肾病综合征患者骨代谢状况及激素的早期影响

Effects of steroid treatment prophase on bone mineral metabolism in serious primary nephrotic syndrome

目的观察重症原发性肾病综合征(PNS)患者骨矿物质代谢改变及糖皮质激素(GC)治疗的早期影响,探讨血清骨碱性磷酸酶(BALP)、耐酒石酸的酸性磷酸酶(TRAP)、25-羟基维生素D[25(OH)D]在骨代谢改变中的应用价值。方法选取重症PNS患者35例作为实验组,测定患者GC治疗前和治疗后第1、2、4周血清中BALP、TRAP、25(OH)D的浓度,对其进行动态观察。健康体检者30例作为对照组。结果 1与对照组相比,实验组治疗前校正钙、血磷(P)、血BALP及TRAP水平升高(P<0.05),25(OH)D水平下降(P<0.01);2经正规激素治疗4周后,患者24 h尿蛋白(24h PRU)明显减少(P<0.01),血浆白蛋白(ALB)水平明显升高(P<0.01);3血总胆固醇(CHO)、血尿酸(BUA)、钙、P水平下降(P<0.05);4血糖(GLU)、血三酰甘油(TG)、血肌酐(CREA)、血尿素氮(BUN)、二氧化碳结合力(TCO2)水平与治疗前相比差异无统计学意义;5血清BALP、TRAP浓度明显高于治疗前水平(P<0.01),25(OH)D浓度治疗前与治疗后各期相比差异均无统计学意义。结论实验组治疗前已存在骨形成和骨吸收功能的异常,GC治疗早期即对骨代谢产生不利影响。血清BALP及TRAP水平可作为监测骨代谢状况的敏感指标。

Objective This study was aimed to observe the effect of steroids on bone mineralization in serious pri-mary nephrotic syndrome（ PNS） of early phase. To explore the clinical application of the change of the serum levels of bone-specific alkaline phosphatase （ BALP） , tartrate-resistant acid phosphatase （ TRAP） and 25-hydroxy vitamin D[25（OH）D] in serious PNS. Methods Thrity-five patients who were first diagnosed as serious PNS received glu-cocorticoid（GC） therapy for four weeks. Before treatment, at the 1^th, 2^th, and 4^th week of initial therapy, the serum levels of BALP, TRAP and 25（OH）D were detected by ELISA method. Thrity healthy people served as controls. Results ① The serious PNS patients revealed a significantly higher adjisted serum calcium for hypoalbuminaemia, phosphate（P）,BALP and TRAP levels（P〈0. 05） and a significantly lower serum 25（OH）D levels（P〈0. 01） that before treatment than controls.②At the 4^th week of treatment, mean value of 24-hour proteinuria（24 hPRU） was significantly lower（P〈0. 01）and mean serum albumin（ALB） levels were significantly increased（P〈0. 01） in comparison to the beginning of therapy.③Mean serum total cholesterol（ CHO） , blood uric acid（ BUA） , P and Ca levels were found to be significantly lower than those at the beginning of the therapy （ P〈0. 05 ） .④ Mean serum glucose（GLU）,triglyceride（TG）,creatinine（CREA）,urea nitrogen（BUN） and carbon dioxide combining power （ TCO2 ） were not statistically significant between the beginning of treatment and the posttreatment.⑤ Mean serum BALP and TRAP levels were significantly increased in comparison to the beginning of therapy（P〈0. 01）. The ex-pression levels of 25（ OH） D was not statistically significant between the beginning of treatment and the posttreat-ment. Conclusion Bone formation and resorption were abnormal in patients with serious PNS of before treatment. Bone mineralization is negatively affected by steroid treatment prophase in serious PNS. Serum BALP and TRAP levels are sensitive and specific indicators to reflect the bone metabolism.