骨化三醇治疗维生素D不足高血压伴肾损害患者的临床观察  

Clinical observation of Calcitriol treating hypertensive nephropathy with vitamin D deficiency

作　　者：黎妮[1] 邹卫 陈文莉[1] 贾琳[1] 黄巧[1] 甘文渊 李永霞[1] 谢立寒[1] 

机构地区：[1]武汉市中心医院肾内科,430014 [2]武汉医药卫生学会联合办公室,武汉430014

出　　处：《临床肾脏病杂志》2016年第1期22-25,共4页Journal Of Clinical Nephrology

摘　　要：目的探讨骨化三醇对维生素D不足的高血压伴肾损害患者的临床疗效。方法.将25-羟维生素D_3[25-hydroxyvitamin D_3,25(OH)D_3]不足的高血压伴肾损害患者65例,采用随机数字表法分为2组,对照组32例,给予常规规范化治疗控制血压;观察组33例,在对照组控制血压治疗基础上给予骨化三醇胶囊0.25μg/次,每晚口服1次,连续应用12周。观察2组患者治疗前后血压、血25(OH)D_3、血钙、血磷、血全段甲状旁腺素(intact parathyroid hormone,iPTH)、血清胱抑素C(cystatin C,Cys C)、晨尿微量白蛋白(urine microalbumin,mAlb)及尿β2微球蛋白(urine beta 2 microdobulin,β2-MG)水平。结果对照组治疗前后,其收缩压、舒张压、血钙、血磷、25(OH)D_3及血iPTH均无明显改变(P>0.05)。观察组治疗前与对照组治疗前相比,2组相关指标均无统计学差异(P>0.05);观察组给予骨化三醇治疗后第12周,血25(OH)D_3水平较治疗前明显升高(P<0.05),血钙水平升高(P<0.05),血iPTH水平下降(P<0.05),但均在正常范围内;2组治疗前后收缩压、舒张压及血磷水平无明显变化(.P>0.05)。对照组治疗前后,血清CysC、尿mAlb及β2-MG均呈下降趋势,但差异无统计学意义(P>0.05)。观察组治疗前与对照组治疗前相比,2组相关指标均无统计学差异(P>0.05),但观察组给予骨化三醇治疗后第12周时,血清CysC、尿mAlb及β2-MG明显下降,差异有统计学意义(P<0.01),其下降水平分别为9.4%、18.8%、38.0%。结论骨化三醇能减轻维生素D不足的高血压伴肾损害患者的尿mAlb、β2-MG及血清Cys C水平。Objective To study the therapeutic effect of caleitriol treating hypertensive nephrop- athy with vitamin D deficiency. Methods Totally 65 cases of hypertensive nephropathy complicated with microalbuminuria and vitamin D deficiency were randomly divided into control group （32 cases） and observation group （33 cases）. The control group was given conventional standardized treatment to control blood pressure, and the observation group was given oral administration of ealeitriol capsules （0. 25μg, once a night） for totally 12 weeks besides blood pressure control therapy. The levels of blood pressure, serum 25-hydroxyvitamin D3, calcium, phosphorus, serum intact parathyroid hormone, serum cystatin C, first morning urine microalbumin and urine beta-2 mierodohulin were com- pared between these two groups before and after treatment. Results There was no significant difference in the clinic characteristics before treatment between two groups （P〉0. 05）. There was no sig- nificant difference in the phosphorus, and systolic and diastolic blood pressure before and after treat- ment in these two groups （P〉0.05）. As compared with the control group and those before treatment, the levels of serum 25-hydroxyvitamin D3, and calcium were higher, and serum intact parathyroid hormone was lower after treatment in observation group （P〈0. 05）, however, these values were within the normal range. The levels of serum cystatin C, urine microalbumin and urine beta-2 microdobulin were decreased significantly after treatment in observation group （P〈0. 01）. Conclusions Calcitriol can reduce the levels of serum cystatin C, urine microalbumin and urine beta-2 microdohulin in the hypertensive nephropathy patients with vitamin D deficiency.

关 键 词：高血压肾病 25-羟维生素D3 骨化三醇 微量白蛋白 血清胱抑素C 

分 类 号：R544.1[医药卫生—心血管疾病] R692[医药卫生—内科学]