;Medical College of Nanchang University,Nanchang 330000,China;Department of Transplantation,Jiangxi Provincial People's Hospital Affiliated to Nanchang University,Nanchang 330000,China)

机构地区：[1]江西省人民医院(南昌大学附属人民医院)内分泌骨质疏松科,南昌330000 [2]江西省人民医院(南昌大学附属人民医院)科教科,南昌330000 [3]南昌大学医学院研究生院,南昌330000 [4]江西省人民医院(南昌大学附属人民医院)器官移植科,南昌330000

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2021年第2期108-113,共6页Chinese Journal Of Osteoporosis And Bone Mineral Research

基　　金：国家自然科学基金(2016YFC0901205)。

摘　　要：目的观察成年男性肾移植受者在未接受过任何抗骨质疏松治疗的情况下,肾移植后10年内骨密度及骨生化指标的变化。方法纳入2018年8月至2019年9月江西省人民医院(南昌大学附属人民医院)定期随访的男性成年肾移植受者,均完成一般情况问卷、生化指标检测、骨密度及前后段胸腰椎侧位X线摄片。结果成年男性肾移植受者141例患者纳入研究,平均年龄(40.94±8.90)岁,其中脆性骨折者5例(3.55%)。所有患者均使用糖皮质激素(以泼尼松计算),目前使用量在5~10 mg/d之间占95.06%。患者平均移植年龄(37.57±9.99)岁,平均透析时间为12(6.48,36)个月,平均移植龄29(12,63)个月;在成年男性肾移植受者中,骨量丢失者72例,占51.06%。通过腰椎骨密度诊断骨量丢失者69例,占总骨量丢失组的95.83%,而单独通过全髋和股骨颈骨密度诊断的人数分别只有3例(4.17%)和17例(12.06%)。股骨颈、腰椎、全髋骨密度随着移植龄延长均呈下降趋势,但只有股骨颈骨密度下降呈显著统计学差异(P=0.005);随着移植龄变化,钙(calcium,Ca)、磷(phosphorus,P)、1型原胶原N-端肽(procollagen type 1 N-terminal peptide,P1NP)、碱性磷酸酶(alkaline phosphatase,ALP)、β1型胶原交联C-末端肽(β-isomerized cross-liked C-telopeptide of type 1 collagen,βCTX)、全段甲状旁腺素(intact parathyroid hormone,iPTH)、25羟基维生素D[25-hydroxy vitamin D,25(OH)D]的浓度变化均具有显著性差异(均P<0.05),移植龄和血P(β=0.269,P=0.002)、25(OH)D(β=0.209,P=0.007)呈正相关,和βCTX(β=-0.327,P=0.006)呈负相关。结论男性成年肾移植后肾功能得到改善并一直维持稳定,但骨密度仍呈下降趋势,骨生化标志物10年内自然变化逐渐趋于平稳。Objective To observe the changes in bone mineral density and bone biochemical markers in adult male kidney transplant recipients without anti-osteoporosis treatment during 10 years after kidney transplantation.Methods Adult male kidney transplant recipients were included who were regularly followed up by Jiangxi Provincial People’s Hospital of Nanchang University from August 2018 to September 2019.All of them completed general questionnaires,bone biochemical markers tests,and bone mineral density,X-ray of thoracolumbar measured.Results Totally 141 adult male kidney transplant recipients were included,with an average age of 40.94±8.90 years old,and 5 of them had fragility fractures(3.55%).All patients took glucocorticoids(calculated as prednisone),and the current dosage of 95.06%patients was between 5-10 mg/d.The average transplant age of the patients was 37.57±9.99 years old,and the median dialysis duration was 12(6.48,36)months,with the median duration of transplant of 29(12,63)months.There were 72 cases with bone mass loss,accounting for 51.06%,and 69 cases(95.83%)had bone loss at lumbar spine,and 3 cases(4.17%)and 17 cases(12.06%)had bone loss at total hip and femoral neck respectively.The bone mineral density at femoral neck,lumbar spine,and hip all showed a downward trend with the prolongation of duration of transplantation,but only the decline of the femoral neck bone density showed a significant statistical difference(P=0.005).With duration of transplantation,calcium(Ca),phosphorus(P),procollagen type 1 N-terminal peptide(P 1 NP),alkaline phosphatase(ALP),β-isomerized cross-liked C-telopeptide of type 1 collagen(β-CTX),intact parathyroid hormone(iPTH),25-hydroxy vitamin D[25(OH)D]concentration had significant differences(P<0.05).The duration of transplant age was positively correlated with serum P(β=0.269,P=0.002),25(OH)D(β=0.209,P=0.007),and negatively correlated withβ-CTX(β=-0.327,P=0.006).Conclusion Renal function has been improved and maintained stable after kidney transplantation,but the bon

关 键 词：肾移植 骨密度 骨折 骨生化指标 

分 类 号：R617[医药卫生—外科学] R681[医药卫生—临床医学]