肾移植受者与透析患者骨代谢异常的比较
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摘要
目的:评估肾移植受者及慢性肾脏病透析患者骨代谢异常情况,探讨肾移植术后骨代谢状态的变化。方法:回顾性分析南京医科大学第一附属医院2017年1月—2018年6月住院随访复查的156例肾移植术后半年及以上的受者,同步纳入2018年1—5月住院的77例透析患者。比较两组骨代谢标志物及骨密度(BMD)水平。结果:肾移植组vs.透析组,各骨代谢标志物异常发生率:低校正血钙0.0%vs. 9.5%、高校正血钙14.8%vs. 9.5%、低磷25.0%vs. 2.6%、高磷3.2%vs.85.5%、高甲状旁腺激素(PTH)51.4%vs.85.9%、低25-羟基维生素D 63.7%vs.81.9%、高骨钙素17.8%vs.98.6%、高Ⅰ型胶原N端肽84.6%vs.100.0%、高Ⅰ型胶原C端肽80.8%vs.100.0%、高抗酒石酸酸性磷酸酶5 b(TRAP-5b)18.2%vs. 46.5%,两组比较差异有统计学意义(P <0.05)。两组间骨型碱性磷酸酶水平比较差异无统计学意义(P> 0.05),两组右股骨颈骨量及椎骨量减少及骨质疏松发生率比较差异均无统计学意义(P> 0.05)。多因素分析BMD的影响因素,肾移植组为与术前甲状旁腺切除史、体重指数(BMI)、总胆固醇(TC)、血磷水平呈正相关,与中性粒细胞(NE)呈负相关(P <0.05),透析组为与年龄和PTH呈负相关(P <0.05)。结论:肾移植术后随着肾功能的改善,骨代谢异常指标可得到改善,但仍有部分患者出现持续骨代谢异常。综合各骨代谢指标的变化及趋势,有助于评估肾移植术后矿物质与骨代谢异常。
Objective:To evaluate the abnormalities of bone metabolism in renal transplant recipients and chronic kidney disease patients undergoing stage 5 dialysis,and to explore the changes of bone metabolism after renal transplantation. Methods:Retrospective analysis was performed on 156 recipients who were hospitalized for follow-up review in the First Affiliated Hospital of Nanjing Medical University from January 2017 to June 2018. All recipients had received kidney transplantation for six months or more. Total 77 dialysis patients hospitalized from January to May 2018 were simultaneously included. Serum calcium(Ca),phosphorus(P),25-hydroxy vitamin D[25(OH)D],parathyroid hormone(PTH),bone-specific alkaline phosphatase(bALP),osteocalcin(OC),type I collagen cross-linked N-terminal peptide(NTx),type I collagen cross-linked C-terminal peptide(CTx),tartrate-resistant acid phosphatase 5 b(TRAP-5 b),and bone mineral density(BMD)were compared between the two groups to investigate changes of bone metabolism after kidney transplantation. Results:The mean age of 156 kidney transplant recipients was(39.9 ± 9.5)years old,and 65.4% were male.The mean age of 77 dialysis patients was(38.2 ± 10.2)years old,and 71.4% were male. The incidence of abnormal bone metabolism markers in renal transplantation group vs. dialysis group:Low correction Ca was 0.0% vs. 9.5%,high correction Ca was 14.8% vs. 9.5%,low P 25.0% vs. 2.6%,high P 3.2% vs. 85.5%,high PTH 51.4% vs. 85.9%,low 25(OH)D 63.7% vs. 81.9%,high OC 17.8% vs. 98.6%,high NTx 84.6% vs. 100.0%,high CTx 80.8% vs. 100.0%,high TRAP-5 b 18.2% vs. 46.5%. There were significant differences in those markers between the two groups(P < 0.05). There was no difference in bALP between two groups(P > 0.05). The incidence of right femur neck osteopenia and osteoporosis was 19.0% and 3.6% in the kidney transplantation group,respectively,and was 17.7% and4.8% in the dialysis group,respectively. The incidence of lumbar spine osteopenia and osteoporosis was 26.5% and 4.4% in the kidney transplantation group,respectively,and was 19.4% and 4.8% in the dialysis group,respectively. Both showed no differences between two groups(P > 0.05). The influence factors of BMD were preoperative history of parathyroidectomy,body mass index(BMI),total cholesterol(TC),normal blood phosphorus levels and neutrophils(NE)(P < 0.05)in the kidney transplantation group. While,age and PTH were influence factors of BMD in the dialysis group. Conclusion:This study showed that the indicators of bone metabolism abnormalities could be improved after kidney transplantation,but under the condition of stable renal function,some patients still showed persistent bone metabolism abnormalities. It is helpful to evaluate mineral and bone metabolism abnormalities after kidney transplantation by synthesizing changes and trends of bone metabolism indexes.
