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目的 探讨长期用糖皮质激素 (glucorticoid ,GC)治疗对肾小球疾病患者骨密度 (bonemineraldensity ,BMD)的影响。方法 前瞻性对 41例肾小球疾病患者 ,应用常规剂量GC治疗 ,于治疗前及治疗后每隔 3～ 6个月 ,用双能X线吸收仪测量腰椎 (L2 -4)和股骨BMD ;PCR -RFLP法检测维生素D受体 (VDR)基因多态性。结果 用药 15个月后各部位BMD均减少 ( 2 9 9～ 83 8)mg/cm2 ,以L2 -4和股骨粗隆更明显 (P =0 0 1,P <0 0 5 ) ,两部位BMD减少与GC累计剂量 (P均 <0 0 5 )及用药时间负相关 (P <0 0 0 1和0 0 1) ;各部位BMD减少与病程负相关 (P <0 0 5 )。用药前BMD减低组 4/14例用药 15个月后发展为骨质疏松、BMD正常组中 6/2 7例发生BMD减少。用药 15个月、GC累计剂量 10克以上时 ,BMD减少和 (或 )骨质疏松的患者从用药前 1/3增至 1/2。VDR基因型 :AA、aa型以L2 -4BMD下降明显 ( P 均 <0 0 5 ) ,而Aa型以股骨颈部下降明显 ;三组用药前BMD或治疗后骨丢失率间的差别无统计学意义。结论 GC治疗后各部位BMD均减少 ,以L2 -4最突出 ,骨丢失与病程、GC累计剂量及用药时间负相关与VDR基因多态性无相关。治疗前骨密度是GC治疗后是否发生骨密度减少和 /或骨质疏松的决定性因素
Objective To investigate the effects of long-term glucorticoid (GC) treatment on bone mineral density (BMD) in patients with glomerular diseases. Methods Forty - one patients with glomerular disease were prospectively treated with conventional dose of GC. Lumbar spine (L2-4) and femur BMD were measured by dual energy X - ray absorptiometry before treatment and every 3 to 6 months after treatment. PCR-RFLP method was used to detect the gene polymorphism of vitamin D receptor (VDR). Results After 15 months of treatment, the BMD of each part decreased (299 ~ 83 8) mg / cm2, and L2 - 4 and femur trochanter were more obvious (P = 0.01 and P <0.05) (P <0 05) and the time of drug use (P 0 01 and 0 0 1). The decrease of BMD in each site was negatively correlated with the course of disease (P 0 05). BMD reduced group 4/14 medication used 15 months after the development of osteoporosis, BMD normal group 6/2 7 cases of BMD decreased. 15 months of medication, GC cumulative dose of more than 10 grams, BMD reduction and / or osteoporosis patients from the former medication 1/3 to 1/2. VDR genotype: AA, aa type L2 -4BMD decreased significantly (all P <0 05), while Aa type of femoral neck decreased significantly; three groups before treatment BMD or bone loss after treatment, no statistically significant difference significance. Conclusion After treatment with GC, the BMD of each part decreased and L2-4 was the most prominent. There was no correlation between the bone loss and the course of disease, the cumulative dose of GC and the time of treatment, and the polymorphism of VDR gene. Bone mineral density before treatment is the decisive factor for the reduction of bone mineral density and / or osteoporosis after GC treatment