Comparison of single CT scan assessment of bone mineral density, vascular calcification and fat mass with standard clinical measurements in renal transplant subjects: the ABC HeART study.
Comparison of single CT scan assessment of bone mineral density, vascular calcification and fat mass with standard clinical measurements in renal transplant subjects: the ABC HeART study.
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DOI：
10.1186/s12882-015-0182-6
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发表时间：
2015-11-11
期刊：
影响因子：
2.3
通讯作者：
Eustace JA
中科院分区：
文献类型：
--
作者：
Kinsella S;Murphy K;Breen M;O'Neill S;McLaughlin P;Coyle J;Bogue C;O'Neill F;Moore N;McGarrigle A;Molloy MG;Maher MM;Eustace JA
尽管常规方法存在局限性，但临床实践指南支持肾移植受者骨密度（BMD）和血管钙化的评估。脂肪量的变化也发生在移植后，尽管传统上难以准确测量。我们报告的可行性，方便性和准确性的测量上述3个参数使用一种新的CT协议。我们对64例首次肾移植受者（eGFR > 30 ml/min/1.73 m2）进行了横断面研究。使用CT腰椎（GE Medical Systems Lightspeed VCT & Mindways QCT Pro Bone Mineral Densitometry System Version 4.2.3）进行定量CT（QCT）BMD分析，以计算脊柱体积BMD，并与标准DXA计算的脊柱、髋关节和前臂远端的面积BMD进行比较。采用半定量主动脉钙化指数（ACI）方法评估腹主动脉钙化，并与侧位腰椎X线Kappuila评分和脉搏波传导速度（PWV）进行比较。将内脏和皮下脂肪组织体积（Osirix 16版本3.7.1）与BMI进行比较。61%的参与者为男性，平均年龄为47岁，ESKD中位持续时间为5.4年，平均eGFR为54 ml/min。股骨近端iDXA中位T评分为-1.2，腰椎为-0.2。腰椎的中位QCT骨小梁T评分为-1.2。按临床试验机构和方法列出的T评分<2.5的受试者百分比为：DXA股骨近端：7%，DXA桡骨远端：17%，DXA脊柱：9%，QCT（美国放射学会临界值）：9%。CT衍生的ACI与PWV（r = 0.29，p = 0.02）、脉搏波压力（r = 0.51，p < 0.001）、QCT小梁（-0.31，p = 0.01）和皮质体积BMD和心血管事件史（Mann-Whitney U，p = 0.02）相关。内脏脂肪和皮下脂肪与BMI均呈显著正相关（r = 0.63和0.64，p < 0.001）。单次CT扫描骨密度、血管钙化和身体成分三重评估是监测肾移植术后危险因素的一种有效、准确、方便的方法。
Despite limitations of routine methods, Clinical Practice Guidelines support the assessment of bone mineral density (BMD) and vascular calcification in renal transplant recipients. Changes in fat mass also occur post-transplantation, although they are traditionally difficult to measure accurately. We report the feasibility, convenience and accuracy of measuring the above 3 parameters using a novel CT protocol. We conducted a cross-sectional study of 64 first renal allograft recipients (eGFR > 30 ml/min/1.73 m2). Quantitative CT (QCT) BMD analysis was conducted using CT lumbar spine (GE Medical Systems Lightspeed VCT & Mindways QCT Pro Bone Mineral Densitometry System Version 4.2.3) to calculate spinal volumetric BMD and compared with standard DXA calculated areal BMD at the spine, hip and distal forearm. Abdominal aortic calcification was assessed by semi-quantitative Aortic Calcification Index (ACI) method and compared with lateral lumbar x-ray Kappuila score and pulse wave velocity (PWV). Visceral and subcutaneous adipose tissue volume (Osirix 16 Ver 3.7.1) was compared with BMI. Participants were 61 % male, had a mean age of 47 years, median ESKD duration of 5.4 years and a mean eGFR of 54 ml/min. iDXA median T-score at proximal femur was −1.2 and at lumbar spine was −0.2. Median QCT Trabecular T-score at lumbar spine was −1.2. The percent of subjects with a T-score of <2.5 by site and method was DXA Proximal Femur: 7 %, DXA distal radius: 17 %, DXA spine: 9 %, QCT (American College of Radiology cutoffs): 9 %. CT derived ACI correlated with PWV (r = 0.29, p = 0.02), pulse wave pressure (r = 0.51, p < 0.001), QCT Trabecular (−0.31, p = 0.01) and cortical volumetric BMD and history of cardiovascular events (Mann–Whitney U, p = 0.02). Both visceral and subcutaneous adipose tissue correlated with BMI (r = 0.63 & 0.64, p < 0.001). Single CT scan triple assessment of BMD, vascular calcification and body composition is an efficient, accurate and convenient method of risk factor monitoring post renal transplantation.