骨密度测定在特发性血小板减少性紫癜激素治疗患儿中的应用及临床意义

Clinical application and value of bone mineral density determination in children with idiopathic thrombocytopenia(ITP)

为探讨糖皮质激素治疗特发性血小板减少性紫癜 (ITP)时 ,对骨密度 (BMD)的影响及预防措施 ,将44例ITP患儿分3组 ,分别为初发病组、单纯激素治疗6周组及激素加钙和维生素D治疗6周组 (混合治疗组 ) ,以30例单纯呼吸道感染、无内分泌疾患小儿为对照组 ,采用双能X线骨密度测量仪测量骨密度 ,同时进行血清、钙、磷、碱性磷酸酶、肝肾功能及脊椎X线平片检查。单纯激素治疗6周以上的ITP患儿骨密度下降 ,与初发病组、混合治疗6周组及对照组比较 ,差异均有显著意义 (P<0.01,<0.01,<0.05) ;而初发病组、混合治疗组、对照组之间比较 ,差异均无显著意义。表明单纯应用激素治疗ITP6周以上 ,对小儿骨代谢即可产生十分明显的影响 ;在激素治疗同时并用钙、维生素D治疗 。

To explore the effect of glucocorticoid on bone mineral density(BMD)in children with ITP,44 children with ITP were randomly divided into 3 groups.That is group A(untreated,n=21),group B(only received glucocorticoid treatment for six weeks,n=12)and group C(not only received glucocorticoid but also received calcium and vitamin D complement for six weeks,n=11).At the same time,30 children with no any endocrine diseases were selected as normal control(group N).The bone mineral density of the spine was determined with dual energy X-ray absorptometry.Meanwhile the serum calcium,phosphorus,alkaline phosphatase and X-ray photograme of spine were measured.In comparison with the BMD results in group N,group A and group C,the BMD in group B was significantly decreased(P<0.01,<0.01,<0.05 respectively).But,no significant difference could be found in group N,group A and C(P>0.05).Treatment with glucocorticoid for 6 weeks may result in the alteration of the BMD in children with ITP and glucocorticoid treatment combined with calcium and vitamin D may prevent bone disorders.