糖皮质激素对狼疮性肾炎患者骨代谢影响的相关性研究

目的　观察狼疮性肾炎患者长期强的松治疗后骨矿含量及骨代谢生化指标的变化。方法　研究对象包括对照组 (A组 ) 2 0例 ,强的松治疗前组 (B组 ) 2 5例 ,强的松治疗后组 (C组 ) 31例 ,用双能X线骨密度仪测定相关部位的骨密度 ,同时测定血钙、磷、碱性磷酸酶、甲状旁腺激素(PTH M )、骨钙素 (BGP)、2 4小时尿钙及尿肌酐。结果　 ( 1)C组病人各部位骨密度较A组和B组明显下降 (P <0 .0 1、P <0 .0 5 ) ;( 2 )C组病人血PTH、尿钙 /肌肝 (Ca/Cr)分别高于A组和B组 (P <0 .0 1) ,血BGP分别低于A组和B组 (P <0 .0 1) ;( 3)C组病人中骨量减少发生率随强的松应用时间的延长而增加。多元逐步法回归分析结果显示 ,腰L2～L4、大转子、ward’s三角区的骨密度仅与强的松应用时间相关 ,与病情活动、CTX冲击、血总蛋白、尿Ca/Cr无关。结论　狼疮性肾炎患者长期强的松治疗后可引起骨量减少或骨质疏松 ,随时间的延长发生率渐增 ,血BGP和PTH是反映继发性骨量减少的敏感性生化指标 ,较骨形态学改变早。

Effect of glucocorticoid on bone metabolism in patients with lupus nephritis

Objective To investigate the changes of the bone mass and metabolic makers in patients with lupus nephritis (LN) after long-time prednisone treatment.Methods Seventy-six 16-45 years old women were divided into three groups:group A(20 cases,healthy controls),group B (25 cases, LN before prednisone therapy) and group C (31 cases, LN after prednisone). Dual-energy X-ray absorptiometry was used to measure BMD.Simultaneously, the serum calcium,phosphate,alkaline phosphate enzyme and the PTH-M,BGP,24-hour urine calcium,creatinine were examined in all of them.Results (1)The BMDs were significantly lower in group C than those in group A and group B(P<0.01).(2)The PTH-M, urine calcium/creatinine were significantly higher and BGP was significantly lower in group C than those in group A and group B.(3)In group C, the incidences of bone mass reduction and osteoporosis were increased with time.Multivariate stepwise regression analysis revealed that the BMD in the L2-L4,the Ward's,the great trochanter had correlation only with the prednisone taking time,but had no correlation with disease activity,CTX therapy, serum total protein and urine Ca/Cr.Conclusion (1)The incidences of reduced bone mass and osteoporosis increased gradually with time in patients with lupus nephritis after long-time prednisone treatment.(2)The serum BGP decreased while PTH increased after long time prednisone treatment.They were sensitive markers to monitor secondary bone loss.