van der Sluis I M, Boot A M, Nauta J, Hop W C, de Jong M C, Lilien M R, Groothoff J W, van Wijk A E, Pols H A, Hokken-Koelega A C, de Muinck Keizer-Schrama S M
Department of Pediatrics, Division of Endocrinology and Nephrology, Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands.
Pediatr Nephrol. 2000 Dec;15(3-4):221-8. doi: 10.1007/s004670000470.
Metabolic bone disease and growth retardation are common complications of chronic renal failure (CRF). We evaluated bone mineral density (BMD), bone metabolism, body composition and growth in children with CRF, and the effect of growth hormone treatment (GHRx) on these variables. Thirty-three prepubertal patients with CRF were enrolled including 18 children with growth retardation, who were treated with growth hormone for 2 years. Every 6 months, BMD of lumbar spine and total body, and body composition were measured by dual-energy X-ray absorptiometry. Biochemical parameters of bone turnover were assessed. Mean BMD of children with CRF did not differ from normal. During GHRx, BMD and bone mineral apparent density of lumbar spine and height SDS increased, whereas BMD of total body did not change. Lean body mass increased in the GH group. Alkaline phosphatase increased significantly in the GH group only. The other biochemical parameters of bone turnover increased in both groups, none of them correlated with the changes in BMD. No serious adverse effects of GHRx were reported. In conclusion, BMD of children with CRF did not differ from healthy children. Adequate treatment with alpha-calcidiol or the short duration of renal failure may have attributed to the absence of osteopenia in our patients. BMD of the axial skeleton and growth improved with GHRx.
代谢性骨病和生长发育迟缓是慢性肾衰竭（CRF）的常见并发症。我们评估了CRF患儿的骨矿物质密度（BMD）、骨代谢、身体组成和生长情况，以及生长激素治疗（GHRx）对这些变量的影响。纳入了33例青春期前的CRF患者，其中18例生长发育迟缓的儿童接受了2年的生长激素治疗。每6个月通过双能X线吸收法测量腰椎和全身的BMD以及身体组成。评估骨转换的生化参数。CRF患儿的平均BMD与正常儿童无差异。在GHRx治疗期间，腰椎的BMD和骨矿物质表观密度以及身高标准差评分增加，而全身的BMD没有变化。GH组的瘦体重增加。仅GH组的碱性磷酸酶显著升高。两组的其他骨转换生化参数均升高，且均与BMD的变化无关。未报告GHRx的严重不良反应。总之，CRF患儿的BMD与健康儿童无差异。使用阿法骨化醇进行充分治疗或肾衰竭病程较短可能是我们的患者未出现骨质减少的原因。GHRx使轴向骨骼的BMD和生长情况得到改善。
