目的：观察锌、维生素D、钙联用对婴幼儿佝偻病的疗效及对生化指标的影响。方法：选择80例符合入组标准的婴幼儿佝偻病患儿作为观察对象,按随机数字表法分为观察组和对照组各40例。对照组患儿给予维生素D、钙剂联合治疗,维生素D3肌肉注...目的：观察锌、维生素D、钙联用对婴幼儿佝偻病的疗效及对生化指标的影响。方法：选择80例符合入组标准的婴幼儿佝偻病患儿作为观察对象,按随机数字表法分为观察组和对照组各40例。对照组患儿给予维生素D、钙剂联合治疗,维生素D3肌肉注射30万IU,4周后改为口服维生素AD滴剂1粒/次,qd,维持用药8周,氨基酸螫合钙每次半粒,每日1次,12周为1个疗程;观察组患儿在对照组治疗基础上给予葡萄糖酸锌口服液每天10~20 m L口服,连用12周。观察两组患儿治疗前后症状、体征改善情况,进行X线检查及血液生化检查,包括血锌、血钙、骨碱性磷酸酶（NBAP）、血清25-羟基维生素D3[25-（OH）D3]水平,采用单光子吸收计测定桡骨、尺骨的骨密度,比较两组临床疗效。结果：观察组症状消失和好转率、体征好转率、左手X线片好转率明显高于对照组（χ2分别为12.75、11.67、11.67,P均〈0.01）;观察组和对照组治疗后血钙、25-（OH）D3水平较治疗前明显升高（t分别为6.73、25.66和5.81、20.43,P均〈0.01）,NBAP水平较治疗前明显降低（t分别为8.61、6.24,P均〈0.01）,观察组治疗后血锌水平较治疗前明显升高（t=13.76,P〈0.01）;观察组治疗后血锌、血钙、25-（OH）D3水平明显高于对照组（t分别为6.22、3.63、9.71,P均〈0.05）,NBAP水平明显低于对照组（t=3.74,P〈0.05）;观察组和对照组治疗后桡骨骨密度、尺骨骨密度均明显高于治疗前（t分别为3.76、3.84和3.34、3.26,P均〈0.05）,且观察组治疗后桡骨骨密度、尺骨骨密度明显高于对照组（t分别为3.36、3.62,P均〈0.05）;观察组临床总有效率为92.5%,对照组为72.5%,两组比较差异有统计学意义（χ2=9.589,P〈0.01）。结论：锌、维生素D、钙联用是治疗婴幼儿佝偻病安全、可靠的方法,能相互协同促进儿童佝偻病的康复,值得临床推广应用。展开更多
Background Hypophosphatemic rickets/osteomalacia is a group of diseases characterised by defective mineralization of bone due to hypophosphatemia and low 1,25-dihydroxy vitamin D. To explore the role of fibroblast gro...Background Hypophosphatemic rickets/osteomalacia is a group of diseases characterised by defective mineralization of bone due to hypophosphatemia and low 1,25-dihydroxy vitamin D. To explore the role of fibroblast growth factor 23 （FGF-23） in the regulation of phosphate homeostasis, we measured the circulating concentrations of this growth factor in healthy individuals and in patients with hypophosphatemic rickets/osteomalacia. Methods Nineteen patients with hypophosphatemic rickets/osteomalacia were included in hypophosphatemic group （HP, 12 female and 7 male, mean age was 30 years）, and 19 healthy age-matched individuals served as the control group. Full length FGF-23 fragments were measured by two-site enzyme-linked immunosorbent assay.Results Mean FGF-23 concentrations were significantly higher in the HP group （（87.4±43.6） pg/ml） compared with the control group （（19.2±6.16） pg/ml; P 〈0.001）. In 1 patient with tumour-induced osteomalacia, serum FGF-23 concentrations were 84.1 pg/ml; these concentrations were normalized 2 hours after a hemangiopericytoma resection （7.8 pg/ml）. Subsequently, serum 1,25（OH）2 vitamin D3 concentrations significantly increased from 21.3 pg/ml to 89.3 pg/ml, and serum phosphorus levels were normalized. Conclusions Serum FGF-23 concentrations were markedly elevated in patients with hypophosphatemic rickets. FGF-23 plays an important role in the pathogenesis of hypophosphatemic rickets/osteomalacia.展开更多
