【摘要】 目的 观察肝移植后长期存活者骨矿物质密度和骨代谢状态的变化。方法 采用双能X线骨密度仪(DEXA),测量31例肝移植后5年存活者腰椎L2～L4和股骨颈骨密度(BMD),同时检测成骨细胞活性指标:骨钙素、骨特异性碱性磷酸酶(BAP)和Ⅰ型前胶原羧基末端前肽(PICP);破骨细胞功能指标:Ⅰ型胶原交联羧基末端肽(ICTP),25-OH-维生素D和甲状旁腺素(PTH),并与34例肝移植前慢性肝功能衰竭患者(CLF)和38例正常健康者作比较。结果 肝移植后5年存活者L2～L4 BMD(Z-score)水平明显高于CLF患者,其骨质疏松(Z-score<-2.0)发生率明显降低。与正常健康者比较,5年存活者存在成骨细胞活性和破骨细胞功能增高,但无继发性甲状旁腺功能亢进和维生素D代谢异常;而与肝移植前CLF患者比较,5年存活者血清骨钙素水平增高,BAP和ICTP降低,PICP无明显变化,血清25-OH-维生素D和PTH正常。结论 肝移植后5年存活者骨质丢失减轻,骨质疏松发生率减少和骨代谢有改善。

Xu Hao^* , HermannEichstaedt. ^* The First Affiliated Hospital, Ji'nan University Medical College,Guangzhou, 510630

【Abstract】 Purpose To observe bone loss and bone metabolism status in 5-year survivorsafter orthotopic liver transplantation (OLT). Methods Measurement of bone mineral density (BMD) of the lumbarspine (L2～L4) and femoral neck using dualenergy X-ray absorptiometry (DEXA) and analysis of biochemical markers of bone turnover,such as ostecalcin (OSC), bone alkaline phosphatase (BAP), carboxyterminal propeptide oftype Ⅰ procollagen (PICP), carboxyterminalcross-linked telopeptide of type Ⅰ collagen(ICTP), PTH and 25-hydroxy-vitamin D (25-OH-D). These markers were measured in 31 5-yearsurvivors after OLT, 34 patients with chronic liver failure (CLF) before OLT and 38 normalsubjects. Results Age-matchedZ-score of BMD (Z-score) at L2～L4 wassignificantly higher in 5-year survivors than that in patients with CLF before OLT.Incidence of osteoporsis (Z-score<-2.0) in 5-year survivors was significantly lowerthan that in patients with CLF before OLT. Although serum concentrations of bone formationand bone resorption markers in 5-year survivors were high than those of normal subjects,as compared to patients with CLF before OLT, serum OSC was increased, serum ICTP and BAPwere reduced, serum PICP was unchanged. Serum PTH and 25-OH-D level was normal. Conclusions In 5-year survivors following liver transplantation therewas a reduction in bone loss and incidence of osteoporosis and an improvement of bonemetabolism.

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