预防性应用VitD、钙剂对糖皮质激素治疗儿童肾病综合征骨密度的影响

目的:观察维生素D(VitD)、钙剂对应用泼尼松治疗肾病综合征(NS)患儿骨密度(BMD)的作用,探讨其变化对NS患儿骨代谢的影响及意义。方法:以本院2009年1月至2011年5月临床资料完整的激素敏感型NS患儿90例为对象,男52例,女38例,55例为初发,35例为复发病例,平均年龄(5.33±2.86)岁,随机分为A、B、C三组,每组30例。A组单用激素治疗,口服泼尼松1.5～2 mg/(kg.d),最大剂量80 mg/d,并逐渐减量,疗程9～12个月;B组在A组治疗基础上加用VitD;C组在B组治疗基础上加用钙剂治疗。所有患儿在激素治疗前、激素治疗后1个月及6个月分别测量血清钙、BMD。结果:三组患儿治疗1个月、6个月后与治疗前比较,BMD降低(P<0.01),治疗1个月后A、B组BMD下降更明显,与C组比较差异有统计学意义(P<0.05);治疗6个月后A组BMD由(0.751±0.042)g/cm2降至(0.639±0.035)g/cm2(P<0.01),B组由(0.750±0.040)g/cm2降至(0.640±0.025)g/cm2(P<0.01),较C组由(0.748±0.041)g/cm2降至(0.665±0.038)g/cm2(P<0.01)下降更明显(P<0.01);血清钙值A组由(1.940±0.068)mmol/L降至(1.742±0.048)mmol/L,B组由(1.932±0.085)mmol/L升至(2.158±0.131)mmol/L,C组由(1.921±0.083)mmol/L升至(2.338±0.081)mmol/L,差异有统计学意义(P<0.01)。结论:糖皮质激素治疗NS患儿可降低BMD,加用适当剂量VitD和钙剂可减轻但并不能完全阻止骨质疏松,未发现其他不良反应。

Impact of Prophylactic Vitamin D and Calcium Treatments on Bone Mineral Density in Children with Nephritic Syndrome during Glucocorticoids Treatment

Objective: To observe the changes of bone mineral density in children with nephritic syndrome by using prophylactic vitamin D and calcium treatments during prednisolone therapy,and to explore the effects of its changes on bone metabolism.Methods: This prospective study was randomized conducted to determine the effects and prophylactic role of vitamin D and calcium treatments on bone and mineral metabolism in children receiving prednisolone treatment.A total of 90 children with average age(5.33±2.86) years receiving prednisolone therapy were selected from January 2009 to May 2011 in our hospital.All of them(52 boys and 38 girls) with nephritic syndrome(55 new-onsets and 35 relapses) were included in the study.All children received prednisolone 1.5~2 mg/(kg·d).The patients were randomized into A,B(vitamin D 500 IU daily) and C(vitamin D 500 IU plus calcium 300 mg daily) groups.Serum Ca2+ and bone mineral density were analyzed at the beginning and the 6th month after the treatment.Results: Bone mineral density was significantly decreased in the A group (0.751±0.042)g/cm2 to(0.639±0.035)g/cm2,P<0.01],B group (0.749±0.040)g/cm2 to(0.655±0.039)g/cm2,P<0.01] and C group (0.748±0.041)g/cm2 to(0.665±0.038)g/cm2,P<0.01].But the percentage of bone mineral density decrease was found to be significantly lower in A,B group than that in C group.Serum calcium was decreased in A group (1.940±0.068)mmol/L to(1.742±0.048)mmol/L],but increased in B group (1.931±0.073)mmol/L to(2.328±0.076)mmol/L]and C group (1.921±0.083)mmol/L to(2.338±0.081)mmol/L] after prednisolone treatment(P<0.01).Conclusions: Steroid treatment decreases bone mineral density in children with nephritic syndrome.Vitamin D plus calcium therapy at the current doses reduces but does not completely prevent bone loss,with no additional adverse effects.