阿仑膦酸钠治疗糖皮质激素依赖的肾病综合征研究

Treatment of glucocorticoid-dependent nephrotic syndrome by alendronate sodium

目的探讨阿仑膦酸钠治疗糖皮质激素依赖的肾病综合征（NS）的效果及机制。方法选取Ns患者60例，随机分为观察组和对照组，每组各30例。对照组予以钙尔奇D片和阿法骨化醇，观察组在对照组的基础上，给予阿仑膦酸钠。于治疗前、治疗3个月、6个月和1年时比较2组的血清BGP、BALP、Ca、P及PTH水平，测定L2-4、股骨颈（Neck）和髋关节（InterTro）的BMD。结果2组治疗3个月、6个月、1年时与治疗前比较，对照组BGP降低，BALP、PTH升高（P〈0．05或P〈0．01）；观察组BGP高于对照组，BALP、PTH低于对照组（P〈0．05或P〈0．01）。治疗1年时与治疗前比较，对照组L2～4、InterTro水平均降低（P〈0．05），观察组L2～4、Neck、InterTro的BMD均高于对照组（P〈0．05）。结论阿仑膦酸钠治疗糖皮质激素依赖的NS可预防糖皮质激素性骨质疏松的发生，治疗中骨代谢指标及BMD比较稳定，可能在于阿仑膦酸钠干扰了破骨细胞的信号转导并最终导致细胞凋亡，维持了骨吸收与骨形成之间的稳态。

Objective To explore the effect and mechanism of glucocorticoid-dependent nephrotic syndrome＇ s treatment by alendronate sodium. Methods 60 cases with NS were selected,and were randomly divided into observation group and control group,30 cases per group. Patients in control group were given Caltrate with vitamin D and alfacaleidol, and patients in observation group were given alendronate sodium based on control group. Two groups＇ serum BGP, BALP, Ca, P and PTH levels were compared, and BMD of L2-4 , Neck and Inter Tro were tested before treatment, treatment for 3 months,6 months and 1 years. Results Comparing with before treatment and treatment for 3 months,6 months and 1 years,control group＇ s BGP decreased,yet BALP and PTH increased（ P 〈 0.05 or P 〈 0.01 ）. Observation group＇ s BGP was higher than that of control group, yet BALP and PTH were lower than those of control group （P 〈 0.05 or P 〈 0.01 ）. Comparing with before treatment and treatment for 1 years, observation group＇ s BMD of L2 -4, Neck and Inter Tro were all higher than those of control group （ P 〈 0.05 ）. Conclusion It can prevent GIOP by alendronate sodium on patients with glucoeorticoid-dependent nephrotic syndrome, and bone metabolic index and BMD was relatively stable during treatment, and it maybe relate with alendronate sodium＇ s interfering signal transduction of osteoclasts and eventually lead to apoptosis, so it maintained the steady state between bone resorption and formation.