老年肾移植术后糖皮质激素冲击所致骨质疏松的危险因素分析

Analysis of risk factors for osteoporosis induced by glucocorticoid after renal transplantation in elderly patients

目的探讨老年肾移植术后糖皮质激素冲击所致骨质疏松患者的血清氧化应激指标变化及危险因素。方法选取2015年2月至2017年2月郑州市第七人民医院收治的老年肾移植术后糖皮质激素冲击所致骨质疏松患者43例作为观察组,收集同期21例经肾移植术后未发生骨质疏松的老年人作为对照组,观察两组患者骨密度、血清氧化应激、炎症因子等指标变化,并分析骨密度同血清氧化应激、炎症因子之间相关性以及影响骨质疏松发生的危险因素。结果观察组骨密度水平低于对照组,差异具有统计学意义(P <0. 05);观察组晚期氧化蛋白产物(AOPP)、丙二醛(MDA)高于对照组,超氧化物歧化酶(SOD)、总抗氧化能力(TAC)低于对照组,差异具有统计学意义(P <0. 05);观察组C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)高于对照组,差异具有统计学意义(P <0. 05); Pearson相关分析显示骨密度与SOD、TAC呈正相关(r=0. 531,0. 474),与AOPP、MDA、CRP、TNF-α、IL-6呈负相关(r=-0. 592,-0. 486,-0. 327,-0. 421,-0. 307,均P <0. 05); logistic回归分析显示年龄、AOPP、MDA、TAC是影响骨质疏松发生的危险因素(P均<0. 05)。结论老年肾移植术后糖皮质激素冲击所致骨质疏松患者的骨密度与AOPP、CRP、TNF-α、IL-6呈负相关,且年龄、AOPP、MDA、TAC均是影响骨质疏松发生的危险因素。

Objective To analys is risk factors in elderly patients with osteoporosis induced by glucocorticoid impact after renal transplantation. Methods Forty-three elderly patients with osteoporosis after renal transplantation treated in Zhengzhou Seventh People’s Hospital from Feb 2015 to Feb 2017 were selected as observation group, meanwhile, 21 elderly patients without osteoporosis after renal transplantation were recruited as control group. The changes of bone density, serum oxidative stress indexes and inflammatory factors in two groups were observed, and the correlations between bone density with serum oxidative stress, inflammatory factors and the risk factors of osteoporosis were also analyzed. Results The bone density level in observation group was significantly lower than that in control group （ P 〈0.05）; the levels of advanced oxidation protein products （AOPP） and malondialdehyde （MDA） in observation group were significantly higher than those in control group, superoxide dismutase （SOD） and total antioxidant capacity （TAC） were significantly lower than those in control group, and the differences were statistically significant （ P 〈0.05）; the C-reactive protein （CRP）, tumor necrosis factor-α （TNF-α） and interleukin-6 （IL-6） in observation group were significantly higher than those in control group, and the differences were statistically significant （ P 〈 0.05）. Pearson correlation analysis showed that BMD was positively correlated with SOD and TAC （ r =0.531/0.474） and negatively correlated with AOPP, MDA, CRP, TNF-α and IL-6 （-0.592/-0.486/-0.327/-0.421/-0.307, all P 〈0.05）. Logistic regression analysis showed age, AOPP, MDA, SOD, TAC, CRP, TNF-α and IL-6 were risk factors for osteoporosis （ P 〈0.05）. Conclusion Bone mineral density is negatively correlated with AOPP, CRP, TNF-α and IL-6 in elderly patients with osteoporosis induced by glucocorticoid shock after renal transplantation, and age, AOPP, MDA, SOD, TAC, CRP, TNF-α and IL-6 are all risk factors of osteoporosis.