Clin Osteol 2015; 20(2): 40-44
Transplantácia pečene a kostná denzitaPůvodní práce
Úvod: Zníženie kostnej denzity a fraktúry sú častou komplikáciou pečeňovej cirhózy a hrajú dôležitú úlohu u pacientov nielen pred, ale aj po ortotopickej transplantácii pečene (OLT - orthotopic liver transplantation).
Cieľ: Cieľom práce bolo retrospektívne zistiť v súbore pacientov stav kostnej denzity, vybrané laboratórne parametre a rtg chrbtice rok po OLT a porovnať so súborom pacientov, ktorí transplantovaní neboli.
Súbor a metodika: Súbor tvorilo 51 pacientov (37 mužov, 14 žien) s cirhózou pečene. 36 pacientov bolo po transplantácii pečene a 15 bez transplantácie. Vekové rozpätie bolo 38-63 rokov, priemerný vek 50 rokov. Kostnú denzitu sme hodnotili DXA metodikou v oblasti driekovej chrbtice, krčku femuru a bedrového kĺbu. Z laboratórnych vyšetrení sme hodnotili hladinu vápnika, albumínu, celkového 25-hydroxyvitamínu D (25-OH D) a realizovali sme rtg Th, L chrbtice. Na hodnotenie sme použili štatistickú analýzu Študentov t-test so stanovením štatistickej významnosti p < 0,05.
Výsledky: V oblasti driekovej chrbtice sme zistili štatisticky významné zvýšenie kostnej denzity u pacientov po transplantácii, na rozdiel od pacientov, ktorí transplantovaní neboli (p < 0,02). U pacientov sme rok po OLT zistili nesignifikantné zníženie kostnej denzity
v oblasti bedrového kĺbu a krčku femuru a signifikantné zníženie kostnej denzity u tých, ktorí transplantovaní neboli (p < 0,001; p < 0,04). Hladina vápnika sa v oboch skupinách pacientov výrazne nezmenila. Priemerná hodnota hladiny 25-OH D u pacientov po OLT sa zvýšila, na rozdiel od pacientov, ktorí OLT neabsolvovali. Hladiny 25-OH D boli pred transplantáciou v norme len u 4 pacientov, ostatní mali nízku hladinu 25-OH D, po transplantácii malo v norme hladinu vitamínu D 22 pacientov, pod normu 14. U pacientov po OLT priemerná hladina albumínu stúpla na normálne hodnoty, pacienti bez OLT mali hladiny albumínu bez zmeny. Nezistili sme novú fraktúru v oblasti Th, L u pacientov po OLT Dvaja pacienti bez transplantácie mali fraktúry v oblasti Th chrbtice.
Záver: Zistili sme, že pacienti po transplantácii pečene už po roku mali zlepšenie kostnej denzity v oblasti driekovej chrbtice s normalizáciou sledovaných laboratórnych parametrov. OLT pečene v kombinácii s dostatočnou substitúciou vápnika a vitamínu D vedie k zlepšeniu kostnej denzity s následnou redukciou rizika fraktúr.
Klíčová slova: liver transplantation, liver cirrhosis, osteoporosis, densitometry
Background: Decreased bone density and fractures are frequent complications of liver cirrhosis, playing an important role in patients not only prior to but also after orthotopic liver transplantation (OLT).
Objectives: The objective was to retrospectively analyze a group of patients to determine bone density status, selected laboratory parameters and X-ray of the spine at one year after OLT and to compare them with a group of patients who were not transplanted.
Material and Methods: The group comprised 51 patients (37 males, 14 females) with liver cirrhosis. The age range was 38-63 years; the mean age was 50 years. Bone density was measured using the DXA method at the lumbar spine, femoral neck and hip. The laboratory parameters included calcium, albumin and total 25-hydroxyvitamin D (25-OH D) levels. X-rays of the thoracic and lumbar spine were obtained. The data were processed using Student?s t-test with statistical significance p < 0.05.
Results: In the lumbar spine region, bone density was statistically significantly increased in post-transplantation patients as compared with patients who were not transplanted (p < 0.02). Bone density in the hip and femoral neck regions was insignificantly decreased in patients at one year after OLT and significantly increased in those who were not transplanted (p < 0.001; p < 0.04). Calcium levels were not significantly changed in either of the groups. The mean level of 25-OH D increased in patients after OLT as compared with those who did not undergo OLT. Prior to transplantation, only 4 patients had normal 25-OH D levels and the others had low levels of 25-OH D. After transplantation, normal vitamin D levels were found in 22 patients and low levels in 14 patients. In patients after OLT, the mean albumin level rose to normal values; patients without OLT had unchanged albumin levels. No new fractures in the area of the thoracic and lumbar spine were observed in patients after OLT. Two patients without transplantation had fractures in the thoracic spine region.
Conclusions: It was found that as early as one year after liver transplantation, patients had better bone density in the lumbar spine region and normalized laboratory parameters. OLT combined with sufficient calcium and vitamin D supplementation leads to improved bone density and subsequent fracture risk reduction.
Zveřejněno: 11. prosinec 2015 Zobrazit citaci
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