糖皮质激素对肾小球疾病患者骨密度和骨转换指标的影响

The effect of glucocorticoid on bone mineral density and bone turnover makers in patients with glomerular diseases

目的:观察长期糖皮质激素(GC)治疗对肾小球疾病患者骨密度和骨转换指标的影响。方法:采用双能量X线骨密度仪测定应用GC治疗的97例肾小球疾病患者和20例对照组腰椎(L1~L4)、股骨颈、大粗隆的骨密度,用ELISA法测定骨转换指标(血I型原胶原N端前肽PINP和I型胶原交联C末端肽CTX-I)的浓度。结果:(1)所有患者各部位骨密度、PINP浓度均较对照组减低,CTX-I较对照组增加(P均<0.05);(2)随着应用GC时间的延长及累积剂量的增加,腰椎、股骨颈、大粗隆骨密度及血清PINP浓度呈递减趋势,而血清CTX-I浓度则呈递增趋势(P均<0.05);(3)多元线性回归分析结果显示腰椎、大粗隆骨密度与激素累积使用时间呈负相关(回归系数=-0.470^-0.387,P均<0.01),PINP、CTX-I浓度与激素累积剂量相关(r=-0.310 vs.0.221,P均<0.05);(4)规律服用维生素D加钙剂的患者,骨质异常发生率减低(P<0.05)。结论:肾小球疾病患者长期糖皮质激素治疗后可导致骨质异常,联合测定骨密度与骨转换指标有利于早期防治糖皮质激素性骨质疏松。

Objective To investigate the the effect of long-term glucocorticoid on bone mineral density （BMD） and bone turnover makers in patients with glomernlar diseases. Methods The dual-energy x-ray absorptiometry （DXA） was used to measure the bone mineral density of lumbar spine （L1-L4）, femoral neck and trochanter of the 97 patients treated with glueocorticoid and the 20 patients in the control group. In addition, ELISA assay was used to measure the concentrations of bone turnover makers including serum PINP and CTX - I. Results （1）Compared with the control group, the BMD of lumbar spine （L1 - L4）, femoral neck and trochanter and the concentrations of PINP were significantly lower, while the concentration of CTX-I was increased （P 〈 0.05） ; （2） Following up the passage of time and the accumulation of the amount of GC application, the BMD of lumbar spine, femoral neck and troebanter, and the concentrations of PINP decreased, while the concentration of CTX-I steadily increased （P 〈 0.05 ） ; （3）Multiple linear regression analysis indicated that the BMD of lumbar spine and trochanter were negatively correlated with the time of GC application （P 〈 0.01）, and the concentrations of PINP and CTX-I were correlated with the cumulative doses of GC （r = -0.310 vs 0.221, P 〈 0.05） ; （4）The incidence of bone abnormalities in patients received vitamin D and calcium was markedly redueed（P 〈0.05）. Conclusion The long-term glucocortieoid treatment for the patients with glomernlar diseases can lead to bone mass reduction or osteoporosis, it can be helpful for early prevention and treatment of glueocorticoid osteoporosis with bone mineral density and bone turnover makers.