糖皮质激素对肾病综合征患儿骨代谢的影响

目的 探讨糖皮质激素（GC）治疗对肾病综合征（NS）患儿骨代谢的影响。方法选择初发特发性肾病综合征（INS）患儿48例，予以GC治疗，并辅以钙尔奇D片，分别在GC治疗前（活动期）、激素治疗尿蛋白转阴后（缓解期）及肾病持续缓解5个月时（恢复期）检测血清骨钙蛋白（BGP）、骨特异性碱性磷酸酶（BALP）、甲状旁腺素（PTH）和钙水平。以同期儿保科体检的30例健康儿童为对照。结果INS患儿活动期血清BGP、钙水平较对照组明显降低（P〈0．01），血清BALP、FPTH较对照组明显升高（P〈0．01）。缓解期血清BGP最著低于活动期（P〈0．01）；血清BALP较活动期明显下降（P〈0．01），但与对照组比较无显著性差异（P〉0．05）；血清VFH高于活动期（P〈0．05）；血清钙高于对照组（P〈0．01），与活动期无显著性差异（P〉0．05）。NS患儿恢复期血清BGP、BALP、PTH、钙与对照组比较均无显著性差异（P〉0．05）。结论NS本身和GC治疗均可引起患儿骨代谢异常，但只要合理应用激素并及时补充VitD和钙制剂，骨代谢异常可以逆转。

Influence of Glucocorticoid on Bone Metabolism in Children with Nephrotic Syndrome

Objective To study the influence of glucocorticoid(GC)treatment on bone metabolism in children with nephrotic syndrome(NS).Methods Forty-eight children with idiopathic nephrotic syndrome(INS) were assigned as study group treated with GC and caltrate.Serum levels of osteocalcin(BGP),bone-specific alkaline phosphatase(BALP),parathyroid hormone(PTH) and calcium(Ca) were measured before GC treatment(active stage),just after the urine protein turned to negative(paracme) and after 5 months of the relief from nephropathy state(convalescence stage).During the same period,30 healthy children were selected as control group.Results In children with INS at active stage,the serum levels of BGP and Ca were significantly lower than those in control group(all P<(0.01));the serum levels of BALP and PTH were markedly higher than those in control group(all P<0.01).The serum level of BGP at paracme was significantly lower than that at active stage((P<0.01).)The serum level of BALP at paracme was markedly lower than that at active stage(P<(0.01)),and there was no(diffe)rence compared with that in control group(P>0.05).The serum level of PTH at paracme was higher than that at active stage((P<0.05).)The serum level of Ca was not different compared with that at active stage((P>0.05)),but it was significantly higher than that in control group(P<0.01).All of the serum levels of above markers at convalescence stage were not significantly different compared with those in control group(all P>0.05).Conclusions Not only NS itself but also GC treatment can bring the abnormal bone metabolism to the children with INS.But it can be reversed if it can receive reasonable treatment of GC and additional vitmine D and Ca.