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

摘要:

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。

关键词:肾脏用药;糖皮质激素类;骨密度;类钙剂;维生素D

Abstract:

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 0.25 μg, and B2 group received calcium acetate capsule 1200 mg combined with calcitriol 0.5 μg. 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 0.25 μg 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 0.5 μg and calcium acetate capsule 1200 mg is not enough to prevent bone loss.

Key words:pharmacy; glucocorticoids; bone density; calcium; vitamin D