儿童肾性骨营养不良。1,25 - 二羟胆钙化醇治疗（作者译）

[Renal osteodystrophy in children. Therapy with 1,25-dihydroxy-cholechalciferol (author's transl)].

作者信息

Bulla M, Delling G, Benz-Bohm G, Stock G J, Sánchez de Reutter A, Ziegler R, Lühmann H, Severin M, Kalbitzer E, Manegold C

出版信息

Klin Wochenschr. 1980 May 16;58(10):511-9. doi: 10.1007/BF01477068.

DOI:10.1007/BF01477068

PMID:7392529

Abstract

Growth arrest and renal osteodystrophy are major problems in renal insufficiency of children. The present report describes our experiences in managing renal osteodystrophy in 14 dialyzed children using 1,25-DHCC for 12 months. Values in plasma of Ca, P, Mg, alkaline phosphatase, iPTH, 25-OH-D, and 1,25-DHCC were determined regulary. Skeletal X-rays and analysis of iliac crest biopsies were obtained in each child. In treatment with 1,25-DHCC episodes of severe but reversible hypercalcemia occurred. Alkaline phosphatase and iPTH normalized completely. Radiographic examinations revealed marked improvement. Histological signs of fibro-osteoclasia and resorptive defects disappeared but there was no recovery of osteomalacia. A reduction of osteoblast population and of bone transformation was obvious. 1,25-DHCC failed to normalize growth in uremic children. In short, neither vitamin D nor 1,25-DHCC can guarantee complete recovery of renal osteodystrophy and growth arrest in uremic children.

摘要

生长停滞和肾性骨营养不良是儿童肾功能不全的主要问题。本报告描述了我们使用1,25 - 二羟胆钙化醇对14名接受透析的儿童进行肾性骨营养不良治疗12个月的经验。定期测定血浆中钙、磷、镁、碱性磷酸酶、甲状旁腺激素、25 - 羟维生素D和1,25 - 二羟胆钙化醇的值。对每个儿童进行骨骼X线检查和髂嵴活检分析。在使用1,25 - 二羟胆钙化醇治疗期间发生了严重但可逆的高钙血症。碱性磷酸酶和甲状旁腺激素完全恢复正常。影像学检查显示有明显改善。纤维性骨炎和吸收缺陷的组织学征象消失，但骨软化症未恢复。成骨细胞数量和骨转换明显减少。1,25 - 二羟胆钙化醇未能使尿毒症儿童的生长恢复正常。简而言之，无论是维生素D还是1,25 - 二羟胆钙化醇都不能保证尿毒症儿童的肾性骨营养不良和生长停滞完全恢复。