不同剂量维生素D联合钙剂治疗儿童初发及非频复发肾病综合征

Vitamin D combined with calcium in treatment of new-onset and infrequently relapsing nephrotic syndrome in children

目的探讨两种不同剂量维生素D3(1400 IU/d vs 1000 IU/d)联合钙剂治疗儿童初发及非频复发肾病综合征(nephrotic syndrome,NS)的疗效与安全性。方法将64例初发(12例)及非频复发(52例)NS患儿随机分为两组,A组32名NS患儿在常规糖皮质激素治疗的基础上予以维生素D31400 IU/d联合钙剂500 mg/d,B组32名NS患儿在常规糖皮质激素治疗的基础上予以维生素D31000 IU/d联合钙剂500 mg/d。于治疗前、治疗1个月以及3个月分别测定两组患儿血清25-羟维生素D[25-(OH)D]、血清总钙、血浆甲状旁腺素、24 h尿蛋白定量、血浆白蛋白的水平,治疗期间监测各组的药物不良反应及感染发生率。结果1)治疗1个月、3个月后,A组患儿血清25-(OH)D提升率显著高于B组(P<0.05);两组患儿同时间的血清总钙、血浆甲状旁腺素变化率无统计学差异(P>0.05)。2)治疗3个月后,排除A、B两组中并发感染的病例,A组患儿24 h尿蛋白定量较B组降低(P<0.05),血浆白蛋白水平较B组升高(P<0.05)。3)A、B两组NS患儿治疗期间的感染发生率无统计学义差异(P>0.05)。4)两种治疗方案均未导致维生素D中毒或高血钙等不良反应。结论维生素D31400 IU/d联合钙剂治疗儿童初发及非频复发肾病综合征疗效较维生素D31000 IU/d联合钙剂更佳,且无不良反应发生。

Objective To study the therapeutic effect and safety of different dosages of vitamin D3(1400 IU/day vs 1000 IU/day)combined with calcium on children with new-onset and infrequently relapsing nephrotic syndrome(IFRNS).Methods Totally 64 children with new-onset nephrotic syndrome(n=12)or IFRNS(n=52)were selected and randomly divided into two groups.In group A,32 children were treated with vitamin D3(1400 IU/day)combined with calcium(500 mg/day)on the basis of glucocorticoid therapy.In group B,32 children were treated with vitamin D3(1000 IU/day)combined with calcium 500 mg/day on the basis of glucocorticoid therapy.The level of serum 25-hydroxyvitamin D(25-[OH]D),serum calcium,parathyroid hormone,24-hour urine protein and plasma albumin in two groups were detected before and after treatment.The side effects and the rates of infection in the period of treatment were recorded.Results At one month and three months after treatment,the percentage increase in serum 25-(OH)Din group A was significantly higher than that of group B at the same time point(P<0.05),but the percentage increase in serum calcium and parathyroid hormone in the two groups showed no significant difference(P>0.05).Excluding the infection cases,the level of 24-hour urine protein was lower in group A than group B at three months after treatment(P<0.05),while the level of plasma albumin was higher in group A than group B at three months after treatment(P<0.05).There was no significant difference in rates of infection between group A and group B(P>0.05).No adverse event,such as Vitamin D poisoning or hypercalcemia,were found in the two groups.Conclusion Vitamin D3(1400 IU/day)combined with calcium(500 mg/day)in children with new-onset and infrequently relapsing nephrotic syndrome is more effective than vitamin D3(1000 IU/day)combined with calcium(500 mg/day),without adverse reactions.