Chesney R W, Rose P, Mazess R B, DeLuca H F
Department of Pediatrics, University of California, Davis Medical Center, Sacramento 95817.
Pediatr Nephrol. 1988 Jan;2(1):22-6. doi: 10.1007/BF00870374.
Bone mineral content (BMC) was measured by photon absorptiometry in the non-dominant forearm of children with chronic renal failure followed for a total of 2472 months. From 48 children, 302 measurements were made, and changes which occurred in BMC over time were correlated with several factors. Patients were divided into those who had received glucocorticoids (group 1) and those who had not (group 2). Group 1 patients had a lower mean serum creatinine (Cr) (p less than 0.05), a lower growth velocity (p greater than 0.02) and were more demineralized than group 2 patients. There was no correlation between BMC and height velocity or estimated creatinine clearance. BMC and height Z-score (SDS) were highly correlated. Over the period of study, group 1 patients remained shorter, had a lower height velocity, a lower BMC Z-score and a lower BMC for each serum creatinine level. Long-term therapeutic intervention with oral 1,25(OH)2D improved bone mineral status in three children in the nonsteroid group, but none of those in the steroid group. This study demonstrates that steroid administration is probably the most important factor causing bone demineralization, possibly even more important than renal failure.
采用光子吸收法对慢性肾功能衰竭患儿非优势前臂的骨矿物质含量（BMC）进行了测量，随访时间共计2472个月。对48名儿童进行了302次测量，并将BMC随时间的变化与多个因素进行了关联分析。患者被分为接受糖皮质激素治疗的患者（第1组）和未接受糖皮质激素治疗的患者（第2组）。第1组患者的平均血清肌酐（Cr）较低（p<0.05），生长速度较低（p>0.02），且骨矿脱失程度比第2组患者更严重。BMC与身高增长速度或估计的肌酐清除率之间无相关性。BMC与身高Z评分（标准差分值）高度相关。在研究期间，对于每个血清肌酐水平，第1组患者的身高仍较矮，身高增长速度较低，BMC Z评分较低且BMC较低。口服1,25(OH)2D进行长期治疗干预使非类固醇组的3名儿童骨矿物质状况得到改善，但类固醇组儿童无一人改善。本研究表明，给予类固醇可能是导致骨矿脱失的最重要因素，甚至可能比肾功能衰竭更重要。
