定量超声技术检测糖皮质激素对儿童肾脏疾病骨量的影响

Evaluation of glucocorticoid - induced osteoporosis in childhood kidney diseases by quantitative ultrasound

目的应用定量超声技术（QUS）检测糖皮质激素对儿童肾脏疾病骨量的影响，分析其影响因素。方法采用QUS检测67例使用糖皮质激素的肾脏疾病患儿胫骨及桡骨的骨密度（BMD），收集性别、年龄、体质量指数（BMI）、激素应用时间及激素当前剂量等临床资料。以Sunlight公司提供的亚洲儿童BMD数据库为参照标准进行分析总结。对12岁以上患儿同时应用双能X线吸收仪（DEXA）测定BMD，同时与定量超声BMD仪测定不同分期进行一致性比较。结果67例患儿中男45例、女22例，采用Sunlight公司提供的亚洲儿童BMD数据库为参照标准分为4组：骨量正常组（41例）、轻度骨质疏松组（18例）、中度骨质疏松组（5例）及严重骨质疏松组（3例）。定量超声BMD仪与DEXA在骨质疏松不同分期一致性比较，具有较好的一致性（P〉0．05）。3组骨质疏松组激素应用时间、激素当前剂量均大于骨量正常组，差异均有统计学意义（P均〈0．05）。相关性分析显示BMI与胫骨的骨量异常呈正相关（r=0．395，P〈0．01），激素应用时间、激素当前剂量分别与桡骨的骨量异常呈负相关（r=-0．474、-0．381，P均〈0．01）。Logistic回归分析显示激素应用时间及激素当前剂量是骨量异常的危险因素。结论BMI是儿童糖皮质激素性骨质疏松的保护因素，激素应用时间及激素当前剂量是其危险因素。QUS用于儿童骨质疏松的监测与DEXA一致性高，且无DEXA的放射性、依赖骨骼大小及操作繁琐等缺点，更适合应用于生长发育期的儿童。

Objective To observe the glucocorticoid- induced osteoporosis（GIOP） in children with kidney diseases by quantitative ultrasound （ QUS ） , and to analyze its influencing factors. Methods The tibia/radius bone mineral density（BMD） was checked obtained in 67 cases with childhood kidney diseases treated with glucocortieoid by QUS,BMD was measured in children over the age of 12 by dual -energy X -ray absorptiometry （DXEA）, and BMD was measured with QUS consistency and different stages of osteoporsis were compared. The clinical data of gender, age, body mass index（BMI） , administration duration and daily dosage of glucocorticoid were analyzed. The association be- tween the durationof glucocorticoid use, and daily dosage of glucocorticoid and the different degrees of BMD was ana- lyzed by Logistic regression analysis. Results Sixty - seven patients （ male 45, female 22） were divided into 4 groups ac- cording to the reference standard of Asian children BMD data provided by Sunlight Company：the normal BMD group（41 cases） , the mild osteoporosis group （ 18 cases ） , moderate osteoporosis group （ 5 cases ） , and severe osteoporosis group （ 3 cases ）. Both QUS and DEXA were highly correlated with BMD in patients measured（ P 〉 0.05 ）. The duration of glueoeor- ticoid treatment and daily dosage of glucocorticoid in 3 abnormal BMD groups were all significantly longer and larger than those of the normal BMD group （ all P 〈 0.05 ）. Correlation analysis showed that BMI was positively correlated with the bone mass of the tibia（ r = 0. 395,P 〈 0.01 ）. The duration of glucocorticoid treatment and daily dosage of glueoeortieoid were negatively correlated with those of radius BMD（ r = -0.474, -0.381, all P 〈 0. 01 ）. Analysis showed that both the duration of glucocorticoid, and the daily dosage of glueocorticoid were the risk factors for GIOP. Conclusions QUS is a better method for evaluating of BMD and diagnosing of GIOP compared with DEXA in children. The daily dosage of glu- cocorticoid and the duration of glueocorticoid treatment are both the risk factors for GIOP.