| ObjectiveThis study was aimed to observe the effect of steroids on bone mineralization in serious primary nephrotic syndrome(PNS) of early phase. To explore the early specific changes of the serum levels of bone-specific alkaline phosphatase(BALP), tartrate-resistant acid phospha-tase(TRAP) and 25-hydroxy vitamin D[25(OH)D] in serious PNS. Aimed at these biochemical indices can be found in an early, sensitive to reflect changes in bone metabolism in patients with serious PNS and provide a basis for clinical applications. Methods Subjects: PNS selected patients with severe episode 2012.12- 2014.01 second hospital of anhui medical university, 35 patients admitted to hospital as the experimental group. Another medical center in our hospital 30 cases of healthy people as a control group. Experimental research objects are the attacks did not accept any immune inhibitors and calcium, and severe PNS diagnosis standard, and with the exception of secondary kidney disease, such as purpura nephropathy, diabetic nephropathy, such as multiple myeloma. Control all the object of study is a normal healthy people. Methods: The experimental group according to the GC treatment time, divided into before and after treatment 1, 2, 4 weeks, respectively in different stages of the extraction in patients with early in the morning on an empty stomach blood test plasma albumin, glucose, cholesterol, calcium and phosphorus, creatinine, urea nitrogen, uric acid, carbon dioxide combining power, and to return the 24 h urine testing protein content. Another morning fasting venous blood 3 ml, centrifugal separation after serum on- 80 ℃ refrigerator, after the unified method of enzyme-linked immunosorbent(ELISA) were used to detect serum BALP, TRAP and 25(OH) D concentration. Control group take the morning fasting venous blood two tube, with the method to detect the target. Statistical methods: Data analysis using SPSS 16.0 software, the indicators concentration using x ± s, said two groups were compared using the t test, multiple sets of comparison between the single factor analysis of variance, sex ratio using c2 test. Results 1. Biochemical examination of all subjects in the control group were completely normal, and groups age, sex ratio was no significant difference(P> 0.05), comparable. 2. The serious PNS patients revealed a significantly higher serum calcium(Ca), phosphate(P), BALP and TRAP levels(P<0.05) and a significantly lower serum 25(OH)D levels(P<0.01) that at the before treatment than controls. 3. At the 4th week of treatment, mean value of 24-hour proteinuria(24 hPRU) was significantly lower(P<0.01) and mean serum albumin(ALB) levels were significantly increased(P<0.01) in comparison to the beginning of therapy. Mean serum total cholesterol(CHO), blood uric acid(BUA), P and Ca levels were found to be significantly lower than those at the beginning of the therapy(P<0.05). Mean serum glucose(GLU), triglyceride(TG), creatinine(CREA), urea nitrogen(BUN) and carbon dioxide combining power(TCO2) were no statistically significant between the beginning of treatment and the posttreatment. 4. Mean serum BALP and TRAP levels were significantly increased in comparison to the beginning of therapy(P<0.01). The expression levels of 25(OH)D was no statistically significant between the beginning of treatment and the posttreatment.Conclusion 1. Bone formation and resorption were abnormal in patients with serious PNS of before treatment. And routine use of GC treatment, early that adversely effect on bone metabolism, further aggravating the bone metabolism. 2. Serum BALP and TRAP are respectively reflect bone formation and bone resorption sensitive and specific indicators to monitor changes in serum levels of bone metabolism can reflect changes in early, so as to achieve early detection, early diagnosis and treatment, so as to achieve early discovery, early diagnosis and treatment, improve the quality of life in severe patients with PNS. |
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