文摘目的：观察锌、维生素D、钙联用对婴幼儿佝偻病的疗效及对生化指标的影响。方法：选择80例符合入组标准的婴幼儿佝偻病患儿作为观察对象,按随机数字表法分为观察组和对照组各40例。对照组患儿给予维生素D、钙剂联合治疗,维生素D3肌肉注射30万IU,4周后改为口服维生素AD滴剂1粒/次,qd,维持用药8周,氨基酸螫合钙每次半粒,每日1次,12周为1个疗程;观察组患儿在对照组治疗基础上给予葡萄糖酸锌口服液每天10~20 m L口服,连用12周。观察两组患儿治疗前后症状、体征改善情况,进行X线检查及血液生化检查,包括血锌、血钙、骨碱性磷酸酶（NBAP）、血清25-羟基维生素D3[25-（OH）D3]水平,采用单光子吸收计测定桡骨、尺骨的骨密度,比较两组临床疗效。结果：观察组症状消失和好转率、体征好转率、左手X线片好转率明显高于对照组（χ2分别为12.75、11.67、11.67,P均〈0.01）;观察组和对照组治疗后血钙、25-（OH）D3水平较治疗前明显升高（t分别为6.73、25.66和5.81、20.43,P均〈0.01）,NBAP水平较治疗前明显降低（t分别为8.61、6.24,P均〈0.01）,观察组治疗后血锌水平较治疗前明显升高（t=13.76,P〈0.01）;观察组治疗后血锌、血钙、25-（OH）D3水平明显高于对照组（t分别为6.22、3.63、9.71,P均〈0.05）,NBAP水平明显低于对照组（t=3.74,P〈0.05）;观察组和对照组治疗后桡骨骨密度、尺骨骨密度均明显高于治疗前（t分别为3.76、3.84和3.34、3.26,P均〈0.05）,且观察组治疗后桡骨骨密度、尺骨骨密度明显高于对照组（t分别为3.36、3.62,P均〈0.05）;观察组临床总有效率为92.5%,对照组为72.5%,两组比较差异有统计学意义（χ2=9.589,P〈0.01）。结论：锌、维生素D、钙联用是治疗婴幼儿佝偻病安全、可靠的方法,能相互协同促进儿童佝偻病的康复,值得临床推广应用。
基金This study was supported by National Natural Science Foundation of China （NSFC） （No. 30370781） and Doctoral Fund of Ministry of Education of China （No. 20040023055） The authors state that there are no conflicts of interest in this study.
文摘Background Hypophosphatemic rickets/osteomalacia is a group of diseases characterised by defective mineralization of bone due to hypophosphatemia and low 1,25-dihydroxy vitamin D. To explore the role of fibroblast growth factor 23 （FGF-23） in the regulation of phosphate homeostasis, we measured the circulating concentrations of this growth factor in healthy individuals and in patients with hypophosphatemic rickets/osteomalacia. Methods Nineteen patients with hypophosphatemic rickets/osteomalacia were included in hypophosphatemic group （HP, 12 female and 7 male, mean age was 30 years）, and 19 healthy age-matched individuals served as the control group. Full length FGF-23 fragments were measured by two-site enzyme-linked immunosorbent assay.Results Mean FGF-23 concentrations were significantly higher in the HP group （（87.4±43.6） pg/ml） compared with the control group （（19.2±6.16） pg/ml; P 〈0.001）. In 1 patient with tumour-induced osteomalacia, serum FGF-23 concentrations were 84.1 pg/ml; these concentrations were normalized 2 hours after a hemangiopericytoma resection （7.8 pg/ml）. Subsequently, serum 1,25（OH）2 vitamin D3 concentrations significantly increased from 21.3 pg/ml to 89.3 pg/ml, and serum phosphorus levels were normalized. Conclusions Serum FGF-23 concentrations were markedly elevated in patients with hypophosphatemic rickets. FGF-23 plays an important role in the pathogenesis of hypophosphatemic rickets/osteomalacia.
