糖皮质激素对肾小球疾病患者骨代谢影响因素的研究

Effects of glucocorticoid on bone metabolism in patients with glomerular disease

目的 探讨长期应用糖皮质激素 (GC)治疗对肾小球疾病患者骨代谢影响的因素。方法 2 0 7例肾小球疾病患者 ,应用常规剂量GC治疗 ,于治疗前及治疗后每隔 3～ 6个月 ,进行了 35 7例次腰椎和股骨近端骨密度 (BMD)、血钙、血磷和骨钙素浓度测定。结果 ①用GC后骨钙素浓度明显降低 (P均 <0 0 0 5 ) ,但其不能预测BMD下降。②用药 15个月后男性各部位BMD均减少 (32 2～111 5 )mg/cm2 ,以L1 4和股骨粗隆更明显 (P均 <0 0 5 ) ,骨丢失率 3 3%～ 10 3% ;女性L1 4BMD均减少(4 3 8～ 76 0 )mg/cm2 ,以L1更明显 (P <0 0 5 ) ,骨丢失率 3 9%～ 7 9%。③年龄与各部位BMD变化呈负相关 ,但不影响GC造成的骨丢失。男性各部位、女性L1 4BMD减少与GC累计剂量和GC用药时间负相关。④用GC15个月 (GC累计剂量 10g以上 ) ,男性L1 4BMD正常的比例从 3/ 4至 3/ 5 ;女性L1和L2 BMD正常者从 3/ 4减少到 1/ 2。结论 长期口服糖皮激素导致与剂量和用药时间相关的腰椎和男性股骨粗隆骨丢失 ,年龄偏大和男性患者骨丢失更明显。

Objective To investigate the effects of glucocorticoid on bone metabolism in patients with glomeruar disease. Methods We studied 207 patients with glomerular disease after long-term glucorticoid therapy and measured bone mineral density (BMD) in their lumbar spines (L 1-4) and proximal femora by dual-energy X-ray absorptiometry and determined the serum calcium, phosphate and osteocalcin before and after receiving glucorticoids every 3 to 6-months. Results ①The concentration of osteocalcin significantly declined (P<0.005) but could not predict the degree of bone loss. ② After 15-month administration of glucocorticoid, in male patients, the BMD in all measured sites decreased 32.3-111.5) mg/cm2, being significantly lower in L 1-4 and trochanter (P<0.05), and the rate of bone loss was 3.3#-10.3%; in female patients, BMD declined (43.8-76.0) mg/cm2, being significanlty lower in L 1-4, In L 1 (P<0.05), and the rate of bone loss was 3.9-7.4%. ③ There was negative correlation between the age and the BMD in all measured sites, but no effect on the glucocorticoid-induced bone loss. There was negative correlation between the reduetion in BMD of all measured sites in the men (L 1-4 in the women) and cumulative glucocorticoid dose and therapy duration. ④The rate of normal BMD in L 1-4 decreased from 3/4 to 3/5 in the men, L 1 and L 2 from 3/4 to 1/2 in the women after 15 months glucocorticoid therapy (cumulative glucocorticoid dose over 10 gram). Conclusions Administration of glucocorticoid leads to dose-and therapy duration-related bone loss in the lumba spines and trochanter in the men and the bone loss is greater in the older and male patients.