骨化三醇治疗对糖尿病肾病维持性血液透析患者心脏结构、功能的影响  

Effect of 25(OH) D_3 on cardiac structure and function in diabetic patients with maintenance hemodialysis

作　　者：韩英[1] 龚艳晖[1] 王瑞鑫[1] 严跃红[1] 江雁琼[1] 张凤玲[1] 黄莹[2] 黄爱群[1] 张少峰 

机构地区：[1]广州医科大学第五附属医院内科,510700 [2]广州医科大学第二附属医院内科,510260 [3]广州市荔湾区第三医院内科,510000

出　　处：《疑难病杂志》2014年第11期1134-1136,共3页Chinese Journal of Difficult and Complicated Cases

基　　金：广东省医学科学技术研究基金面上项目(No.WSTJJ201112034401061970081018249)

摘　　要：目的研究骨化三醇治疗对糖尿病肾病(DN)维持性血液透析患者心脏结构和功能的影响。方法 41例DN维持性血液透析患者接受骨化三醇治疗(0.25μg口服,每天1次)共24周,观察治疗前后血清25(OH)D_3、25(OH)D_2、脑钠肽(BNP)、甲状旁腺素(iPTH)、Ca^(2+)水平、QT离散度/校正的QT离散度(QTd/QTed)、左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室后壁舒张期厚度(LVPWDT)、室间隔舒张期厚度(IVSDT)、左室射血分数(LVEF)及舒张早期和舒张晚期二尖瓣口最大血流速度之比(E/A)等的变化并对比分析。结果治疗后,血25(OH)D_3及血Ca^(2+)水平明显上升,BNP、iPTH水平明显下降,QTd及QTcd明显缩短,LVEDD、LVPWDT、LAD、IVSDT、LVEF、E/A均有明显改善(P<0.01,P<0.05);25(OH)D_3与血BNP、iPTH、QTd、QTcd、LAD、LVPWDT、IVSDT、LVEDD均呈负相关,(r=-0.39,r=-0.49,r=-0.65,r=-0.66,r=-0.48,r=-0.49,r=-0.50,r=-0.52,P<0.05,P<0.01),与LVEF及E/A呈正相关(r=0.47,r=0.46,P<0.01)。结论 25(OH)D_3治疗可改善DN维持性血液透析患者的心脏结构和功能,减轻心室肌复极不同步性及不稳定性。Objective To investigate the effect of 25（ OH） D3 in the treatment of diabetic nephropathy （ DN） with maintained hemodialysis patients ’ cardiac structure and function.Methods Forty-one patients undergoing 25 （ OH） D3 treat-ment for DN maintenance hemodialysis （.25 μg orally,once a day） for 24 weeks, observe and compare before and after treatment, serum 25 （OH） D3, 25 （OH） D2, brain natriuretic peptide （BNP）, parathyroid hormone （iPTH）,Ca2＋level, QT dispersion/corrected QT dispersion （ QTd/QTcd ） , left atrial diameter （ LAD ） , left ventricular end diastolic diameter （LVEDD）, left ventricular posterior wall thickness （LVPWDT）, diastolic ventricular septal diastolic thickness （IVSDT）, left ventricular ejection fraction （ LVEF） and diastolic early and late diastolic mitral valve maximum blood flow velocity ratio （E/A.Results After treatment, blood 25（OH）D3 and blood Ca2＋levels increased obviously increased , BNP, iPTH levels were decreased , QTd and QTcd significantly shortened , LVEDD, LVPWDT, LAD, IVSDT, LVEF, E/A were obviously im-proved （ P 〈0.01, P 〈0.05）;25 （ OH） D3 was negatively correlated with blood BNP , iPTH, QTd, QTcd, LAD, LVP-WDT, IVSDT, LVEDD（ r =-0.39, r =-0.49 r =-0.65, r =-0.66, r =-0.48, r =-0.49, r =-0.50, r =-0.52, P 〈0.05, P 〈0.01）, 25（OH）D3 was positively correlated with LVEF and E/A （ r =0.47, r =0.46, P 〈0.01.Conclusion It demonstrated that the 25 （OH） D3 could improve the cardiac structure and function of DN mainte-nance hemodialysis patients , reduce ventricular repolarization asynchrony and instability.

关 键 词：糖尿病肾病 25(OH)D3 维持性血液透析 心脏结构 心脏功能 

分 类 号：R587.2[医药卫生—内分泌]