中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2011年
2期
82-86
,共5页
王玲%袁伟杰%谷立杰%尚明花
王玲%袁偉傑%穀立傑%尚明花
왕령%원위걸%곡립걸%상명화
糖皮质激素类%肾病综合征%胰岛素样生长因子1%骨密度%骨代谢
糖皮質激素類%腎病綜閤徵%胰島素樣生長因子1%骨密度%骨代謝
당피질격소류%신병종합정%이도소양생장인자1%골밀도%골대사
Glucocorticoids%Nephrotic syndrome%Insulin-like growth factor 1%Bone density%Bone metabolism
目的 观察糖皮质激素(GC)治疗的原发性肾病综合征(PNS)患者胰岛素样生长因子1(IGF-1)变化,探讨其水平改变对PNS患者骨代谢的影响及意义.方法 以本院2008年1月至2009年8月临床资料完整的PNS患者39例为对象.口服泼尼松0.8～1.0 mg·kg-1·d-1,完全缓解2周后,以每2周减去原剂最的5%～10%的方式减量.最终每日或隔日5～10 mg维持(总疗程＞24周).测定应用激素前、治疗第4、8、12、24周末血白蛋白、24 h尿蛋白量、血清钙、磷、甲状旁腺激素(PTH)、25羟基维生素D3(25-(OH)D3)、骨钙素(BGP)、I型胶原吡啶交联C终端肽(CTx)及尿钙/肌酐;双能X线骨密度仪检测患者骨密度(BMD);酶联免疫法测定血清IGF-1水平.使用Pearson相关分析探讨IGF-1与骨代谢改变的关系.结果 36例完成随访,并具备完整临床数据.治疗第4、8、12和24周与治疗前比较,患者血钙、25-(OH)D3水平均呈时间依赖性升高(P＜0.05),相关分析提示,与尿蛋白量呈负相关(r=-0.749,r=-0.831,P＜0.05).骨形成指标血BGP、IGF-1水平呈时间依赖性降低(P＜0.05),骨吸收指标CTx逐渐升高,至第12周起差异有统计学意义(P＜0.05).第4周各部位BMD与治疗前差异均无统计学意义;第8周起腰椎(L1～L4)BMD值较治疗前显著下降(P＜0.05);第24周,股骨颈和股骨干的BMD与治疗前差异有统计学意义(P＜0.05).PNS患者经糖皮质激素治疗后,IGF-1与BMD和BGP呈正相关(r=0.495和r=0.896,均P＜0.05),与血CTx呈负相关(r=-0.697,P＜0.05).结论 糖皮质激素呈时间依赖性导致PNS患者血清IGF-1水平降低.IGF-1下降与患者早期骨形成指标降低、骨吸收指标增高及后期骨密度下降相关.IGF-1途径可能参与GC引起的PNS患者骨代谢改变.IGF-1有望成为反映或预测糖皮质激素诱导的骨质疏松的新型生化指标.
目的 觀察糖皮質激素(GC)治療的原髮性腎病綜閤徵(PNS)患者胰島素樣生長因子1(IGF-1)變化,探討其水平改變對PNS患者骨代謝的影響及意義.方法 以本院2008年1月至2009年8月臨床資料完整的PNS患者39例為對象.口服潑尼鬆0.8～1.0 mg·kg-1·d-1,完全緩解2週後,以每2週減去原劑最的5%～10%的方式減量.最終每日或隔日5～10 mg維持(總療程＞24週).測定應用激素前、治療第4、8、12、24週末血白蛋白、24 h尿蛋白量、血清鈣、燐、甲狀徬腺激素(PTH)、25羥基維生素D3(25-(OH)D3)、骨鈣素(BGP)、I型膠原吡啶交聯C終耑肽(CTx)及尿鈣/肌酐;雙能X線骨密度儀檢測患者骨密度(BMD);酶聯免疫法測定血清IGF-1水平.使用Pearson相關分析探討IGF-1與骨代謝改變的關繫.結果 36例完成隨訪,併具備完整臨床數據.治療第4、8、12和24週與治療前比較,患者血鈣、25-(OH)D3水平均呈時間依賴性升高(P＜0.05),相關分析提示,與尿蛋白量呈負相關(r=-0.749,r=-0.831,P＜0.05).骨形成指標血BGP、IGF-1水平呈時間依賴性降低(P＜0.05),骨吸收指標CTx逐漸升高,至第12週起差異有統計學意義(P＜0.05).第4週各部位BMD與治療前差異均無統計學意義;第8週起腰椎(L1～L4)BMD值較治療前顯著下降(P＜0.05);第24週,股骨頸和股骨榦的BMD與治療前差異有統計學意義(P＜0.05).PNS患者經糖皮質激素治療後,IGF-1與BMD和BGP呈正相關(r=0.495和r=0.896,均P＜0.05),與血CTx呈負相關(r=-0.697,P＜0.05).結論 糖皮質激素呈時間依賴性導緻PNS患者血清IGF-1水平降低.IGF-1下降與患者早期骨形成指標降低、骨吸收指標增高及後期骨密度下降相關.IGF-1途徑可能參與GC引起的PNS患者骨代謝改變.IGF-1有望成為反映或預測糖皮質激素誘導的骨質疏鬆的新型生化指標.