Objective:To evaluate the abnormalities of bone metabolism in renal transplant recipients and chronic kidney disease patients undergoing stage 5 dialysis,and to explore the changes of bone metabolism after renal transplantation. Methods:Retrospective analysis was performed on 156 recipients who were hospitalized for follow-up review in the First Affiliated Hospital of Nanjing Medical University from January 2017 to June 2018. All recipients had received kidney transplantation for six months or more. Total 77 dialysis patients hospitalized from January to May 2018 were simultaneously included. Serum calcium(Ca),phosphorus(P),25-hydroxy vitamin D[25(OH)D],parathyroid hormone(PTH),bone-specific alkaline phosphatase(bALP),osteocalcin(OC),type I collagen cross-linked N-terminal peptide(NTx),type I collagen cross-linked C-terminal peptide(CTx),tartrate-resistant acid phosphatase 5 b(TRAP-5 b),and bone mineral density(BMD)were compared between the two groups to investigate changes of bone metabolism after kidney transplantation. Results:The mean age of 156 kidney transplant recipients was(39.9 ± 9.5)years old,and 65.4% were male.The mean age of 77 dialysis patients was(38.2 ± 10.2)years old,and 71.4% were male. The incidence of abnormal bone metabolism markers in renal transplantation group vs. dialysis group:Low correction Ca was 0.0% vs. 9.5%,high correction Ca was 14.8% vs. 9.5%,low P 25.0% vs. 2.6%,high P 3.2% vs. 85.5%,high PTH 51.4% vs. 85.9%,low 25(OH)D 63.7% vs. 81.9%,high OC 17.8% vs. 98.6%,high NTx 84.6% vs. 100.0%,high CTx 80.8% vs. 100.0%,high TRAP-5 b 18.2% vs. 46.5%. There were significant differences in those markers between the two groups(P < 0.05). There was no difference in bALP between two groups(P > 0.05). The incidence of right femur neck osteopenia and osteoporosis was 19.0% and 3.6% in the kidney transplantation group,respectively,and was 17.7% and4.8% in the dialysis group,respectively. The incidence of lumbar spine osteopenia and osteoporosis was 26.5% and 4.4% in the kidney transplantation group,respectively,and was 19.4% and 4.8% in the dialysis group,respectively. Both showed no differences between two groups(P > 0.05). The influence factors of BMD were preoperative history of parathyroidectomy,body mass index(BMI),total cholesterol(TC),normal blood phosphorus levels and neutrophils(NE)(P < 0.05)in the kidney transplantation group. While,age and PTH were influence factors of BMD in the dialysis group. Conclusion:This study showed that the indicators of bone metabolism abnormalities could be improved after kidney transplantation,but under the condition of stable renal function,some patients still showed persistent bone metabolism abnormalities. It is helpful to evaluate mineral and bone metabolism abnormalities after kidney transplantation by synthesizing changes and trends of bone metabolism indexes.
