1α-羟基维生素D3对伴蛋白尿的IgA肾病患者肾小管功能的影响  

Effect of 1α-hydroxyvitamin D3 on renal tubular function in patients with IgA nephropathy accompanied with proteinuria

作　　者：刘兰香[1] 李六生[1] 林其玲[1] 闫志群[1] 

机构地区：[1]三峡大学人民医院/湖北省宜昌市第一人民医院肾内科,443000

出　　处：《重庆医学》2017年第17期2369-2371,共3页Chongqing medicine

基　　金：湖北省宜昌市科技研究与开发项目(A15301-20)

摘　　要：目的观察1α-羟基维生素D3对伴蛋白尿的IgA肾病(IgAN)患者肾小管功能的影响。方法选择符合条件的48例IgAN患者设为IgAN组,再按数字表法随机分为对照组和治疗组,同时选取同一时期健康体检人群30例为正常组。治疗组在维持原有双倍剂量肾素血管紧张素系统(RAS)阻断剂不变等常规治疗的基础上,口服1α-羟基维生素D3胶丸0.5μg,1次/天;对照组继续采用原治疗方案,疗程均为12周。12周后比较两组患者治疗前后尿胱抑素C(Cys-C)、尿α1微球蛋白(α1-MG)和尿N-乙酰-β-D氨基葡萄糖苷酶(NAG)、24h尿蛋白定量(UTP)、血尿素氮(BUN)、血肌酐(Scr)、血钙(Ca)、血磷(P)及血全段甲状旁腺激素(iPTH)水平的变化。结果与正常组比较,IgAN组尿Cys-C、α1-MG和NAG水平均明显升高(P<0.01)。经过12周治疗,治疗组尿Cys-C、α1-MG和NAG水平较治疗前及对照组均有明显下降,差异均有统计学意义(P<0.05),两组治疗后UTP与本组治疗前比较差异有统计学意义(P<0.05),治疗组较对照组下降更显著(P<0.05)。两组患者治疗前后BUN、Scr、Ca、P、iPTH比较差异均无统计学意义(P>0.05)。结论伴蛋白尿的IgAN存在肾小管间质损伤,1α-羟基维生素D3能显著降低IgAN患者蛋白尿、改善肾小管功能。Objective To observe the effects of α1-hydroxyvitamin D3 on renal tubular function in the patients with IgA nephropathy（IgAN） accompanied with proteinuria. Methods Forty-eight eligible patients with IgAN were selected as the IgAN group and divided into the treatment group and control group according to the random number table method, meanwhile 30 healthy adults undergoing healthy physical examination were selected as the normal group. On the routine treatment such as maintaining the double dose of renin-angiotensin system（RAS） blocker, the treatment group took oral l a-hydroxyvitamin D3 capsule （0.5 μg,once a day）;the control group continued to adopt the original treatment scheme. The treatment course lasted for 12 weeks. The changes of urinary cystatin C（Cys-C）, α1-microglobulin（α1-MG）, N-acetyl-β-D-glucosaminidase （NAG）, 24 h urinary total protein （UTP）, blood urea nitrogen（BUN）, serum creatinine （Scr）, serum calcium（Ca）, serum phosphorus （P） and intact parathyroid hormone （iPTH） in two groups were respectively compared between before and after treatment. Results Compared with the normal group, urinary Cys-C,α1-MG and NAG levels in the IgAN group were significantly increased （P^0.01）. After 12-week treatment, the levels of Cys-C, α1-MG and NAG were obviously declined compared with that before treatment and in the control group, the differ- ences were statistically significant （P〈0.05）, meanwhile the UTP level had statistical difference between the two groups after treatment and between before and after treatment in the same group （P〈0.05） ,hut the decrease in the treatment group was more significant than that in the control group（P〈0.05）. There was no statistically significant difference in BUN, Scr,Ca,P and iPTH between the two groups before and after treatment（P〉0.05）. Conclusion There exists tubulointerstitial injury in IgAN with pro- teinuria, 1α-hydroxyvitamin D3 can significantly decrease urine protein and improves the ren

关 键 词：1α-羟基维生素D3 IGA肾病 肾小管功能 蛋白尿 

分 类 号：R692.31[医药卫生—泌尿科学]