文章摘要
乌日娜,王蔚,王小冬,陈华,郑春玉,肖峰,徐仲卿.社区医院应用骨化三醇联合氯沙坦治疗糖尿病肾病的疗效研究[J].中国临床保健杂志,2019,22(2):224-228.
社区医院应用骨化三醇联合氯沙坦治疗糖尿病肾病的疗效研究
Effect of calcitriol combined with losartan on patients with diabetic nephropathy in community
投稿时间:2018-12-02  
DOI:10.3969/J.issn.1672-6790.2019.02.021
中文关键词: 糖尿病肾病  25-羟维生素D2  骨化三醇
英文关键词: Diabetic nephropathies  25-Hydroxyvitamin D2  Calcitriol 〖FL
基金项目:上海市长宁区科学技术委员会科研课题(CNKW2015S01)
作者单位E-mail
乌日娜 上海市长宁区周家桥街道社区卫生服务中心,200051 zhongqing_xu@126.com 
王蔚 上海市长宁区周家桥街道社区卫生服务中心,200051 zhongqing_xu@126.com 
王小冬 上海市长宁区周家桥街道社区卫生服务中心,200051 zhongqing_xu@126.com 
陈华 上海市长宁区周家桥街道社区卫生服务中心,200051 zhongqing_xu@126.com 
郑春玉 上海市长宁区周家桥街道社区卫生服务中心,200051 zhongqing_xu@126.com 
肖峰 上海市长宁区周家桥街道社区卫生服务中心,200051 zhongqing_xu@126.com 
徐仲卿 上海市同仁医院全科医学科 zhongqing_xu@126.com 
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中文摘要:
      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0.25 μg/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。
英文摘要:
      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 stage Ⅲ-Ⅳ diabetic 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 0.25 μg/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.
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