阿法骨化醇对大剂量糖皮质激素治疗肾小球疾病所致的骨质疏松的影响

目的：观察阿法骨化醇联合钙剂对肾脏病患者发生糖皮质激素性骨质疏松的预防作用。方法：28例病人随机分为治疗组16例,阿法骨化醇1μg日一次口服和碳酸钙750 mg日三次口服;对照组12例,碳酸钙750 mg日三次口服。治疗前及以后每3个月检查血清白蛋白、钙、磷、24小时尿蛋白定量、甲状旁腺素,腰椎和股骨颈骨密度,观察6个月。结果：两组患者腰椎和股骨颈骨密度均呈下降趋势,治疗6个月时,治疗组骨密度高于对照组（腰椎0.967±0.105,0.896±0.131,P〈0.05;股骨颈1.078±0.124,0.925±0.107,P〈0.05）,对照组骨密度较治疗前明显下降。结论：阿法骨化醇合用钙剂对预防慢性肾脏病患者发生糖皮质激素性骨质疏松是安全有效的药物。

Effect of alfacalcidol on osteoporosis induced by large dose glucocorticoid treatment in glomerulonephritis patients

AIM：To observe the effect of alfacalcidol on osteoporosis induced by large dose glucocorticoid treatment in glomerulonephritis patients.METHODS：28 patients with glomerulonephritis receiving glucocorticoids were divided into two groups randomly.16 patients received calcium carbonate 750 mg three times plus alfacalcidol 1μg one time orally a day（treatment group）,and 12 patients received calcium carbonate 750 mg three times orally a day（control group）.Bone mineral density（BMD） in the lumbar spine（L2-4） and the femoral neck were measured by dual-energy X-ray absorptiometry （DEXA）.Intact parathyroid hormone（iPTH）, serum albumin（ALB）,serum calcium and phosphorus were detected before and 3,6 months after treatment.RESULTS：BMD in the treatment group at the sixth month were higher than control group（lumbar spine 0.967±0.105,0.896±0.131,P〈0.05;femoral neck 1.078±0.124,0.925±0.107,P〈0.05）.BMD in the control group at the sixth month were lower than those before treatment.There were no statistical differences in iPTH,ALB,serum calcium and phosphorus in two groups before and 3, 6 months after therapy.CONCLUSION：Alfacalcidol can decrease loss of bone mass in the lumbar spine and the femoral neck in the glomerulonephritis patients receiving glucocorticoid therapy.