Background: To evaluate bone-mineral-density-BMD determined by dual-energy X-ray absorptiometry-DEXA and bone turnover markers in chronic-kidney-disease-CKD patients. Method: An observational-clinical study of all pat...Background: To evaluate bone-mineral-density-BMD determined by dual-energy X-ray absorptiometry-DEXA and bone turnover markers in chronic-kidney-disease-CKD patients. Method: An observational-clinical study of all patients who were scanned by DEXA-scan in 2018. All patients with low-bone-density or osteoporosis-based on World-Health-Organization-WHO definition were included. Results: 505 patients with abnormal-BMD, 87.3% were in early-stage CKD-stage I - II, 8.5% were in CKD-stage III - V and 4.2% did not have renal tests. 95 (18.8%) were male with a mean age of 57.0 years and 410 (81.2%) were females with a mean age of 55.8 years. Patients of ≥65 years had lower T-score than those who were younger than 65 years-old. Among CKD patients, those with late-CKD (stage III - V) had less BMD-measurements and lower T-score than those with early-CKD (stage I - II). A significant positive correlation exists between parathyroid hormone-PTH-level and the lower T-score. Female had a worse T-score at the lumbar-region whereas male had a worse T-score at the femoral-region. There was no significant difference between males and females for the T-score at hip-region. Conclusion: We observed a distribution of abnormal BMD among different age, sex and CKD groups. Measurements of BMD by DEXA might be a useful test to diagnose osteoporosis in CKD patients. Femoral and total hip areas were more affected, however DEXA might not be able to detect osteoporosis in the lumbar area of CKD patients. T-scores are lower in patients with more severe CKD and lower in elderly patients. PTH level is associated proportionally to the degree of bone loss. Early intervention and proper management must be implemented early among CKD patients with multidisciplinary team approach strategy. More studies are needed to determine if DEXA techniques are enough to distinguish the quantity of bone loss between different stages of CKD.展开更多
DXA测量的骨密度(bone mineral density,BMD)结果和T-值为骨质疏松症领域的临床医生所熟知,且常作为诊断骨质疏松症和治疗决策制定的依据。日常临床和药物研究中,常可见到不同DXA和参考数据造成的测量结果差异、腰椎和股骨近端T-值不一...DXA测量的骨密度(bone mineral density,BMD)结果和T-值为骨质疏松症领域的临床医生所熟知,且常作为诊断骨质疏松症和治疗决策制定的依据。日常临床和药物研究中,常可见到不同DXA和参考数据造成的测量结果差异、腰椎和股骨近端T-值不一致等现象,这些差异和不一致的测量结果常会使医生在骨质疏松症诊断和干预措施选择等方面产生困惑。为提高对上述等问题的认识和对BMD测量结果和T-值的进一步解析,本文进行了相关历史文献回顾和介绍。展开更多
目的:比较不同内皮活化和应激指数(EASIX)评分预测多发性骨髓瘤患者嵌合抗原受体T细胞(chimeric antigen receptor T cell,CAR-T)治疗后出现凝血功能障碍的效能。方法:选取2019年5月—2022年10月于徐州医科大学附属医院血液科住院治疗行...目的:比较不同内皮活化和应激指数(EASIX)评分预测多发性骨髓瘤患者嵌合抗原受体T细胞(chimeric antigen receptor T cell,CAR-T)治疗后出现凝血功能障碍的效能。方法:选取2019年5月—2022年10月于徐州医科大学附属医院血液科住院治疗行CAR-T细胞输注、且满足入组条件的53例多发性骨髓瘤患者,收集临床资料进行回顾性分析。构建受试者工作特征(ROC)曲线,计算曲线下面积,并进行比较。采用单因素logistic回归分析EASIX评分(乳酸脱氢酶×肌酐/血小板)及2个改良EASIX评分[简化EASIX(s-EASIX)即不包括肌酐的EASIX;改良EASIX(m-EASIX)即用C反应蛋白代替肌酐的EASIX]在不同时间点与凝血功能障碍之间的关系。结果:53例患者中,男35例(66%),女18例(34%),中位年龄为57(31~70)岁,29例(54.7%)患者发生了凝血功能障碍。根据EASIX、s-EASIX、m-EASIX评分在不同时间点ROC曲线下面积(area under curve,AUC)的结果表明,在淋巴细胞清除预处理前,EASIX的AUC值最大(80.5%),在第0天、第7天及第14天,s-EASIX的AUC值最大(74.3%vs 79.2%vs 75.3%,P<0.05)。单因素分析显示CAR-T细胞治疗后凝血功能障碍的发生与血小板的减少显著相关(P<0.05)。结论:s-EASIX评分是预测多发性骨髓瘤患者CAR-T细胞治疗后出现凝血功能障碍的最佳评分系统,其次是EASIX评分。展开更多
