Change in bone mineral density at one year following glucocorticoid withdrawal in kidney transplant recipients.
Change in bone mineral density at one year following glucocorticoid withdrawal in kidney transplant recipients.
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DOI：
10.1111/j.1399-0012.2010.01344.x
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发表时间：
2011-03
影响因子：
2.1
通讯作者：
Lane NE
中科院分区：
文献类型：
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作者：
Ing SW;Sinnott LT;Donepudi S;Davies EA;Pelletier RP;Lane NE
在肾移植中糖皮质激素（GC）治疗会对骨骼产生有害影响，但在这一人群中停用GC的研究有限。本研究评估了GC停药后骨密度（BMD）的变化。受试者在肾移植后一年入组，随机继续或停止泼尼松治疗;所有受试者继续使用环孢素和吗替麦考酚酯。在入组时采用双能X线骨密度仪测量BMD，并在一年内重复测量，并对测量值进行标准化。GC停药组与继续给药组腰椎标准化BMD年变化的平均值±标准差分别为+4.7% ± 5.5 vs. + 0.9% ± 5.3（p = 0.0014）;全髋关节+2.4% ± 4.2 vs. −0.4% ± 4.2（p = 0.013），股骨颈+2.1% ± 4.6 vs. +1.0% ± 6.0（p = 0.37）。入组前的泼尼松剂量、进入研究后肌酸酐清除率、体重或骨活性药物使用的变化没有造成混淆。多变量分析确定BMD的变化与基线碱性磷酸酶和肌酐清除率呈正相关，与基线BMD呈负相关。肾移植后停用GC可改善BMD，BMD的增加依赖于基线骨转换、肾功能和BMD。
Glucocorticoid (GC) therapy induces deleterious effects on the skeleton in kidney transplantation but studies of GC discontinuation in this population are limited. This study evaluated changes in areal bone mineral density (BMD) with GC withdrawal. Subjects were enrolled one yr after renal transplantation and randomized to continue or stop prednisone; all subjects continued cyclosporine and mycophenolate mofetil. BMD measured by dual-energy X-ray absorptiometry was performed at enrollment and repeated at one yr and values were standardized. Mean ± standard deviation of annualized change in standardized BMD between GC withdrawal vs. continuation group at the lumbar spine was +4.7% ± 5.5 vs. + 0.9% ± 5.3 (p = 0.0014); total hip +2.4% ± 4.2 vs. −0.4% ± 4.2 (p = 0.013), and femoral neck +2.1% ± 4.6 vs. +1.0% ± 6.0 (p = 0.37). There was no confounding by prednisone dose prior to enrollment, change in creatinine clearance, weight, or use of bone-active medications following study entry. Multivariate analysis determined that the change in BMD was positively associated with baseline alkaline phosphatase and creatinine clearance and negatively associated with baseline BMD. BMD improves with GC withdrawal after renal transplantation, and this gain in BMD is dependent on the baseline bone turnover, renal function, and BMD.
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影响因子：
6.2
作者：
Hui, SL;Gao, SJ;Genant, H
通讯作者：
Genant, H
影响因子：
158.5
作者：
JULIAN, BA;LASKOW, DA;QUARLES, LD
通讯作者：
QUARLES, LD
影响因子：
5.6
作者：
Abbott, KC;Oglesby, RJ;Duncan, WE
通讯作者：
Duncan, WE
影响因子：
4.1
作者：
Canalis, E;Bilezikian, JP;Giustina, A
通讯作者：
Giustina, A
DOI：
10.1038/ki.2009.188
发表时间：
2009-08-01
期刊：
Kidney international. Supplement
影响因子：
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作者：
通讯作者：
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