小儿肾病综合征相关骨代谢异常及防治

Prevention and treatment of nephrotic syndrome associated bone metabolic abnormality in children

肾病综合征（Ns）时的代谢性骨病正日益受小儿肾科医师的关注。在NS起病之初因钙结合蛋白、维生素D结合蛋白自尿中丢失，骨代谢生化异常即已发生。治疗性糖皮质激素（GC）大剂量、长疗程的应用则进一步加剧了骨代谢异常，其主要机制为GC抑制成骨细胞的活性、促进成骨细胞的凋亡以及促进破骨细胞的生成、引起继发性甲状旁腺功能亢进，导致骨质疏松、生长迟缓、骨折风险增加，严重危及儿童身心健康。骨转换的生物标志物可以早期反映NS患儿骨代谢的异常；椎体骨双能X线吸收法骨密度检测是判断GC相关性骨质疏松症的最佳部位与方法。在GC治疗NS的始终，钙剂和维生素D的联合使用对于代谢性骨病的防治是最常用和有效的手段。目前尚缺乏针对儿童NS骨代谢异常的预防及治疗指南。

Metabolic bone disease in nephrotic syndrome（NS） are increasingly being renal physician＇s atten- tion. As calcium binding protein and VitD binding protein losing with a large number of protenuria, the bone metabolic biochemical abnormalities had happened at the beginning of the onset of the nephrotic syndrome, and is further exacer- bated by therapeutic high - dose or long course of glucocorticoids （ GC ） application. The main mechanism of the glu- cocorticoid -induced osteoporosis （GIOP） is for GC to inhibit the activity of osteoblasts and promote apoptosis of osteo- blasts and formation of osteoclasts, resulting in secondary hyperparathyroidism,leading to increasing the risk of osteopo- rosis,slow growth and fracture,seriously ham] to children＇s physical and mental health. The biomarkers of bone trans- form can prompt the NS with bone metabolic abnormalities early ; vertebral body bone dual - energy X - ray absorptio- metry bone mineral density detection is the best method and position to determine GIOP. As the most commonly used and effective means to prevent and control metabolic bone disease, calcium supplements and VitD were always taken when GC was treated for NS, even the dosage of GC was very low. So far, it is still lack of guideline of prevention and treatment of bone metabolic abnormalities in NS in children.