肾病综合征患者糖皮质激素性骨质疏松的发病及预防治疗  

Prevention and mechanism of Glucocorticoid-induced osteoporosis in patients with primary glomerulonephritis

作　　者：陈航[1] 张金超[2] 孙静[1] 贾海红[1] 高燕[1] 赵真[1] 

机构地区：[1]河北工程大学附属医院,河北邯郸071000 [2]河北工程大学药物化学与分子诊断教育部重点实验室,河北邯郸071000

出　　处：《中国现代医学杂志》2009年第12期1858-1860,1863,共4页China Journal of Modern Medicine

基　　金：河北大学附属医院博士基金课题(No:2005011)

摘　　要：目的了解肾病综合征患者糖皮质激素性骨质疏松的发病及预防治疗情况。方法记录应用糖皮质激素(GC)的肾病综合征患者的年龄、性别、体重指数、吸烟史、应用GC的时间、累积剂量、骨质疏松预防治疗用药情况;测定腰椎和股骨颈骨密度。结果123例病人中骨质异常(骨量减少和骨质疏松)者82例(66.7%),骨密度正常者41例(33.3%)。腰椎骨密度随GC的累积剂量的增加而逐渐下降,服用GC在>1个月的各组与<1个月组相比腰椎骨密度下降明显(P<0.05),>12个月者与3个月者相比腰椎骨密度下降显著(P<0.05)。只有43名患者能规律服用维生素D加钙剂,在服用GC累积剂量及时间无差异的条件下。规律服用维生素D加钙剂组骨质异常发生率(34.9%)明显低于单纯服用钙剂组(78.2%)及不用药组(73.4%)(P<0.05)。结论应用GC治疗的肾病综合征患者骨密度随GC的累积剂量增加而逐渐下降,GC的累积剂量及未预防应用维生素D及钙剂是骨密度下降的危险因素。[Objective] To investigate the state of Glucocortieoid-induced osteoporosis （GIOP） and the current prevention of GIOP in patients with primary glomerulonephritis. [Methods] Primary glomerulonephritis patients receiving glucoeorticoid therapy were observed and bone mineral density BMD in the lumbar spine and the femoral neck were measured. Age, sex, body-mass-index, smoking history, the time and aeeumulative dose of glueoeorticoid treatment, and the state of osteopomsis prevention were investigated, the factors that influence the BMD were analyzed. [Results] A total of one hundred and twenty-three patients were included in this study. Among them, osteoporosis and osteopenia were found in 20 （17%） and 61 （50%） patients respectively. Lumbar spine BMD decrease gradually with the increase of the acumulative dose of glucocorticoid. There were statistical differences in the BMD of lumbar spine in patients with receving GC at the period of less than 1 month compared with other groups （1-〈3, 3-〈6, 6-〈9, 9-〈12, 〉12 months） （P 〈0.05）. Among 123 patients, only 1/3 of them took Vitamin D and agent containing calcium regularly, but the incidence of abnormal BMD in this group is significant decreased compared with other only taking agent containing calcium and without treatment at the same state of GC treatment period and acumulative dose （P 〈0.05）. [Conclusion] BMD in patients with primary glomerular nephritis receiving glucocortieoid therapy decreased gradually with the increasing of acumulative dose of glucocortieoid. Aeumulative dose of glueocortieoid and without receiving osteoperosis prevention therapy were risk factors of abnormility of BMD.

关 键 词：糖皮质激素性骨质疏松 肾病综合征 骨密度 预防 

分 类 号：R58[医药卫生—内分泌]