بررسی تراکم استخوان در بیماران با نارسایی کلیه قبل و بعد از پیوند کلیه

نوع مقاله : مقاله پژوهشی

نویسندگان

1 اســتاد نفرولــوژی دانــشگاه علــوم پزشــکی مشهد، مشهد، ایران

2 اســـتادیار نفرولـــوژی دانـــشگاه علـــوم پزشکی مشهد، مشهد، ایران

3 دانشیارروماتولوژی دانـشگاه علـوم پزشـکی مشهد، مشهد، ایران

4 متخصص داخلی، مشهد، ایران

5 استادیار روماتولوژی دانشگاه علوم پزشکی مشهد، مشهد، ایران

چکیده

مقدمه
یکی از شایعترین عوارض متابولیک پیوند کلیه، کاهش تـراکم اسـتخوانی خـصوصا " در ابتـدای پیونـد مـی باشـد .
تشخیص به موقع و درمان آن در ابتدای پیوند می تواند مانع از بروز شکستگی و بـدتر شـدن آن بـه دنبـال مـصرف
کورتیکواستروئید باشد.
روش کار
این پژوهش یک مطالعه توصیفی بوده و به صورت مقطعی در فروردین تا مهر ماه 1385 در دانشگاه علوم پزشـکی
مشهد انجام شده است، 50 بیمار که در طی دوره مطالعه گرافت دریافت کرده بودند وارد مطالعه شدند و31 نفرآن
را به اتمام رسانیدند. این بیماران از لحاظ تراکم استخوانی بلافاصله قبـل پیونـد، 6 مـاه و1 سـال پـس از آن توسـط
روش جذب سنجی دوگانه اشعه ایکس ارزیابی شدند . اطلاعات بدست آمده در نرم افزار SPSS تجزیه و تحلیـل
شد و از آزمون های آماری دوگانه و کای دو و آنالیز واریانس نیز استفاده شد.
نتایج
از 31 نفر 17 نفر زن (54/8%) و 14 نفر مرد (45/2%) بودند. قبل از پیوند متوسـط تـی اسـکوئر در گـردن فمـور و
ستون فقرات کمری به ترتیب 0/88±1/19- و 0/37±1/12- بود. در ماه ششم پس از پیونـد، متوسـط آن درگـردن
فمور و ستون فقرات کمری به ترتیب به 1/42±0/95- و 1/41±1/36- کـاهش یافـت (p> 0/05). در پایـان سـال
اول، متوسط تی اسکوئر، در این مناطق معادل 1/13±1/11- و1/29±1/33- بود که نـسبت بـه نوبـت قبـل کـاهش
.(p> 0/05) نداشت بارزی
نتیجه گیری
کاهش تراکم استخوان در بعد از پیوند کلیه بیشتر در 6 مـاه ابتـدای پیونـد رخ مـی دهـد . لـذا بهتـر اسـت اقـدامات
پیشگیری و درمانی از ابتدای پیوند ویا حتی قبل ازآن آغاز شود. 

کلیدواژه‌ها


عنوان مقاله [English]

Assessment of Bone Density in Patients before and after Kidney Transplantation

نویسندگان [English]

  • Mohammad Javad Mojahedi 1
  • Farzaneh Sharifipour 2
  • Maryam Hami 2
  • Masoud Saghafi 3
  • Bita Dadpour 4
  • Nayereh Saadati 5
1 Professor of Nephrology, Mashhad University of Medical Sciences, Mashhad, Iran
2 Assistant Professor of Nephrology, Mashhad University of Medical Sciences, Mashhad, Iran
3 Associated Professor of Rheumatology, Mashhad University of Medical Sciences, Mashhad, Iran
4 Specialist in internal diseases (internist), Mashhad University of Medical Sciences, Mashhad, Iran
5 Assistant Professor of Rheumatology, Mashhad University of Medical Sciences, Mashhad, Iran
چکیده [English]

Introduction
Accentuation of bone loss is one of the most important skeletal complications after transplantation. Early diagnosis and treatment of osteopenia and osteoporosis reduce risk of fractures and prevent the aggravation of it by using corticosteroid after kidney transplantation.
Materials and Methods
A total of 50 patients that received graft during the research time, 31 of them completed it. They were screened for decreased bone mineral density at baseline, 6 and 12 months after transplantation with dual-energy x-ray absorptiometry (DEXA) of lumbar spine and hip.
Results
A total of 31 patients [17 (55.8%) female and 14 (45.2%) male] with end stage renal disease entered the study. The mean age of patients in both genders were 39.67±14.5 years (range: 20-67years). Replacement therapy in 24 patients (77.4%) was hemodialysis and in 7 patients (22.6%) was peritoneal dialysis. Before transplantation, the mean of T-score in femoral neck and lumbar vertebra were -0.88±1.19 and-0.37±1.12 respectively, osteopenia was found in 41.9% and 29% of each region. On 6 months after transplantation, the mean of T-score in femoral neck and lumbar vertebra -1.42±0.95 and -1.41±1.36 respectively. Incidence of osteopenia in each region was 83.9% and 64.5% in turn. We tried to examine them in the first year after transplantation, the mean of T-score in femoral neck was-1.13±1.11 and in lumbar vertebra was -1.29±1.33. After 6 months, bone mass reduction was significant (p<0.05), but there was not any significant difference between 6 and 12 months following transplantation (p>0.05).
Conclusion
Bone losswas highest in the first 6 months after transplantation. Then, treatment was necessary during this period of time.

کلیدواژه‌ها [English]

  • Bone densitometry
  • Renal transplantation
  • Osteopenia
  • Osteoporosis
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