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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。
Objective: To observe the effects of vitamin D and calcium on bone mineral density (BMD) in children with nephrotic syndrome (NS) treated with prednisone and to explore the effect and significance of these changes on bone metabolism in children with NS. Methods: From January 2009 to May 2011 in our hospital, 90 patients with hormone-sensitive NS were enrolled in this study. There were 52 males and 38 females, of whom 55 were newly diagnosed and 35 were relapsed. The mean Age (5.33 ± 2.86) years old, were randomly divided into A, B, C three groups, 30 cases in each group. Group A was treated with hormones alone, prednisone 1.5 ~ 2 mg / (kg.d) and maximum dose 80 mg / d were given orally. The course of treatment was 9-12 months. In group B, With VitD; C group in the B group on the basis of treatment with calcium treatment. All children before and after hormone therapy, hormone therapy at 1 month and 6 months were measured serum calcium, BMD. Results: The BMD decreased (P <0.01) in the three groups of children at 1 month and 6 months after treatment, and the BMD decreased more significantly in groups A and B after 1 month of treatment, with a statistically significant difference as compared with group C (P <0.01). The BMD of group A decreased from (0.751 ± 0.042) g / cm2 to (0.639 ± 0.035) g / cm2 to (0.640 ± 0.025) g / cm2 (P <0.01), and decreased more significantly from (0.748 ± 0.041) g / cm2 to (0.665 ± 0.038) 0.01). Serum calcium value in group A decreased from (1.940 ± 0.068) mmol / L to (1.742 ± 0.048) mmol / L in group A, and (1.932 ± 0.085) mmol / L in group B increased to (2.158 ± 0.131) mmol / The level of C increased from (1.921 ± 0.083) mmol / L to (2.338 ± 0.081) mmol / L, the difference was statistically significant (P <0.01). Conclusion: Glucocorticoid treatment of children with NS can reduce BMD, with the appropriate dose of VitD and calcium can reduce but not completely prevent osteoporosis and found no other adverse reactions.