骨化三醇联合钙剂对肾病综合征患儿Th17/Treg免疫及骨代谢的影响  

The effect of calcitriol combined with calcium supplements on Th17/Treg immunity and bone metabolism in children with nephrotic syndrome

作　　者：钟涛[1] 黄郁波[1] 肖淑萍 赖子梅 易玲[1] ZHONG Tao;HUANG Yubo;XIAO Shuping;LAI Zimei;YI Ling(Department of Pediatrics,Ganzhou People’s Hospital,Ganzhou 341000,China)

机构地区：[1]赣州市人民医院儿科,江西赣州341000

出　　处：《中国骨质疏松杂志》2024年第12期1763-1767,1780,共6页Chinese Journal of Osteoporosis

基　　金：江西省卫生计生委科技计划(20187243)。

摘　　要：目的分析骨化三醇联合钙剂辅助治疗肾病综合征(NS)患儿的临床疗效及可能作用机制。方法收集2020年1月至2021年9月接受治疗NS患儿63例临床资料,根据治疗方法分为观察组(32例)、对照组(31例)。所有患儿均给予常规糖皮质激素治疗及营养干预。对照组同时给予维生素D联合钙剂辅助治疗,观察组同时给予骨化三醇联合钙剂辅助治疗。治疗12个月,比较两组Th17/Treg细胞、血钙磷、骨代谢、临床疗效等指标。结果观察组Th17、Th17/Treg低于对照组,Treg高于对照组(P<0.05)。观察组血钙、25-羟维生素D3[25(OH)D3]、白蛋白(ALB)高于对照,24 h-尿蛋白定量(24-UTP)低于对照组(P<0.05)。观察组骨钙素(BGP)高于对照组,甲状腺旁激素(PTH)、碱性磷酸酶(AKT)、Ⅰ型胶原氨基端延长肽(P1NP)、β-胶原特殊序列(β-CTX)低于对照组(P<0.05)。观察组完全及显著缓解率81.25%高于对照组58.06%(χ^(2)=4.019,P<0.05)。结论骨化三醇联合钙剂辅助治疗能够提高NS患儿临床疗效,可能与矫正Th17/Treg免疫失衡、改善血钙磷及骨代谢紊乱等因素有关。Objective To analyze the clinical efficacy and possible mechanism of Calcitriol combined with calcium in the adjuvant treatment of children with NS.Methods 63 children with NS from January 2020 to September 2021 were divided into observation group(32 cases)and control group(31 cases).All patients were given routine glucocorticoid treatment and nutritional intervention.The control group was given vitamin D combinded with calcium therapy,the observation group was given Calcitriol combined with calcium therapy.12 months after treatment,H17/Treg cells,serum calcium and phosphorus,bone metabolism and clinical efficacy were compared between two groups.Results The Th17 and Th17/Treg levels in the observation group were lower than those in the control group,while Treg levels were higher than those in the control group(P<0.05).The observation group had higher levels of blood calcium,25 hydroxyvitamin D3[25-(OH)D 3)],and albumin(ALB)than the control group,while 24-hour urinary protein quantification(24-UP)was lower than the control group(P<0.05).The observation group had higher levels of BGP than the control group,while levels of PTH,AKT,P1NP,andβ-CTX were lower than those in the control group(P<0.05).The complete and significant remission rate of the observation group was 81.25%,which was higher than that of the control group(58.06%,χ^(2)=4.019,P<0.05).Conclusion The combination of calcitriol and calcium supplements as adjuvant therapy can improve the clinical efficacy of NS in children,which may be related to correcting Th17/Treg immune imbalance,improving blood calcium,phosphorus,and bone metabolism disorders.

关 键 词：肾病综合征 骨化三醇 TH17/TREG 骨代谢 

分 类 号：R725.9[医药卫生—儿科] R256.5[医药卫生—临床医学]