| Objective(1)To investigate the effects of calcium and alfacidol on bone mineral density and bone turnover markers in patients with glomerulonephritis who receive glucocorticoid treatment for the first time.(2)To investigate the the effect of long-term glucocorticoid on bone mineral density(BMD)and bone turnover makers(BTMs) in patients with glomerular disease.Patients and methods 1.patients We choose 30 patients with glomerular diseases,who first hospitalized in our department and accepted systematic glucocorticoid treatment for the first time,choose 97 cases of patients with immune glomerular disease out-patient department from February 2013 to April 2014 with long-term application of glucocorticoid treatment,and set up 20 cases of medical technician as the control group. 2.Methods(1) 30 patients with glomerulonephritis were randomly divided into two groups: group A(n=15) treated with alfacidol 0.25μg/d plus calcium 300 mg bid and vitamin D 100 IU bid,and group B(n=15)treated with calcium 300 mg bid and vitamin D 100 IU bid.The bone mineral density(BMD)at the lumbar spine,femoral neck and femoral triangle was measured by Dual-energy X-ray Absorptiometry(DXA),and the serum levels of PINP,CTX-I,calcium,phosphorus,albumin were examined before and 3~4,6~7months after the treatment.(2) 97 patients with glomerular diseases treated with long-term application of GC according to the GC used time is divided into group C(3 months or less,9 cases), group D(3 ~ 6 months or less,10 cases), group E(6 ~ 9 months or less,22 cases), group F(9 ~ 12 months or less,11 cases), group G(> 12 months,45 cases), we used Dual-energy X-ray Absorptiometry(DXA) to measure the bone mineral density of lumbar spine(L1~L4), femoral neck and triangle of the 97 patients treated with glucocorticoid and 20 patients in the control group. In addition, ELISA test was applied to measure their concentrations of bone turnover makers including serum PINP and CTX- I.Results(1)At 3~4 months after the treatment,the values of BMD at the lumbar Spine in group B was significantly different from those before the treatment(P<0.05),the serum levels of PINP was significantly different from those before the treatment(P<0.05),while the serum levels of CTX-I was not in the two groups(P>0.05);(2)At 6~7months after the treatment,the values of BMD of all parts and the serum levels of PINP in group A and B were significantly lower compared with those before the treatment(P<0.05),and the serum levels of CTX-I was lower compared with those before the treatment only in group A(P<0.05);(3)Compared with those of the control group, the BMD of lumbar spine(L1~L4), femoral neck and femoral triangle in group D,group E,group F and group G(P<0.05) were lower significantly;While the BMD of lumbar spine L1 and L4,femoral neck and femoral triangle in group A were not(P>0.05).(4)Compared with those of group C,group D and group E,the BMD of lumbar spine(L1~L4) and femoral neck in group F were lower significantly(P<0.05);Compared with those of group F,the BMD of lumbar spine(L1~L4) in group G were not differentfrom it(P>0.05);The incidence of bone abnormalities in patients taking vitamin D and calcium was lower than others(P < 0.05).(5)Compared with those of the control group, the concentrations of PINP in groups(except group D)were lower significantly(P < 0.05), while the concentration of CTX- I was higher(P < 0.05).(6)Multiple linear regression analysis or Pearson correlation analysis indicated that the BMD of lumbar spine andproximal femur were negatively correlated with the time of GC applied(P < 0.05),the concentrations of PINP was negatively correlated with the cumulative doses of GC and the concentrations of CTX-I(P < 0.05),while the concentrations of CTX-I was positively correlated with the cumulative doses of GC(P < 0.05).Conclusions(1)Treatment of alfacidol 0.25μg/d plus clicium could help maintain the BMD in a period of time,but can not prevent bone loss in the patients with glomerulonephritis for a long time,and could resist bone resorption, but couldn,t resist bone formation caused by GC;(2) These results indicate that long-term glucocorticoid treatment of the patients with glomerular diseases can lead to bone mass reduction or osteoporosis,the serum level of bone formation marker was lower,while the serum level of bone resorption marker was higher,it can be helpful for early prevention and treatment of glucocorticoid osteoporosis with the test of bone mineral density and bone turnover makers. |
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