引文
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[8]金文雅,赵晋华,乔文礼,等.肾移植患者骨密度分析研究[J].世界临床药物,2011,32(11):652-654
[9]秦燕,徐琴君,谭建明,等. 140例移植肾受者骨质丢失原因分析[J].临床内科杂志,2005,22(2):85-88
[10]Chavassieux P,Portero-Muzy N,Roux JP,et al. Are biochemical markers of bone turnover representative of bone histomorphometry in 370 postmenopausal women?[J].The Journal of Clinical Endocrinology and Metabolism,2015,100(12):4662-4668
[11]Ball AM,Gillen DL,Sherrard D,et al. Risk of hip fracture among dialysis and renal transplant recipients[J]. JAMA,2002,288(23):3014-3018
[12]Molnar MZ,Naser MS,Rhee CM,et al. Bone and mineral disorders after kidney transplantation:therapeutic strategies[J]. Transplantation Reviews(Orlando,Fla),2014,28(2):56-62
[13]Julian BA,Laskow DA,Dubovsky J,et al. Rapid loss of vertebral mineral density after renal transplantation[J].The New England Journal of Medicine,1991,325(8):544-550
[14]Rojas E,Carlini RG,Clesca P,et al. The pathogenesis of osteodystrophy after renal transplantation as detected by early alterations in bone remodeling[J]. Kidney international,2003,63(5):1915-1923
[15]黄雪珍,张建东,官荣光,等. 1768例中老年妇女绝经后骨质疏松患病率及危险因素调查分析[J].检验医学与临床,2016,13(13):1841-1843
[2]程东瑞.肾移植后骨病[J].肾脏病与透析肾移植杂志,2010,19(2):187-191
[3]陈德才.骨代谢生化标志物临床应用指南[J].中华骨质疏松和骨矿盐疾病杂志,2015,8(4):283-293
[4]Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO study group[J]. World Health Organization Technical Report Series,1994,843:1-129
[5]Sprague SM,Belozeroff V,Danese MD,et al. Abnormal bone and mineral metabolism in kidney transplant patients-a review[J]. American Journal of Nephrology,2008,28(2):246-253
[6]Block GA,Klassen PS,Lazarus JM,et al. Mineral metabolism,mortality,and morbidity in maintenance hemodialysis[J]. JASN,2004,15(8):2208-2218
[7]Torres A,Rodriguez AP,Concepcion MT,et al. Parathyroid function in long-term renal transplant patients:importance of pre-transplant PTH concentrations[J]. Nephrology,dialysis,transplantation:official publication of the European Dialysis and Transplant Association-European Renal Association,1998,13(Suppl 3):94-97
[8]金文雅,赵晋华,乔文礼,等.肾移植患者骨密度分析研究[J].世界临床药物,2011,32(11):652-654
[9]秦燕,徐琴君,谭建明,等. 140例移植肾受者骨质丢失原因分析[J].临床内科杂志,2005,22(2):85-88
[10]Chavassieux P,Portero-Muzy N,Roux JP,et al. Are biochemical markers of bone turnover representative of bone histomorphometry in 370 postmenopausal women?[J].The Journal of Clinical Endocrinology and Metabolism,2015,100(12):4662-4668
[11]Ball AM,Gillen DL,Sherrard D,et al. Risk of hip fracture among dialysis and renal transplant recipients[J]. JAMA,2002,288(23):3014-3018
[12]Molnar MZ,Naser MS,Rhee CM,et al. Bone and mineral disorders after kidney transplantation:therapeutic strategies[J]. Transplantation Reviews(Orlando,Fla),2014,28(2):56-62
[13]Julian BA,Laskow DA,Dubovsky J,et al. Rapid loss of vertebral mineral density after renal transplantation[J].The New England Journal of Medicine,1991,325(8):544-550
[14]Rojas E,Carlini RG,Clesca P,et al. The pathogenesis of osteodystrophy after renal transplantation as detected by early alterations in bone remodeling[J]. Kidney international,2003,63(5):1915-1923
[15]黄雪珍,张建东,官荣光,等. 1768例中老年妇女绝经后骨质疏松患病率及危险因素调查分析[J].检验医学与临床,2016,13(13):1841-1843