维生素D在预防儿童肾病综合征继发骨质疏松症的量效研究  

Dose-effect relationship of vitamin D in the prevention of osteoporosis secondary to nephrotic syndrome children

作　　者：张玉玲 易玲[1] 曾海江[1] ZHANG Yuling;YI Ling;ZENG Haijiang(Department of Pediatrics,Ganzhou City 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》2025年第4期530-535,共6页Chinese Journal of Osteoporosis

摘　　要：目的探讨不同剂量维生素D联合钙剂在预防儿童肾病综合征继发性骨质疏松症的应用效果。方法收集2021年1月至2023年6月接受治疗的肾病综合征患儿56例临床资料,根据治疗方法分为A组(18例)、B组(21例)、C组(17例)。在常规糖皮质激素治疗、营养干预的基础上,A组给予维生素D_(3)(600 IU/d)、碳酸钙D3(500 mg/d)治疗,B组给予维生素D3(1000 IU/d)、碳酸钙D3(500 mg/d)治疗,C组给予维生素D3(1200 IU/d)、碳酸钙D3(500 mg/d)治疗。治疗12个月后,比较钙磷代谢、骨代谢、营养学、药物不良反应及感染等指标。结果血钙、25-羟维生素D_(3)[25-(OH)D_(3)]:A组<B组<C组(P<0.05);甲状腺旁激素(PTH):A组>B组>C组(P<0.05)。骨碱性磷酸酶(BALP)、Ⅰ型胶原氨基末端肽(PINP)、Ⅰ型胶原C端肽β降解产物(β-CTX):A组>B组>C组(P<0.05);骨密度(BMD):A组<B组<C组(P<0.05)。白蛋白(ALB)、前白蛋白(PALP)、总蛋白(TP):A组<B组<C组(P<0.05)。A组、B组、C组感染率比较(22.22%vs 14.29%vs 11.76%,χ^(2)=0.415,P>0.05)。结论在600~1200 IU/d剂量范围内,维生素D预防儿童肾病综合征继发骨质疏松症存在一定的量效关系,1200 IU/d维生素D能更好地调节钙代谢与骨代谢,改善肾病综合征患儿营养状况,且有良好的安全性。Objective To investigate the effect of different doses of vitamin D combined with calcium in the prevention of secondary osteoporosis in children nephrotic syndrome.Methods Clinical data of 56 children with nephrotic syndrome who received treatment from January 2021 to June 2023 were collected and divided into group A(18 cases),group B(21 cases)and group C(17 cases)according to treatment method.On the basis of routine glucocorticoid therapy and nutritional intervention,group A was treated with vitamin D3(600 IU/d)and calcium carbonate D3(500 mg/d),group B was treated with vitamin D3(1000 IU/d)and calcium carbonate D3(500 mg/d).Group C was treated with vitamin D3(1200 IU/d)and calcium carbonate D3(500 mg/d).After 12 months of treatment,calcium and phosphorus metabolism,bone metabolism,nutrition,adverse drug reactions and infection were compared.Results Serum calcium and 25-hydroxyvitamin D3[25-(OH)D3]:Group A<group B<group C(P<0.05);Parathyroid hormone(PTH):Group A>group B>group C(P<0.05).Bone alkaline phosphatase(BALP),amino terminal peptide of type I collagen(PINP),C-terminal peptideβdegradation product of type I collagen(β-CTX):group A>group B>group C(P<0.05);Bone mineral density(BMD):Group A<group B<group C(P<0.05).Albumin(ALB),prealbumin(PALP),total protein(TP):group A<group B<group C(P<0.05).Comparison of infection rates among Group A,Group B,and Group C(22.22%vs 14.29%vs 11.76%,χ^(2)=0.415,P>0.05).Conclusion Within the dosage range of 600-1200 IU/d,there is a certain dose-response relationship between vitamin D and prevention of secondary osteoporosis in children with nephrotic syndrome.1200 IU/d vitamin D can better regulate calcium metabolism and bone metabolism,improve the nutritional status of children with nephrotic syndrome,and has good safety.

关 键 词：肾病综合征 儿童 维生素D 钙代谢 骨代谢 营养状况 

分 类 号：R725.9[医药卫生—儿科] R589.5[医药卫生—临床医学]