肝移植术后椎体骨折发病率调查及其危险因素分析

Prevalence and risk factors of vertebral fracture after liver transplantation patients

目的 调查我院肝移植术后患者椎体骨折的患病率,分析其主要危险因素.方法 选择在武警总医院随访的肝移植患者.纳入标准：（1）首次肝移植的华裔患者;（2）年龄20 ～ 70岁.排除标准：（1）妊娠或哺乳;（2）伴有其他器官移植.临床资料来源于武警总医院器官移植中心的住院和门诊病历,包括人口学特征（年龄、性别、体重指数）、肝病史、术后免疫抑制治疗方案.入选患者检测胸腰椎正侧位X线片,通过Genant半定量分析法判断椎体压缩骨折程度.结果 共入选肝移植患者179例（男151例,女28例）,年龄30 ～69（51.5±9.3）岁,术后时间2～ 119（41±30）个月.椎体骨折总患病率达32.4％,其中轻、中、重度椎体骨折分别占74.1％、19.0％和6.9％.分析显示,肝移植术后椎体骨折主要与年龄、糖皮质激素和钙调磷酸酶抑制药有关,多发于术后0.5 ～2年,患病率可达51.4％.结论 肝移植术后椎体骨折患病率高,高龄、糖皮质激素和钙调磷酸酶抑制药的使用是主要危险因素.建议在补充钙和维生素D的基础上,积极选用双膦酸盐防治肝移植后骨质疏松及骨折.

Objective To investigate the prevalence rate of vertebral fracture in a single transplant centre and analyze the disease risk factors. Methods Liver transplantation patients were enrolled from August 2011 to February 2013 in The General Hospital of Chinese People＇s Armed Police Forces. Inclusion criteria：l. Liver transplantation for the first time; 2. Age of 20-70 years. Exclusion criteria ： 1. Pregnancy or lactation. 2. Other organ transplantation. The data collected from electronic medical records were as follows ： demographic characteristics （age, gender, BMI）, history of liver disease, immunosuppressive treatment. Frontal and lateral X-ray films of thoracolumbar spine was measured. Results 179 patients were analyzed, including 151 men and 28 women, aging from 30 to 69 years old （ mean age 51.5 years）. The prevalence rates of vertebral fracture was 32.4%. Prevalence of slight, medium and severe vertebral fractures were 74. 1% , 19.0% and 6.9% , respectively. 0.5-2 years postoperatively with vertebral fracture prevalence was highest, 51.4%. Prevalence of vertebral fractures after the surgery mainly involved with glucocorticoid and calcineurin inhibitor dosage, in addition to age. After surgery, the use of diphosphonate could reduce the prevalence of vertebral fractures in patients with liver trans- plantation in Europe and the United States. Conclusions There are high vertebral fracture rates in patients undergoing liver transplan- tation. This rate is likely to reflect long-term use of glucocorticoid and immunosuppressants . It is suggested that we should, on the basis of calcium and vitamin D, select the double phosphonic acid salt to prevent and treat osteoporosis and bone fracture ＇after liver transplantation.