1,25-二羟维生素D_3治疗糖尿病肾病疗效观察
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摘要
目的:探讨1,25-二羟维生素D_3治疗糖尿病肾病(DN)的疗效。方法:将60例DN患者随机分为试验组和对照组,每组30例。2组患者均接受常规降糖治疗,对照组患者口服厄贝沙坦150～300 mg/d;试验组患者口服厄贝沙坦150～300 mg/d,联合口服阿法骨化醇0.25μg,1次/d。记录并比较2组患者治疗前、后血糖化血红蛋白、肌酐等水平。结果:治疗3个月后试验组肌酐、尿N-乙酰-β-氨基葡萄糖苷酶、尿蛋白、血转化生长因子β_1均显著低于对照组(均P<0.05)。结论:1,25-二羟维生素D_3对DN患者有肾保护作用。
Objective: To study the effects of 1,25-dihydroxyvitamin D_3 in the treatment of diabetic nephropathy(DN). Methods: Sixty patients with DN were selected and randomly divided into experimental group(EG, n=30) and control group(CG, n=30). All patients were given the routine hypoglycemic treatment. The control group was treated with irbesartan(150 to 300 mg/day). The experimental group was treated with irbesartan(150 to 300 mg/day), combined with oral administration of alfacalcidol(0.25 μg, once every day). The blood HbA1 c, serum creatinine(Scr) and other biochemical test results before and after the treatement were recorded. Results: After treatment, the Scr, NAG, UPRO and blood TGF-β_1 in the experimental group were significantly lower than those in the control group(P<0.05). Conclusion: 1,25-dihydroxyvitamin D_3 in the treatment of DN has the role to protect the kidney function.
Objective: To study the effects of 1,25-dihydroxyvitamin D_3 in the treatment of diabetic nephropathy(DN). Methods: Sixty patients with DN were selected and randomly divided into experimental group(EG, n=30) and control group(CG, n=30). All patients were given the routine hypoglycemic treatment. The control group was treated with irbesartan(150 to 300 mg/day). The experimental group was treated with irbesartan(150 to 300 mg/day), combined with oral administration of alfacalcidol(0.25 μg, once every day). The blood HbA1 c, serum creatinine(Scr) and other biochemical test results before and after the treatement were recorded. Results: After treatment, the Scr, NAG, UPRO and blood TGF-β_1 in the experimental group were significantly lower than those in the control group(P<0.05). Conclusion: 1,25-dihydroxyvitamin D_3 in the treatment of DN has the role to protect the kidney function.
引文
1 周奕菁,徐宏.1,25-二羟维生素D3联合ARB治疗早期糖尿病肾病疗效观察[J].中国中西医结合肾病杂志,2013,14(1):60-62.
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7 Wolden-Kirk H,Rondas D,Bugliani M,et al.Discovery of molecular pathways mediating 1,25-dihydroxyvitamin D3 protection against cytokine-induced inflammation and damage of human and male mouse islets of Langerhans[J].Endocrinology,2014,155(3):736-747.
8 Lee CT,Wang JY,Chou KY,et al.1,25-Dihydroxyvitamin D3 increases testosterone-induced 17beta-estradiol secretion and reverses testosterone-reduced connexin 43 in rat granulosa cells[J].Reprod Biol Endocrinol,2014,12(1):1-12.
9 龙凯.活性维生素D联合血管紧张素受体拮抗剂治疗 IgA 肾病的疗效观察[J].现代中西医结合杂志,2015,24(9):957-959.
10 Wang L,Yuan T,Du G,et al.The impact of 1,25-dihydroxyvitamin D3 on the expression of connective tissue growth factor and transforming growth factor-β1 in the myocardium of rats with diabetes[J].Diabetes Res Clin Pract,2014,104(2):226-233.
11 Verouti SN,Tsilibary EC,Fragopoulou E,et al.Vitamin D receptor activators upregulate and rescue podocalyxin expression in high glucose-treated human podocytes[J].Nephron Exp Nephrol,2012,122(1-2):36-50.
12 周晓春,陈晓.维生素D与2型糖尿病关系的研究进展[J].中国全科医学,2014,17(14):1577-1580.
13 Thrailkill KM,Fowlkes JL.The role of vitamin D in the metabolic homeostasis of diabetic bone[J].Clin Rev Bone Miner Metab,2013,11(1):28-37.
14 Mann MC,Exner DV,Hemmelgarn BR,et al.The VITAH trial VITamin D supplementation and cardiac Autonomic tone in Hemodialysis: a blinded,randomized controlled trial[J].BMC Nephrol,2014,15(1):1-9.
15 董霞,韩睿.维生素D受体基因多态与糖尿病肾病易感性研究进展[J].中华临床医师杂志(电子版),2014,8(2):327-330.
