泼尼松对慢性血小板减少性紫癜患儿骨代谢的影响及维生素D的干预作用探讨

Effect of Prednisone on Bone Metabolism in Children with Chronic Thrombocytopenic Purpura and the Interventional Effect of Vitamin D

目的:探讨泼尼松对慢性血小板减少性紫癜(ITP)患儿骨代谢的影响及维生素D的干预作用。方法:36例慢性ITP患儿随机分为干预组与未干预组,均口服泼尼松1.5mg·kg-1.d-1,干预组同时口服维生素D3和牡蛎碳酸钙。治疗前及治疗4周后采空腹静脉血测Ⅰ型前胶原羧基末端前肽(PICP),留取晨尿测尿脱氧吡啶啉(DPD)和尿肌酐。选未用激素、钙剂及维生素D的上呼吸道感染患儿26例作对照组。结果:各组治疗前所测指标无显著性差异(P>0.05);干预组治疗后所测指标与其治疗前及对照组比较无显著性差异(P>0.05);未干预组治疗后血清中PICP较其治疗前及对照组明显降低,尿中DPD的排泄率较其治疗前及对照组明显增高,均有显著性差异(P<0.01)。结论:长期应用泼尼松可导致慢性ITP患儿骨形成减少、骨吸收增加,同时应用维生素D和钙剂可以预防泼尼松对骨骼代谢的副作用。

OBJECTIVE： To study the effect of prednisone on bone metabolism in children with chronic thrombocytopenic purpura and the interventional effect of vitamin D. METHODS： Thirtysix children with chronic thrombocytopenic purpura were divided into intervention group and non - intervention group. All of whom were treated with prednisone （1.5 mg· kg^-1· d^ -1） ; however, the intervention group was treated concomitantly with vitamin D and calcium citrate. Children with respiratory infection during the same period treated with no prednisone, vitD or calcium were taken as control group. Before treatment and after 4 weeks＇ treatment, the fasting venous blood sample was taken for measurement of serum carboxyterminal propeptide of type I procollagen （PICP） level and the morning urine sample was taken for measurement of urine deoxypyridinoline （DPD） level and UCr respectively. RESULTS： There were no significant difference in serum PICP and urine DPD compared among groups （P〈0.05）. The serum PICP and the urine DPD of children after 4 weeks＇ treatment showed no significant difference as compared with before treatment or control group （all P 〈 0.05） . The serum P1CP in the non-intervention group was significantly lower after 4 weeks＇ treatment as compared with before treatment or control group, and the urine excretory rate of DPD significantly increased after treatment as compared with before treatment or control group （all PK0.01） . CONCLUSION ： Long - term use of prednisone in children with chronic thrombocytopenic purpura may induce decreased bone formation and increased bone absorption. Treatment with vitamin D and calcium citrate simultaneously can prevent the side effects of prednisone on bone metablism.