肾病综合征患者骨代谢状况及激素的早期影响  

Effects of steroid treatment prophase on bone mineral metabolism in serious primary nephrotic syndrome

作　　者：李晨祥 郝丽[1] 王德光[1] 何衡杰[1] 张丹凤[1] 赵丹[1] 

机构地区：[1]安徽医科大学第二附属医院肾脏内科,合肥230601

出　　处：《安徽医科大学学报》2015年第4期495-499,共5页Acta Universitatis Medicinalis Anhui

基　　金：安徽省卫生厅临床医学应用技术项目(编号:06B112)

摘　　要：目的观察重症原发性肾病综合征(PNS)患者骨矿物质代谢改变及糖皮质激素(GC)治疗的早期影响,探讨血清骨碱性磷酸酶(BALP)、耐酒石酸的酸性磷酸酶(TRAP)、25-羟基维生素D[25(OH)D]在骨代谢改变中的应用价值。方法选取重症PNS患者35例作为实验组,测定患者GC治疗前和治疗后第1、2、4周血清中BALP、TRAP、25(OH)D的浓度,对其进行动态观察。健康体检者30例作为对照组。结果 1与对照组相比,实验组治疗前校正钙、血磷(P)、血BALP及TRAP水平升高(P<0.05),25(OH)D水平下降(P<0.01);2经正规激素治疗4周后,患者24 h尿蛋白(24h PRU)明显减少(P<0.01),血浆白蛋白(ALB)水平明显升高(P<0.01);3血总胆固醇(CHO)、血尿酸(BUA)、钙、P水平下降(P<0.05);4血糖(GLU)、血三酰甘油(TG)、血肌酐(CREA)、血尿素氮(BUN)、二氧化碳结合力(TCO2)水平与治疗前相比差异无统计学意义;5血清BALP、TRAP浓度明显高于治疗前水平(P<0.01),25(OH)D浓度治疗前与治疗后各期相比差异均无统计学意义。结论实验组治疗前已存在骨形成和骨吸收功能的异常,GC治疗早期即对骨代谢产生不利影响。血清BALP及TRAP水平可作为监测骨代谢状况的敏感指标。Objective This study was aimed to observe the effect of steroids on bone mineralization in serious pri-mary nephrotic syndrome（ PNS） of early phase. To explore the clinical application of the change of the serum levels of bone-specific alkaline phosphatase （ BALP） , tartrate-resistant acid phosphatase （ TRAP） and 25-hydroxy vitamin D[25（OH）D] in serious PNS. Methods Thrity-five patients who were first diagnosed as serious PNS received glu-cocorticoid（GC） therapy for four weeks. Before treatment, at the 1^th, 2^th, and 4^th week of initial therapy, the serum levels of BALP, TRAP and 25（OH）D were detected by ELISA method. Thrity healthy people served as controls. Results ① The serious PNS patients revealed a significantly higher adjisted serum calcium for hypoalbuminaemia, phosphate（P）,BALP and TRAP levels（P〈0. 05） and a significantly lower serum 25（OH）D levels（P〈0. 01） that before treatment than controls.②At the 4^th week of treatment, mean value of 24-hour proteinuria（24 hPRU） was significantly lower（P〈0. 01）and mean serum albumin（ALB） levels were significantly increased（P〈0. 01） in comparison to the beginning of therapy.③Mean serum total cholesterol（ CHO） , blood uric acid（ BUA） , P and Ca levels were found to be significantly lower than those at the beginning of the therapy （ P〈0. 05 ） .④ Mean serum glucose（GLU）,triglyceride（TG）,creatinine（CREA）,urea nitrogen（BUN） and carbon dioxide combining power （ TCO2 ） were not statistically significant between the beginning of treatment and the posttreatment.⑤ Mean serum BALP and TRAP levels were significantly increased in comparison to the beginning of therapy（P〈0. 01）. The ex-pression levels of 25（ OH） D was not statistically significant between the beginning of treatment and the posttreat-ment. Conclusion Bone formation and resorption were abnormal in patients with serious PNS of before treatment. Bone mineralization is negatively affected by steroid tr

关 键 词：原发性肾病综合征 糖皮质激素 骨代谢 骨碱性磷酸酶 耐酒石酸的酸性磷酸酶 25-羟基维生素D 

分 类 号：R692[医药卫生—泌尿科学]