16 Larsen T,Mose FH,Bech JN,et al.Effect of paricalcitol on renin and albuminuria in non-diabetic stage III-IV chronic kidney disease: a randomized placebo-controlled trial[J].BMC Nephrol,2013,14(8):1-11.
17 雒华,刘延,贺晓莉.前列地尔联合依帕司他治疗糖尿病肾病患者临床疗效分析[J].内科急危重症杂志,2018,24(4):275-277.
18 Drechsler C,Schmiedeke B,Niemann M,et al.Potential role of vitamin D deficiency on Fabry cardiomyopathy[J].J Inherit Metab Dis,2014,37(2):289-295.
19 王力.糖尿病肾病患者微炎症状态与营养不良的相关性研究[J].内科急危重症杂志,2018,24(3):223-225. (2017-07-28收稿 2018-04-25修回)
2 Zhang X,Zhou M,Guo Y,et al.1,25-Dihydroxyvitamin D3 promotes high glucose-induced M1 macrophage switching to M2 via the VDR-PPARγ signaling pathway[J].Biomed Res Int,2015,20(1):1-14.
3 石东英,郑俊全.1,25二羟维生素D3治疗糖尿病肾病的临床研究[J].临床和实验医学杂志,2016,15(23):2341-2344.
4 Colberg SR,Sigal RJ,Fernhall B,et al.Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement executive summary[J].Diabetes Care,2010,33(12):2692-2696.
5 王静,常保超.1,25-二羟维生素D3联合厄贝沙坦治疗糖尿病肾病的临床观察[J].国际泌尿系统杂志,2014,34(1):58-60.
6 Lee B,Kwon E,Kim Y,et al.1α,25-Dihydroxyvitamin D3 upregulates HIF-1 and TREM-1 via mTOR signaling[J].Immunol Lett,2015,163(1):14-21.
7 Wolden-Kirk H,Rondas D,Bugliani M,et al.Discovery of molecular pathways mediating 1,25-dihydroxyvitamin D3 protection against cytokine-induced inflammation and damage of human and male mouse islets of Langerhans[J].Endocrinology,2014,155(3):736-747.
8 Lee CT,Wang JY,Chou KY,et al.1,25-Dihydroxyvitamin D3 increases testosterone-induced 17beta-estradiol secretion and reverses testosterone-reduced connexin 43 in rat granulosa cells[J].Reprod Biol Endocrinol,2014,12(1):1-12.
9 龙凯.活性维生素D联合血管紧张素受体拮抗剂治疗 IgA 肾病的疗效观察[J].现代中西医结合杂志,2015,24(9):957-959.
10 Wang L,Yuan T,Du G,et al.The impact of 1,25-dihydroxyvitamin D3 on the expression of connective tissue growth factor and transforming growth factor-β1 in the myocardium of rats with diabetes[J].Diabetes Res Clin Pract,2014,104(2):226-233.
11 Verouti SN,Tsilibary EC,Fragopoulou E,et al.Vitamin D receptor activators upregulate and rescue podocalyxin expression in high glucose-treated human podocytes[J].Nephron Exp Nephrol,2012,122(1-2):36-50.
12 周晓春,陈晓.维生素D与2型糖尿病关系的研究进展[J].中国全科医学,2014,17(14):1577-1580.
13 Thrailkill KM,Fowlkes JL.The role of vitamin D in the metabolic homeostasis of diabetic bone[J].Clin Rev Bone Miner Metab,2013,11(1):28-37.
14 Mann MC,Exner DV,Hemmelgarn BR,et al.The VITAH trial VITamin D supplementation and cardiac Autonomic tone in Hemodialysis: a blinded,randomized controlled trial[J].BMC Nephrol,2014,15(1):1-9.
15 董霞,韩睿.维生素D受体基因多态与糖尿病肾病易感性研究进展[J].中华临床医师杂志(电子版),2014,8(2):327-330.
16 Larsen T,Mose FH,Bech JN,et al.Effect of paricalcitol on renin and albuminuria in non-diabetic stage III-IV chronic kidney disease: a randomized placebo-controlled trial[J].BMC Nephrol,2013,14(8):1-11.
17 雒华,刘延,贺晓莉.前列地尔联合依帕司他治疗糖尿病肾病患者临床疗效分析[J].内科急危重症杂志,2018,24(4):275-277.
18 Drechsler C,Schmiedeke B,Niemann M,et al.Potential role of vitamin D deficiency on Fabry cardiomyopathy[J].J Inherit Metab Dis,2014,37(2):289-295.
19 王力.糖尿病肾病患者微炎症状态与营养不良的相关性研究[J].内科急危重症杂志,2018,24(3):223-225. (2017-07-28收稿 2018-04-25修回)