摘要
目的观察口服补充维生素D类药物能否进一步降低糖尿病肾病患者尿蛋白,减缓肾功能的恶化,改善糖代谢。方法选取本社区2型糖尿病、Ⅲ-Ⅳ期糖尿病肾病(CKD 1-3期)患者84例,将患者按随机数字表法分为观察组和对照组,两组在常规治疗基础上,对照组给予氯沙坦100 mg/d,观察组给予骨化三醇0. 25μg/d+氯沙坦100 mg/d,干预12个月,比较两组治疗后6个月、12个月时的疗效。结果治疗12个月后,观察组与对照组相比,血磷下降(P=0. 019);与入组前比较,观察组舒张压、血清胱抑素C、血磷、尿微量清蛋白/尿肌酐下降(P=0. 041、P <0. 001、P=0. 007、P=0. 008),血清25(OH) D升高(P=0. 037);与入组前比较,对照组血清25-(OH) D升高(P <0. 001),血清胱抑素C下降(P <0. 001)。血清25-(OH) D与FIns呈正相关(r=0. 26,P <0. 001),与空腹血糖、糖化血红蛋白、三酰甘油、低密度脂蛋白胆固醇、血磷呈负相关(r=-0. 30、-0. 29、-0. 34、-0. 26、-0. 22,P <0. 001。结论小剂量骨化三醇联合氯沙坦能够升高血清25-(OH) D浓度、改善糖尿病肾病患者钙磷代谢,并对肾脏提供一定的保护。
Objective To study and observe whether oral vitamin D supplements can further reduce urine protein excretion of diabetic nephropathy patients,slow down the deterioration of renal function and improve sugar metabolism.Methods A total of 84 patients with type 2 diabetes and stageⅢ-Ⅳdiabetic nephropathy(CKD 1-3)were selected and divided into observation group and control group in random.On the basis of routine treatment,the control group were given losartan 100 mg/d,the observation group were given calcitriol 0.25μg/d+losartan 100 mg/d,and intervention was carried out for 12 months.The efficacy of the two groups at 6 months and 12 months after treatment were compared.Results After 12 months of treatment,blood phosphorus decreased in the observation group compared with the control group,(P=0.019).After the treatment,diastolic blood pressure,serum cystatin C,blood phosphorus,urine albumin/creatinine decreased(P=0.041,P<0.001,P=0.007,P=0.008),serum 25-hydroxyvitamin D increased(P=0.037)in the observation group.After the treatment,the serum 25-hydroxyvitamin D increased(P<0.001)and the serum cystatin C decreased(P<0.001)in the control group.Serum 25(OH)D was positively correlated with FIns(r=0.26,P<0.001),and negatively correlated with FPG,HbA1c,TG,LDL-C,P(r=-0.30,-0.29,-0.34,-0.26,-0.22,P<0.001).Conclusion Low dose calcitriol combined with losartan can increase serum 25-hydroxyvitamin D concentration,regulate calcium and phosphorus metabolism and provide some reno-protenction for patients with DKD.
作者
乌日娜
王蔚
王小冬
陈华
郑春玉
肖峰
徐仲卿
Wurina;Wang Wei;Wang Xiaodong;Chen Hua;Zheng Chunyu;Xiao Feng;Xu Zhongqing(Zhoujiaqiao Community Health Service Center of Changning District,Shanghai 200051,China)
出处
《中国临床保健杂志》
CAS
2019年第2期224-228,共5页
Chinese Journal of Clinical Healthcare
基金
上海市长宁区科学技术委员会科研课题(CNKW2015S01)
