原发性肾脏病患者糖皮质激素性骨质疏松预防用药最佳时间段的探讨

Investigation of the best treatment period for prevention of glucocorticoid-induced osteoporosis in patients with primary glomerulonephritis.

目的探讨原发性肾脏病患者糖皮质激素性骨质疏松预防用药的最佳时间段。方法将应用糖皮质激素治疗的原发性肾小球疾病患者61例随机分为2组,均予阿法骨化醇0.5μg/d口服,碳酸钙750mg每日3次口服;30例服用6个月,31例服用1年。治疗前及治疗后6、12个月时检测患者腰椎(L_2～L_4)及股骨颈骨密度,同时测定血钙、24h尿蛋白定量、血清白蛋白等常规生化指标。结果2组患者6个月和12个月时腰椎、股骨颈骨密度与治疗前相比均无明显变化(P>0.05)。结论慢性肾脏病患者应用糖皮质激素的同时予以阿法骨化醇0.5μg/d加钙剂应用6个月可以预防其骨丢失。

Objective To explore the best treatment period for prevention of glucocorticoid-induced osteo- porosis in patients with primary glomerulonephritis. Methods Sixty-one patients with primary glomerulonephritis were randomly divided into 2 group： Group Ⅰ （ n = 30 ） treated with alfacidol 0.5 μg/d plus calcium carbonate 750 mg Tid,for six months,and Group Ⅱ（n =31 ） with the same treatment for one year. The bone mineral density （BMD） in the lumbar spine and the femoral neck were measured, and the calcium, phosphorus, albumin （ Alb ）, and creatine （ Scr ） were examined before and 6,12 months after the treatment. Results No differences were found in BMD at the lumbar spine and the femoral neck in group Ⅰ and group Ⅱ before and after 6 and 12 months （ P 〉 0.05 ）. Conclusion Alfacalcidol 0.5 μg/d plus calcium carbonate for six months peroids may prevent the bone loss in patients with primary glomerulonephritis receiving glucocorticoid therapy.