Wojnar Julita, Roszkowska-Blaim Maria, Pańczyk-Tomaszewska Małgorzata
Katedra i Klinika Pediatrii i Nefrologii Akademii Medycznej w Warszawie.
Przegl Lek. 2007;64(9):552-8.
Children with idiopathic nephrotic syndrome (NS) are at risk for a disorder of bone metabolism. The role of metabolites of vitamin D supplements in prevention of this disorder has not been yet clarified. The aim of the study was to evaluate changes in selected bone biochemical markers in children with NS treated with different doses of prednisone and metabolites of vitamin D.
40 patients with NS (mean age 9.2 +/- 3.6 years) treated with prednisone were evaluated in three groups depending on supplementation with metabolites of vitamin D: I--18 patients with alphacalcidol (0.05 mg/kg/week); II--10 patients with vitamin D (800 IU/day); III--12 patients without metabolites of vitamin D. In all patients, calciuria (Cau), phosphaturia (Pu), serum calcium (Cas), phosphate (Ps), parathyroid hormone (PTH), alkaline phosphatase (AP), carboxyterminal propeptide of type I procollagen (PICP), carboxyteminal pyridinoline cross-linked telopeptide of type I collagen (ICTP) and PICP/ICTP ratio were checked three times: T0--before prednisone treatment; T1--after 2 weeks of therapy with prednisone 2 mg/kg/24h; T2--after 2 weeks of treatment with prednisone 2 mg/kg/48h.
Mean Cau and Pu values found at T1 were significantly higher and mean values of Ps, AP, PICP, ICTP concentration and PICP/ICTP ratio were significantly lower in 3 groups of pts in comparison to TO. A significant increase of Cas concentration was found in group I and control group, but there were no significant differences among values of Cas in 3 groups. In T2 period PICP and PICP/ICTP ratio increased (T2 vs T1) in all groups, however mean values of AP did not change significantly. Moreover, there was an increase of Cas and decrease of PTH in group I. In group I and II, levels of phosphaturia showed a significant difference among 3 studied groups.
特发性肾病综合征（NS）患儿存在骨代谢紊乱风险。维生素D补充剂代谢产物在预防该紊乱中的作用尚未明确。本研究旨在评估不同剂量泼尼松和维生素D代谢产物治疗的NS患儿中选定骨生化标志物的变化。
40例接受泼尼松治疗的NS患儿（平均年龄9.2±3.6岁）根据维生素D代谢产物补充情况分为三组：I组——18例服用阿法骨化醇（0.05mg/kg/周）；II组——10例服用维生素D（800IU/天）；III组——12例未服用维生素D代谢产物。所有患儿均检测尿钙（Cau）、尿磷（Pu）、血清钙（Cas）、磷（Ps）、甲状旁腺激素（PTH）、碱性磷酸酶（AP）、I型前胶原羧基端前肽（PICP）、I型胶原羧基末端吡啶啉交联端肽（ICTP）及PICP/ICTP比值三次：T0——泼尼松治疗前；T1——泼尼松2mg/kg/24h治疗2周后；T2——泼尼松2mg/kg/48h治疗2周后。
与T0相比，三组患儿在T1时的平均Cau和Pu值显著升高，Ps、AP、PICP、ICTP浓度及PICP/ICTP比值的平均值显著降低。I组和对照组的Cas浓度显著升高，但三组的Cas值之间无显著差异。在T2期，所有组的PICP和PICP/ICTP比值均升高（T2 vs T1），但AP的平均值无显著变化。此外，I组的Cas升高而PTH降低。在I组和II组中，三组研究对象的尿磷水平存在显著差异。
