| Objective:To observe the characteristics of postoperative bone mineral density and bone metabolism index in renal transplant recipients and analyze its influencing factors.To provide a clinical basis for the prevention and treatment of bone diseases with renal transplant recipients.Methods:A total of 172 kidney transplant recipients who were followed up in the outpatient department of Jiangxi Provincial People’s Hospital from December 20 to October 21,2018 were selected for questionnaire survey,physical examination,blood test and DXA bone mineral density measurement.Statistical analysis was performed using SPSS 23.0 software.Reduced bone mass,lower bone density than peers,and osteoporosis are collectively referred to as low bone mass.Results:172 renal transplant recipients,128(74.4%)males and 44(25.6%)females,were between 18 and 75 years old.Among them,24 males over 50 years old and 14 postmenopausal females.105 cases(61%)were low bone mass,the incidence of low bone mass in men and women was high in the lumbar vertebrae;7 cases(4.1%)in fragility fractures;2 people(1.2%)who had bone mineral density measurement using DXA after renal transplantation.All renal transplant recipients did not receive calcium,vitamin D and anti-osteoporosis drugs.Univariate analysis showed that age,female menopause,exercise,fragility fracture history,dialysis,and immunosuppressive regimen were significantly associated with bone mineral density,and the difference was statistically significant(P<0.05).Compared with the normal bone mass group,the patients with low bone mass had lower weight and BMI,and longer age of transplantation,the use time of glucocorticoid,tacrolimus and mycophenolate,the difference was statisticallysignificant(P < 0.05).Binary Logistic multivariate regression analysis showed that,in renal transplant recipients,menopause was an independent risk factor for increasing osteoporosis,with the OR of 186.08(95% CL: 5.527-6264.581),and proper weight and exercise were the independent protection factors to reduce the occurrence of osteoporosis,with the OR values were 0.763(95% CL: 0.625-0.932)and 0.247(95% CL:0.067-0.918),respectively.In renal transplant recipients,the total vitamin D level gradually increased with the prolongation of transplant age,from(18.81±7.03)ng/ml to(24.64±8.42)ng/ml;The levels of PTH,serum calcium,P1 NP,β-CTX and AKP decreased gradually,respectively from 87.15(54.50,157.77)pg/ml to 72.27(43.67,84.76)pg/ml,2.51(2.40,2.60)mmol/L decreased to 2.33(2.21,2.39)mmol./L,73.74(54.16,93.47)ng/ml decreased to 50.76(40.67,69.58)ng/ml,0.86(0.69,1.28)ng/ml decreased to0.51(0.36,0.86)ng/ml and 82.0(68.3,117.5)IU/L decreased to 79.0(64.0,95.0)IU/L,and the difference was statistically significant(P<0.05).The levels of PTH,P1 NP,and β-CTX decreased significantly in 3 years after transplantation;however the level of blood phosphorus increased,from(0.86±0.22)mmol/L to(1.06±0.26)mmol/L,the difference was statistically significant(P<0.05).With the prolongation of age of transplantation,the total femoral neck and hip bone mineral density decreased gradually,which respectively decreased from(0.74±0.10)g/cm2 to(0.65±0.07)g/cm2,(0.89±0.11)g/cm2 to(0.80±0.07)g/cm2,the difference was statistically significant(P<0.05);Lumbar vertebrae bone mineral density showed a downtrend,but the difference was not statistically significant(P>0.05);Female femoral neck,hip total and lumbar vertebrae’s bone mineral density did not follow the age of transplantation to change,the difference was‘t statistically significant(P>0.05).Conclusions:Renal transplant recipients have lower bone mass,and bone turnover is faster in the first 3 years after transplantation,and vitamin D is insufficient.Renal transplant recipients should be regularly measured bone mineral density,supplemented withvitamin D,exercise appropriate,maintain ideal body weight,and timely intervention to reduce the occurrence of osteoporosis and fragility fractures. |
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