骨病是肾移植术后最突出的并发症之一。骨疾病包括骨质疏松症,持续性继发性甲状旁腺功能亢进,和血管坏死(AVN)。我们研究了维生素D受体(VDR)基因的多态性与肾移植后发生的骨骼疾病之间的关系。
该研究包括234名肾移植受者,肾移植后至少随访5年。肾小球滤过率小于30mL/min/1.73m2,有甲状旁腺切除术史的患者,双膦酸盐在移植前或移植后使用,并排除Cinacalcet移植后使用。我们评估了VDR基因多态性之间的关联(BsmI,TaqI,ApaI,FokI,和Cdx2),第一年骨密度(BMD)评分,持续性继发性甲状旁腺功能亢进,AVN。
BMD评分较低的患者明显年轻(P=0.03),并且具有较高的完整副甲状腺激素(iPTH)水平(P=0.03)。Cdx2TT基因型显著增加低BMD评分的风险(OR:3.34,P=0.04)。较高的磷酸盐水平可预防异常的BMD评分(OR:0.53;P=0.03)。持续性甲状旁腺功能亢进患者的透析时间明显延长,移植前iPTH水平较高(分别为P=0.02和P<0.001)。Cdx2,CT/TT,和ApaICA/AA基因型显着增加持续性甲状旁腺功能亢进的风险(分别为OR:6.81,P<0.001,OR:23.32,P<0.001,OR:4.01,P=0.02,OR:6.30,P=0.01)。发现BsmICT/TT基因型增加AVN风险,HR为3.48(P=0.03)。更高的血红蛋白水平也被发现降低AVN风险,HR为0.76(P=0.05)。
某些VDR基因多态性与肾移植术后骨病的高风险相关。
Bone disease is one of the most prominent complications after kidney transplantation. Bone diseases include osteoporosis, persistent secondary hyperparathyroidism, and avascular necrosis (AVN). We investigated the relationship between the polymorphisms of the vitamin D receptor (VDR) gene and bone diseases occurring after kidney transplantation.
The study consists of 234 kidney allograft recipients with a minimum follow-up of five years after kidney transplantation. Patients with glomerular filtration rates less than 30 mL/min/1.73m2, a history of parathyroidectomy, bisphosphonate use pre- or post-transplantation, and cinacalcet use posttransplantation excluded. We evaluated associations between the polymorphisms of the VDR gene (BsmI, TaqI, ApaI, FokI, and Cdx2), the first-year bone mineral density (BMD) scores, persistent secondary hyperparathyroidism, and AVN.
Patients with low BMD scores were significantly younger (P = 0.03) and had higher intact parathormone (iPTH) levels (P = 0.03). Cdx2 TT genotype significantly increases the risk of low BMD scores (OR: 3.34, P = 0.04). Higher phosphate levels were protective against abnormal BMD scores (OR: 0.53; P = 0.03). Patients with persistent hyperparathyroidism had significantly longer dialysis vintage and higher pretransplantation iPTH levels (P = 0.02 and P < 0.001, respectively). Cdx2, CT/TT, and ApaI CA/AA genotypes significantly increase the risk of persistent hyperparathyroidism (OR: 6.81, P < 0.001, OR: 23.32, P < 0.001, OR:4.01, P = 0.02, and OR: 6.30, P = 0.01; respectively). BsmI CT/TT genotypes were found to increase AVN risk with an HR of 3.48 (P = 0.03). Higher hemoglobin levels were also found to decrease AVN risk with an HR of 0.76 (P = 0.05).
Certain VDR gene polymorphisms are associated with a higher risk for bone diseases after kidney transplantation.