Kruse K, Büsse M, Kracht U, Kruse U, Wohlfart K
Universitäts-Kinderklinik Würzburg.
Monatsschr Kinderheilkd. 1988 May;136(5):237-42.
The effects of glucocorticoids on calcium and bone metabolism were investigated in 11 children (aged 6 months to 13 years) who were treated with dexamethasone, prednisolone and depot-ACTH because of different disorders. Alkaline phosphatase activity and osteocalcin in serum, representing indices of osteoblastic bone synthesis, and urinary hydroxyproline in relation to creatinine in morning fasting urine specimens, an index of osteoclastic bone degradation, decreased by 53-61% from baseline (P less than 0.01), with a highly significant relationship of all 3 indices to each other. Additional influences of glucocorticoids were hyperphosphaturia due to decreased renal phosphate reabsorption not mediated by secondary hyperparathyroidism, as well as marked hypercalciuria. As the consequence of the present study the following prophylactic or therapeutic recommendations are given during steroid-treatment: 1. Approvement of the negative balance of calcium and phosphate by correcting the hypercalciuria with hydrochlorothiazide, and the hypophosphatemia with oral phosphate and 2. in elder children with osteoporosis, stimulation of the decreased osteoblastic bone formation by sodium fluoride.
对11名因不同疾病接受地塞米松、泼尼松龙和长效促肾上腺皮质激素治疗的儿童（年龄在6个月至13岁之间）进行了糖皮质激素对钙和骨代谢影响的研究。血清碱性磷酸酶活性和骨钙素代表成骨细胞骨合成指标，晨尿标本中尿羟脯氨酸与肌酐的比值代表破骨细胞骨降解指标，与基线相比下降了53%至61%（P<0.01），这3项指标之间存在高度显著的相关性。糖皮质激素的其他影响包括因肾磷酸盐重吸收减少导致的高磷尿症（并非由继发性甲状旁腺功能亢进介导）以及明显的高钙尿症。作为本研究的结果，在类固醇治疗期间给出以下预防或治疗建议：1. 通过用氢氯噻嗪纠正高钙尿症以及用口服磷酸盐纠正低磷血症来改善钙和磷酸盐的负平衡；2. 对于患有骨质疏松症的大龄儿童，用氟化钠刺激减少的成骨细胞骨形成。
