钙剂联合活性维生素D对使用不同剂量糖皮质激素肾脏病患者骨密度的影响

Effect of calcium combined with active vitamin D on bone mineral density of patients with kidney diseases receving different doses of glucocorticoid

目的观察钙剂联合活性维生素D对肾脏病患者初次接受糖皮质激素(GC)治疗后骨密度的影响。方法将78例接受GC治疗的肾脏病患者按激素使用剂量分为低剂量激素组(A组)和足量激素组(B组),每组根据不同的治疗方案再分为两组(A组分为A1组和A2组,B组分为B1组和B2组)。A1组予醋酸钙胶囊600 mg,A2组与B1组予醋酸钙胶囊600 mg联合骨化三醇0.25μg,B2组予醋酸钙胶囊1 200 mg联合骨化三醇0.5μg。收集第6和12个月腰椎L1~L4的骨密度,以及腰背部疼痛评分并记录不良反应。结果A1组患者治疗第12个月时骨密度比第6个月下降(P<0.05);A2组患者治疗第12个月时骨密度与第6个月相似(P>0.05)。A2组治疗第12个月时骨密度高于A1组(P<0.05)。B1组治疗第12个月时骨密度较第6个月下降(P<0.05),而B2组治疗第12个月时骨密度较第6个月上升(P<0.05)。B1与B2组治疗第6个月时骨密度比较,差异无统计学意义(P>0.05),B2组治疗第12个月时骨密度高于B1组(P<0.05)。结论对于接受中小剂量GC治疗的肾脏病患者,每日补充活性维生素D 0.25μg和醋酸钙胶囊600 mg,能有效防治骨质丢失;对于使用足量激素者,每日活性维生素D 0.5μg和醋酸钙胶囊1 200 mg的治疗不足以防治骨量流失。

Objective To observe the effect of calcium combined with active vitamin D on bone mineral density(BMD)in patients with kidney diseases receving initial glucocorticoid therapy.Methods Seventy-eight patients with kidney diseases treated with glucocorticoids were divided into two groups according to the dosage of glucocorticoids:low dose group(group A)and high dose group(group B).Each group was further divided into two small groups according to different therapeutic regimen(group A was divided into A1,A2 and group B was divided into B1,B2).Group A1 received alcium acetate capsule 600 mg,group A2 and group B1 received calcium acetate capsule 600 mg combined with calcitriol 0.25μg,and B2 group received calcium acetate capsule 1200 mg combined with calcitriol 0.5μg.BMD of lumbar vertebrae L1~4 6 and 12 months after treatment were collected and analysed,meanwhile,pain scores of lumbar and back and adverse reactions were recorded.Results 12 months compared to 6 months after treatment,BMD in group A1 significantly decreased(P<0.05),and no similar differences were observed in group A2(P>0.05).BMD was significantly higher in group A2 than that in group A1 12 months after treatment(P<0.05).12 months compared to that 6 months after treatment,BMD in group B1 significantly decreased(P<0.05)and it significantly increased in group B1(P<0.05).No similar differences were observed between both groups(P>0.05)and BMD in group B2 was significantly higher than that in group B1 after 12-month treatment(P<0.05).Conclusions For patients with kidney diseases receiving low dose glucocorticoid therapy,daily supplementation of active vitamin D 0.25μg combined with calcium acetate capsule 600 mg work effectively in preventing bone loss.For those who use high dose glucocorticoid,the daily treatment of active vitamin D 0.5μg and calcium acetate capsule 1200 mg is not enough to prevent bone loss.