Waller Simon, Ridout Deborah, Rees Lesley
Department of Nephro-Urology, Institute of Child Health and the Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK.
Pediatr Nephrol. 2007 Jan;22(1):121-7. doi: 10.1007/s00467-006-0292-2. Epub 2006 Sep 15.
Bone mineral density (BMD) is important in children and adolescents because of its relationship to long-term skeletal health, and because, in adults with chronic renal failure (CRF), a relationship between low BMD and vascular calcification has been suggested. To investigate the relationship between BMD and manipulable factors that might affect it, i.e. plasma calcium, phosphate and parathyroid hormone (PTH), 64 patients with a median glomerular filtration rate (GFR) of 31 (range 7-60) ml min(-1) 1.73 m(-2) and median age of 10.0 (4.1-16.9) years were followed over 1.3 (0.7-1.7) years at an average of 5 (3-14) clinic visits. At one visit, BMD of the lumbar spine was measured by dual energy X-ray absorptiometry. The mean BMD Z-score was normal (=0.0). Overall mean calcium, phosphate and PTH levels were in their respective normal ranges. The majority of the patients (72%) were treated with calcium carbonate, mean dose 65 mg kg(-1) day(-1); prescription was positively related to serum calcium levels and calcium-phosphate product (P=0.012 and P<0.01 respectively). Almost all patients (98%) were treated with alfacalcidol, mean dose 12 ng kg(-1) day(-1); prescription was not related to investigated factors. Patients grew well; there was no change in height standard deviation score (DeltaHtSDS=0.0). Normal BMD Z-score for age and sex can be achieved in children with CRF managed with the aim of maintaining normal PTH levels by dietary phosphate restriction, calcium-based phosphate binders and small doses of alfacalcidol. Further investigation of the underlying bone by the use of biopsy and histomorphometry is required to determine actual bone health.
骨矿物质密度（BMD）在儿童和青少年中很重要，因为它与长期骨骼健康相关，而且在慢性肾衰竭（CRF）成人患者中，低骨矿物质密度与血管钙化之间存在关联。为了研究骨矿物质密度与可能影响它的可控因素之间的关系，即血浆钙、磷和甲状旁腺激素（PTH），对64例患者进行了为期1.3（0.7 - 1.7）年的随访，平均门诊就诊5（3 - 14）次，这些患者的肾小球滤过率（GFR）中位数为31（范围7 - 60）ml·min⁻¹·1.73 m⁻²，年龄中位数为10.0（4.1 - 16.9）岁。在一次就诊时，通过双能X线吸收法测量腰椎的骨矿物质密度。平均骨矿物质密度Z值正常（=0.0）。总体钙、磷和甲状旁腺激素水平均在各自正常范围内。大多数患者（72%）接受碳酸钙治疗，平均剂量为65 mg·kg⁻¹·d⁻¹；用药与血清钙水平和钙磷乘积呈正相关（分别为P = 0.012和P < 0.01）。几乎所有患者（98%）接受阿法骨化醇治疗，平均剂量为12 ng·kg⁻¹·d⁻¹；用药与所研究因素无关。患者生长良好；身高标准差评分无变化（ΔHtSDS = 0.0）。对于慢性肾衰竭儿童，通过饮食磷限制、钙基磷结合剂和小剂量阿法骨化醇来维持正常甲状旁腺激素水平，可以实现与年龄和性别相匹配的正常骨矿物质密度Z值。需要通过活检和组织形态计量学对潜在骨骼进行进一步研究，以确定实际的骨骼健康状况。
