罗钙全与磷酸盐合剂治疗X-连锁低磷性佝偻病的剂量探讨  

Dosage study of calcitriol and phosphate in treatment of children with X-linked hypophosphataemic rickets

作　　者：李桂梅[1] 郭拥军[2] 项扬[1] 尹洪臣[1] 陈力军[1] 高飞[1] 蒋莎义[1] 

机构地区：[1]山东省立医院,山东济南250021 [2]齐鲁石化公司中心医院

出　　处：《山东医药》2000年第13期12-14,共3页Shandong Medical Journal

摘　　要：对４２例１个月至１２岁健康儿童（Ｃ组）及９例２～１１岁Ｘ－连锁低磷性佝偻病（ＸＬＨＲ）患者，于治疗前后采用全自动生化分析仪测定其血钙（Ｃａ）、磷（Ｐ）、碱性磷酸酶（ＡＬＰ），并计算其钙磷乘积（Ｃａ×Ｐ）。将ＸＬＨＲ患儿分为Ａ、Ｂ两组，Ａ组采用传统治疗，主要给予中性磷酸盐合剂，辅以维生素Ｄ制剂不规则治疗；Ｂ组联合给予罗钙全［１，２５（ＯＨ）２Ｄ３］及磷酸盐合剂规则治疗；两组观察时间为３～１２个月。结果显示，Ａ、Ｂ组治疗前的血Ｃａ、Ｐ及Ｃａ×Ｐ均显著低于Ｃ组，ＡＬＰ显著高于Ｃ组（Ｐ＜０．００１），Ａ、Ｂ组间各项指标均无差异（Ｐ＞０．０５）。治疗后半个月，Ｂ组较Ａ组血Ｃａ、Ｐ及Ｃａ×Ｐ均显著升高（Ｐ分别＜０．０５、＜０．０１、＜０．００１），ＡＬＰ显著降低（Ｐ＜０．０５），且Ｂ组Ｘ线片示骨密度较Ａ组明显进步；治疗后３个月时，Ｂ组Ｃａ×Ｐ已达正常范围，而Ａ组最高值仅为２．５３［正常３．２～５．０］（ｍｍｏｌ／Ｌ）２。提示：①ＸＬＨＲ患儿较健康儿童钙磷乘积降低２～３倍，因此骨骼不能矿化；②罗钙全３０～４０ｎｇ／（ｋｇ·ｄ）及磷８０～１００ｍｇ／（ｋｇ·ｄ）治疗ＸＬＨＲ短期效果好，未出现副作用；③罗钙全的治疗机制可能为?: To evaluate the proper dosage of calcitriol and phosphate in treatment of children with X-linked hypophosphataemic rickets(XLHR).The serum calcium(Ca),phosphate(P),alkaline phosphatase(ALP)level were measured and Ca×P were calculated in 42 healthy children(C group),1 months to 12 years of age,and 9 patients with XLHR ,2 to 11 years of age,before and during treatment by autobiochemical analyzer.These patients with XLHR were divided into two groups.Group A were treated with traditional therapy,received mainly phosphate mixture and adjuncted with vitmin D agents irrgular1;Group B were treated with caicitriol[1,25(OH)2D3] regular and phosphate mixture.The duration of treatment ranged from 3 to 12 months.Results showed that the Ca,P and Ca×P were significantly decreased and elevated ALP in group A and B untreated patients when compared with C group(P<0.001)The indices of calcium.phosphate metablism had no differences between group A and B before treatment(P>0.05)The Ca,P and Ca×P were increased and ALP decreased significantly in group B than in group A after 0.5 month of treatment(P<0.05,<0.01,<0.001 and <0.05,respectively).More marked improvement of roentgenographic rachitic abnormalities were observed in group B than in group A.Ca×P reached the normal range in group B after 3 months of treatment,but the maximal value were 253 in group A(normal range:3.2 to 5.0)This suggest the Ca×P are lower 2 to 3 times in untreated patients with XLHR compared with healthy children,which stopped the bone mineralizationShortterm outcome of combined treatment in XLHR with 30～40ng/kg per day calcitriol and 80～100mg/kg per day phosphate are good,side effects were not observedThe possible mechanism of treatment with calcitriol in XLHR are seem to replacement of decreased 1,25(OH)2D3 levels in serum and promoting the bone mineralization,preventing the development of hyperparathyroidism that secondary to low calcium after administration of high doses of phosphate,stimulating the bone formation,promoting growth hormone secr

关 键 词：X-连锁低血磷性佝偻病 罗钙全 磷酸盐合剂 儿童 

分 类 号：R725.914.4[医药卫生—儿科]