文摘Background: To evaluate bone-mineral-density-BMD determined by dual-energy X-ray absorptiometry-DEXA and bone turnover markers in chronic-kidney-disease-CKD patients. Method: An observational-clinical study of all patients who were scanned by DEXA-scan in 2018. All patients with low-bone-density or osteoporosis-based on World-Health-Organization-WHO definition were included. Results: 505 patients with abnormal-BMD, 87.3% were in early-stage CKD-stage I - II, 8.5% were in CKD-stage III - V and 4.2% did not have renal tests. 95 (18.8%) were male with a mean age of 57.0 years and 410 (81.2%) were females with a mean age of 55.8 years. Patients of ≥65 years had lower T-score than those who were younger than 65 years-old. Among CKD patients, those with late-CKD (stage III - V) had less BMD-measurements and lower T-score than those with early-CKD (stage I - II). A significant positive correlation exists between parathyroid hormone-PTH-level and the lower T-score. Female had a worse T-score at the lumbar-region whereas male had a worse T-score at the femoral-region. There was no significant difference between males and females for the T-score at hip-region. Conclusion: We observed a distribution of abnormal BMD among different age, sex and CKD groups. Measurements of BMD by DEXA might be a useful test to diagnose osteoporosis in CKD patients. Femoral and total hip areas were more affected, however DEXA might not be able to detect osteoporosis in the lumbar area of CKD patients. T-scores are lower in patients with more severe CKD and lower in elderly patients. PTH level is associated proportionally to the degree of bone loss. Early intervention and proper management must be implemented early among CKD patients with multidisciplinary team approach strategy. More studies are needed to determine if DEXA techniques are enough to distinguish the quantity of bone loss between different stages of CKD.
文摘DXA测量的骨密度(bone mineral density,BMD)结果和T-值为骨质疏松症领域的临床医生所熟知,且常作为诊断骨质疏松症和治疗决策制定的依据。日常临床和药物研究中,常可见到不同DXA和参考数据造成的测量结果差异、腰椎和股骨近端T-值不一致等现象,这些差异和不一致的测量结果常会使医生在骨质疏松症诊断和干预措施选择等方面产生困惑。为提高对上述等问题的认识和对BMD测量结果和T-值的进一步解析,本文进行了相关历史文献回顾和介绍。
文摘目的:比较不同内皮活化和应激指数(EASIX)评分预测多发性骨髓瘤患者嵌合抗原受体T细胞(chimeric antigen receptor T cell,CAR-T)治疗后出现凝血功能障碍的效能。方法:选取2019年5月—2022年10月于徐州医科大学附属医院血液科住院治疗行CAR-T细胞输注、且满足入组条件的53例多发性骨髓瘤患者,收集临床资料进行回顾性分析。构建受试者工作特征(ROC)曲线,计算曲线下面积,并进行比较。采用单因素logistic回归分析EASIX评分(乳酸脱氢酶×肌酐/血小板)及2个改良EASIX评分[简化EASIX(s-EASIX)即不包括肌酐的EASIX;改良EASIX(m-EASIX)即用C反应蛋白代替肌酐的EASIX]在不同时间点与凝血功能障碍之间的关系。结果:53例患者中,男35例(66%),女18例(34%),中位年龄为57(31~70)岁,29例(54.7%)患者发生了凝血功能障碍。根据EASIX、s-EASIX、m-EASIX评分在不同时间点ROC曲线下面积(area under curve,AUC)的结果表明,在淋巴细胞清除预处理前,EASIX的AUC值最大(80.5%),在第0天、第7天及第14天,s-EASIX的AUC值最大(74.3%vs 79.2%vs 75.3%,P<0.05)。单因素分析显示CAR-T细胞治疗后凝血功能障碍的发生与血小板的减少显著相关(P<0.05)。结论:s-EASIX评分是预测多发性骨髓瘤患者CAR-T细胞治疗后出现凝血功能障碍的最佳评分系统,其次是EASIX评分。
