原发性肾小球疾病糖皮质激素性骨质疏松预防治疗的临床研究

目的观察原发性肾小球疾病患者应用糖皮质激素治疗后的骨质变化情况,探讨不同剂量阿法骨化醇预防原发性肾小球疾病糖皮质激素性骨质疏松的有效性及安全性。方法将应用糖皮质激素治疗的原发性肾小球疾病患者89例随机分为3组,治疗1组予阿法骨化醇1.0μg/d和碳酸钙750mg每日3次;治疗2组予阿法骨化醇0.5μg/d和碳酸钙750mg每日3次;对照组予碳酸钙750mg每日3次。治疗前及治疗3、6、12个月时检测患者腰椎(L2L4)及股骨颈骨密度,同时测定血骨钙素及血钙、24h尿蛋白定量、血清白蛋白等常规生化指标。结果治疗1组、治疗2组患者3、6、12个月时腰椎、股骨颈骨密度无明显变化;对照组患者腰椎骨密度与治疗前相比均明显下降(0.897±0.099、0.874±0.098、0.856±0.109vs0.981±0.113,P<0.05),股骨颈骨密度变化不显著;对照组腰椎骨密度与治疗1组、治疗2组同期比较明显较低(P<0.05)。治疗1组、治疗2组骨钙素水平于治疗3、6、12个月时与治疗前相比变化不显著,对照组则明显下降(2.43±0.66、2.12±0.61、1.96±0.53vs5.92±1.33,P<0.05),对照组骨钙素水平与治疗1组、治疗2组同期比明显较低(P<0.05),治疗1组与治疗2组同期比无显著性差异。结论原发性肾小球疾病应用糖皮质激素的同时予以阿法骨化醇0.5μg/d加钙剂可预防原发性肾小球疾病患者的骨丢失。

Prevention of glucocorticoid-induced osteoporosis in patients with primary glomerulonephritis

OBJECTIVE: To investigate the changes of bone metabolism in patients with primary glomerulonephritis who receive glucocorticoid (GC) treatment and to compare the therapeutic efficacy and security of alfacalcidol in prevention of glucocorticoid-induced osteoporosis (GIOP). METHODS: 89 patients with primary glomerulonephritis, aged 18 approximately 50, were randomly divided into 3 groups: Group A (n = 30) treated with alfacidol 1.0 microg/d plus calcium carbonate 750 mg Tid, Group B (n = 30) treated with alfacidol 0.5 microg/d plus calcium carbonate 750 mg Tid, and control group (n = 29) treated with calcium carbonate 750 mg Tid. The bone mineral density (BMD) at the lumbar spine and femoral neck was measured, and the serum levels of osteocalcin (OC), calcium, phosphorus, albumin (Alb), and creatine (Scr) were examined before and 3, 6, and 12 months after the treatment. RESULTS: The values of BMD at the lumbar spine and femoral neck before the treatment was not significantly different from those 3, 6, and 12 months after the treatment in Groups A and B (all P > 0.05) and there were no significant differences in the BMD values at different time points between Group A and Group B. In the control group the BMD values at the lumbar spine 3, 6, and 12 months after the beginning of experiment were significantly lower than that before the experiment and significantly lower than the corresponding values of Groups A and B (all P < 0.05), however, there was no significant difference in the BMD value at the femoral neck before and after the experiment in the control group. The serum OC 3, 6, and 12 months after were significantly lower than that before the experiment (all P < 0.05) in the control group. However, there was no significant difference in the value of serum OC before and 3, 6, and 12 months after the treatment in Groups A and B (all P > 0.05). CONCLUSION: Treatment of alfacidol 0.5 microg/d plus calcium carbonate helps preserve the BMD and prevent bone loss in the patients with primary glomerulonephritis.