肝移植术后患者骨质疏松发病率调查及相关危险因素分析

摘要

目的 观察肝移植术后患者骨质疏松的发病率,分析其相关危险因素,并评价亚洲人骨质疏松自我筛查工具(Osteoporosis Self-assessment Tool for Asians,OSTA)对肝移植患者骨质疏松的筛查效率.方法 检测解放军第三○二医院规律随访的126例肝移植术后患者骨密度(bone mineral density,BMD)值,调查骨质疏松发病率.行单因素和多因素分析以探究肝移植术后患者骨质疏松发病的危险因素.对所有患者行OSTA筛查,ROC评估OSTA对于肝移植后患者骨质疏松筛查的诊断效率.结果 肝移植患者骨质疏松发病率为13.5％(17/126),健康对照人群为3.2％ (4/126),两组比较差异有统计学意义(x2=8.779,P=0.003).多因素分析显示年龄、体质量、移植术后时间为肝移植后骨质疏松发生的独立影响因素(OR值1.272、0.868、0.170,P＜0.05).OSTA对移植后患者骨质疏松的诊断价值中等.结论 肝移植术后骨质疏松患病率高于普通人群,高龄、低体重、移植术后短时间患者风险更高,OSTA筛查可以用于初步筛检肝移植后骨质疏松患者.%Objective To investigate the morbidity and risk factors of osteoporosis in patients after liver transplantation (LT),and to evaluate the diagnose efficiency of osteoporosis self-assessment tool for Asians (OSTA) for osteoporosis in patients after LT.Methods The bone mineral density (BMD) of 126 patients who underwent LT in our center was detected.The risk factors of osteoporosis in patients after LT were analyzed using univariate and multivariate logistic regression.The receiver operator characteristic (ROC) curve was used to evaluate the sensitivity and specificity of OSTA in screening osteoporosis.Results The morbidity of osteoporosis was 13.5％ (17/126) in patients after LT and 3.2％ (4/126) in healthy controls (x2 =8.779,P =0.003).Multivariate logistic regression showed that age,body weight and period of postoperative were the independent risk factors of osteoporosis after LT (OR =1.272,0.868,0.170,P＜ 0.05).Area under the ROC curve of OSTA was 0.879 (95 ％ CI:0.796-0.963,P＜0.001).Conclusion The prevalence of osteoporosis in LT patients was higher than that of the general population.The elderly patients with low body weight and short period post LT would have higher risk of osteoporosis after LT.OSTA could be used for osteoporosis screening in patients after LT.