维生素K防治儿童肾病综合征继发性骨质疏松作用的研究

Vitamin K in treating secondary osteoporosis to nephrotic syndrome in children

目的探讨维生素K防治儿童肾病综合征继发性骨质疏松的作用。方法对激素诱导性的骨质疏松肾病患儿(n=62)进行分组,了解其血液中特征性的骨转换的血清学指标(骨钙素及骨碱性磷酸酶等)、骨密度等变化规律以及给予维生素K或/和维生素D干预前后的变化情况。结果肾病活动期患儿足量激素治疗1个月时,骨密度测量值均明显下降。加用维生素K治疗组其血清学指标高于未加用维生素K组(P<0.05)。血中骨钙素及骨碱性磷酸酶水平与骨密度呈正相关。结论儿童肾病继发骨质疏松时骨钙素是血中最敏感、可靠的骨形成指标。维生素K治疗后,血中关键骨形成指标明显提高,骨密度明显改善,是一种安全、简便有效的方法。维生素K与维生素D合用更有协同作用,较单用维生素K的效果为好;维生素D不能明显提高骨密度。

Objective To explore the characterization of children osteoporosis and to find an effective treatment plan. Methods The children （n = 62） with osteoporosis caused by nephropathy or glucocorticoid were randomized to receive vitamin K （ 1 mg · kg^-1· d^-1 ）, or vitamin D （0.03 μmg · kg^-1· d^-1 ）, or vitamin K ＋ vitamin D from one month after hormone therapy. The markers of bone metabolism in blood and bone density were observed before and after hormone therapy. Results After 1 month after high-dose steroid administration, the bone density decreased in all children with nephrotic osteoporosis. The indexes of the children receiving vitamin K ameliorated significantly as compared with before treatment. Osteocalcin and bone specific alkaline phosphatase in blood had a positive correlation with bone density. Conclusion Osteocalcin may be regard as a bone formation index in children just as bone specific alkaline phosphatase. Vitamin K and vitamin D are of synergistic action. Vitamin K is a safe, effective and simple drug and should be used widely.