皮质类固醇,副甲状腺激素和身体成分与移植后骨密度和骨结构的关联
Susan L Ziolkowski1, Jin Long2, Thomas L Nickolas3
1Department of Medicine, Stanford University School of Medicine, Stanford, CA.
概括
接受脏移植的接受者在六个月后显示骨密度有所改善,除了皮质骨稀疏外. 需要采取保护皮层骨的策略,因为瘦身量和BMI的增加可能有助于骨健康.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 整形外科 整形外科 整形外科
- 骨的新陈代谢 骨的新陈代谢
背景情况:
- 移植 (KTxp) 可以改善CKD相关的骨脆弱性,但与骨折风险增加有关.
- 了解KTxp后身体组成和矿物代谢的变化对骨健康至关重要.
研究的目的:
- 评估身体组成和矿物代谢变化对移植后骨矿物质密度 (BMD) 和骨结构的影响.
- 确定影响移植受体骨健康变化的因素.
主要方法:
- 这是一项长达24个月的前性队列研究,涉及60名移植接受者和361名健康对照.
- 测量包括骨矿物质密度 (BMD),体积 BMD (vBMD),皮质尺寸,尾肌肉质量指数 (ALMI) 和脂肪质量指数 (FMI) 使用DXA和pQCT.
- 准最小平方回归模型分析了变化的相关性.
主要成果:
- 与对照组相比,接受者具有较低的基线骨密度和瘦肉量.
- 在KTxp后的6个月内,肌肉质量,脂肪质量和BMI增加,而一些骨指标下降.
- 皮层vBMD从6个月开始增加,与PTH的下降有关. 皮层厚度逐渐下降.
- 较高的BMI和ALMI与改善的骨密度相关;皮质类固醇剂量对骨测量有负面影响.
结论:
- 移植患者的骨缺陷通常在六个月后稳定或改善,有明显的例外,如逐渐皮质稀薄.
- 移植前后需要进行干预,以保护皮质骨在移植前后.
- 体重指数和ALMI的增加可能会对移植后承重区域的骨健康产生积极影响.
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