长期应用糖皮质激素对慢性血小板减少性紫癜患儿骨代谢的影响

目的探讨长期应用糖皮质激素对慢性血小板减少性紫癜患儿骨代谢的影响以及钙剂和维生素D的干预作用。方法将36例慢性血小板减少性紫癜患儿随机分为干预组(A)和未干预组(B),给予口服泼尼松1.5mg/(kg·d),4～6周后逐渐减量。疗程超过6月。干预组同时给维生素D330万IU1次口服,口服牡蛎碳酸钙75mg,Bid(牡蛎碳酸钙:每片150mg,东盛科技启东盖天力股份有限公司)。每周3天,共6月。治疗前及应用激素4周后采集患儿静脉血,分别测定I型前胶原羧基末端前肽(PICP),尿脱氧吡啶啉(DPD)和DPD排泄率。结果两组患儿糖皮质激素治疗前血清中PICP的浓度、尿中DPD的排泄率无显著性差异(P>0.05);干预组糖皮质激素治疗后血清中PICP的浓度、尿中DPD的排泄率与治疗前相比差异无统计学意义(P>0.05);未干预组糖皮质激素治疗后血清中PICP的浓度较治疗前明显降低、尿中DPD的排泄率较治疗前明显增高,差异均具有统计学意义(P<0.05)。结论长期应用糖皮质激素对慢性血小板减少性紫癜患儿骨骼代谢有潜在的影响,早期干预可以改善。

Influence of glucocorticoid on bone metabolism in children with Chronic thrombocytopenic purpura and the early intervention effectiveness of vitamin D

Objective To study the influence of glucocorticoid on bone metabolism in children with Chronic thrombocytopenic purpura and the intervention effectiveness of calcium and vitamin D. Methods Thirty-six children with Chronic thrombocytopenic purpura were assigned as study group treated with glucocorticoid ,administer prednisone to them according to 1.5 mg/(kg·d)exceed 6 months,the quantity of prednisone was decreased after 4-6 weeks. The 36 children were divided into two groups according to the sequence of visit,averagely,one group were given vitamin D and calcium citrate simultaneously. The serum carboxyterminal propeptide of type I procollagen (PICP) level and urine deoxypyridinoline (DPD)level before and after 4 weeks of treatment were measured by radioimmunoassay and competitive enzyme-linked immunoassay,respectively. Results There were no difference in serum PICP and urine DPD between glucocorticoid pretreatment. The serum PICP and the urine DPD of children after 4 weeks treated with glucocorticoid,vitamin D and calcium citrate simultaneously was no significant difference than that in glucocorticoid pretreatment (P>0.05). The serum PICP of children after 4 weeks glucocorticoid therapy only was significantly lower than that in glucocorticoid-pretreatment (P<0.05). The urine DPD significantly increased after glucocorticoid treatment for 4 weeks than that in glucocorticoid pretreatment (P<0.05). Conclusion glucocorticoid treatment for 4 weeks can decrease bone formation and increase bone Absorption in children. Treatment with vitamin D and calcium citrate simultaneously can prevent the adverse reaction of glucocorticold.