RAPID LOSS OF VERTEBRAL MINERAL DENSITY AFTER RENAL-TRANSPLANTATION
RAPID LOSS OF VERTEBRAL MINERAL DENSITY AFTER RENAL-TRANSPLANTATION
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DOI：
10.1056/nejm199108223250804
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发表时间：
1991-08-22
影响因子：
158.5
通讯作者：
QUARLES, LD
中科院分区：
文献类型：
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作者：
JULIAN, BA;LASKOW, DA;QUARLES, LD
背景。骨质减少是肾移植的主要并发症。免疫抑制方案包括环孢素，允许使用较低剂量的糖皮质激素，可以减少糖皮质激素引起的骨质减少。我们前瞻性地研究了20例接受活体亲属供体肾移植的成人骨丢失的程度、分布和机制，这些患者肾功能良好，接受硫唑嘌呤、环孢素和低剂量强的松治疗。测定血清骨代谢生化指标，测定第二、第三、第四腰椎和桡骨轴的骨矿物质密度，分析移植时和移植后6个月髂骨的组织形态学特征。17例患者在移植后18个月重复测量椎体矿物质密度。结果。移植后血清甲状旁腺激素、磷、碱性磷酸酶平均浓度降低，骨化三醇平均浓度升高。移植后6个月椎骨平均（+/- SD）骨密度下降了6.8 +/- 5.6% (P < 0.05)，移植后18个月下降了8.8 +/- 7.0%。移植后6个月桡骨骨密度明显增高（P < 0.05）。组织形态学研究表明，骨形成速率从每年50.5 +/- 44.8 mu-m3 /平方微米下降到23.1 +/- 13.8 mu-m3 /平方微米（P < 0.05），骨形成周期从70 +/- 42天延长到146 +/- 144天（P < 0.05）。因此，在重塑周期中替换的骨量减少。在环孢素时代，与肾移植相关的骨质减少仍然是一个问题。我们研究对象的椎体骨丢失是由于骨重塑的不平衡与糖皮质激素的毒性作用相一致。
Background. Osteopenia is a major complication of renal transplantation. Immunosuppressive regimens including cyclosporine, which permit the use of lower doses of glucocorticoids, may reduce glucocorticoid-induced osteopenia.Methods. We prospectively studied the magnitude, distribution, and mechanism of bone loss in 20 adults who received renal allografts from living related donors, who had good renal function, and who were treated with azathioprine, cyclosporine, and low doses of prednisone. We measured serum biochemical markers of bone metabolism, determined the bone mineral density of the second, third, and fourth lumbar vertebrae and the shaft of the radius, and analyzed the histomorphometric features of iliac bone at the time of transplantation and six months later. Measurements of vertebral mineral density were repeated 18 months after transplantation in 17 of the patients. Results. After transplantation, the mean serum concentrations of Parathyroid hormone, phosphorus, and alkaline phosphatase decreased and the serum calcitriol concentration increased. The mean (+/- SD) bone mineral density of the vertebrae had decreased 6.8 +/- 5.6 percent 6 months after transplantation (P < 0.05) and 8.8 +/- 7.0 percent 18 months after transplantation. In contrast, the bone mineral density of the radius had increased six months after transplantation (P < 0.05). The histomorphometric studies showed that the rate of bone formation decreased from 50.5 +/- 44.8 to 23.1 +/- 13.8-mu-m3 per square micrometer per year (P < 0.05), and the formation period lengthened from 70 +/- 42 to 146 +/- 144 days (P < 0.05). Consequently, the amount of bone replaced during a remodeling cycle diminished.Conclusions. Osteopenia associated with renal transplantation remains a problem in the cyclosporine era. The loss of vertebral bone in our subjects was due to an imbalance in bone remodeling consistent with a toxic effect of glucocorticoids.