목적 관찰당피질격소(GC)치료적원발성신병종합정(PNS)환자이도소양생장인자1(IGF-1)변화,탐토기수평개변대PNS환자골대사적영향급의의.방법 이본원2008년1월지2009년8월림상자료완정적PNS환자39례위대상.구복발니송0.8～1.0 mg·kg-1·d-1,완전완해2주후,이매2주감거원제최적5%～10%적방식감량.최종매일혹격일5～10 mg유지(총료정＞24주).측정응용격소전、치료제4、8、12、24주말혈백단백、24 h뇨단백량、혈청개、린、갑상방선격소(PTH)、25간기유생소D3(25-(OH)D3)、골개소(BGP)、I형효원필정교련C종단태(CTx)급뇨개/기항;쌍능X선골밀도의검측환자골밀도(BMD);매련면역법측정혈청IGF-1수평.사용Pearson상관분석탐토IGF-1여골대사개변적관계.결과 36례완성수방,병구비완정림상수거.치료제4、8、12화24주여치료전비교,환자혈개、25-(OH)D3수평균정시간의뢰성승고(P＜0.05),상관분석제시,여뇨단백량정부상관(r=-0.749,r=-0.831,P＜0.05).골형성지표혈BGP、IGF-1수평정시간의뢰성강저(P＜0.05),골흡수지표CTx축점승고,지제12주기차이유통계학의의(P＜0.05).제4주각부위BMD여치료전차이균무통계학의의;제8주기요추(L1～L4)BMD치교치료전현저하강(P＜0.05);제24주,고골경화고골간적BMD여치료전차이유통계학의의(P＜0.05).PNS환자경당피질격소치료후,IGF-1여BMD화BGP정정상관(r=0.495화r=0.896,균P＜0.05),여혈CTx정부상관(r=-0.697,P＜0.05).결론 당피질격소정시간의뢰성도치PNS환자혈청IGF-1수평강저.IGF-1하강여환자조기골형성지표강저、골흡수지표증고급후기골밀도하강상관.IGF-1도경가능삼여GC인기적PNS환자골대사개변.IGF-1유망성위반영혹예측당피질격소유도적골질소송적신형생화지표.
Objective To observe the change of insulin-like growth factor 1 (IGF-1)before and after glucocorticoid (GC) therapy and to explore the effect of its change on bone metabolism in primary nephrotic syndrome (PNS) patients.Methods A total of 39 PNS patients with mean age of (36.73±12.15) years received GC therapy were selected from January 2008 to August 2009 in our hospital.Serum IGF-1,albumin,calcium,phosphorus,parathormone (PTH),25hydroxy vitamin D3,bone gla protein (BGP),degradation products of C-terminal telopeptides of type I collagen (CTx),24-hour urinary protein excretion and the ratio of urinary calcium to creatinine were measured at five time points-before GC therapy,4 weeks,8 weeks,12 weeks and 24 weeks after the use of GC.BMD was also detected at the same time points.Correlations among indexes were analyzed by Pearson.Results Thirty-six PNS patients fulfilled the follow-up and had complete clinical data,while other 3 patients lost.After GC treatment,serum calcium and 25hydroxy vitamin D3 were significantly increased in a time-dependent manner and were negatively correlated with 24-hour urinary protein excretion (r=-0.749,r=-0.831,P＜0.05,respectively).Serum BGP and IGF-1 were decreased after GC therapy in a time-dependent manner while CTx was significantly increased until week 12 after treatment (P＜0.05).Compared with pre-treatment,BMD of various parts had no significant difference at week 4; BMD of lumbar spine (L1-L4) was significantly decreased until week 8 (P＜0.05); BMD of femoral neck and femoral shaft was significantly decreased at week 24 (P＜0.05).IGF-1 was positively correlated with BGP and BMD (r=0.896,r=0.495,P＜0.05) and negatively correlated with serum CTx (r=-0.697,P＜0.05 ).Conclusions Serum IGF-1 level decreases in a time-dependent manner after GC treatment,which is correlated to BGP,CTx and BMD.Glucocorticoid treatment affects bone metabolism through IGF1 pathway possably in patients with PNS.IGF-1 may be used as a new bone biochemical marker of glucocoritcoid - induced osteoporosis.
