维生素D在膜性肾病患者中的水平及与蛋白尿的相关性  

Level of Vitamin D in patients with membranous nephropathy and the correlation with proteinuria

作　　者：许静[1] 牛文明[1] 聂丽敏 刘娜[1] Xu Jing;Niu Wenming;Nie Limin;Liu Na(Department of Nephrology,the First Hospital of Shijiazhuang,Shijiazhuang 050000,China)

机构地区：[1]河北省石家庄市第一医院肾内科,050000

出　　处：《中国综合临床》2019年第6期485-489,共5页Clinical Medicine of China

基　　金：河北省医学科学研究重点课题(ZL20140270)。

摘　　要：目的探讨维生素D在膜性肾病患者中的水平及其与蛋白尿的相关性。方法选取2012年5月至2017年5月石家庄市第一医院肾内科收治的膜性肾病患者80例,应用随机数字表分为两组,每组40例。对照组单纯给予醋酸泼尼龙口服治疗,研究组给予醋酸泼尼龙及活性维生素D口服治疗。对所有患者随诊1年,每个月对患者血尿素氮(BUN)、血清肌酐(SCr)、C反应蛋白(CRP)、胆固醇(TC)、甘油三酯(TG)、钙(Ca)、磷(P)、甲状旁腺激素(PTH)、尿蛋白、1,25-二羟维生素D3[1,25(OH)2D3]、转化生长因子β(TGF-β1)等相关生化指标进行记录分析。结果治疗前对照组患者1,25(OH)2D3水平为(3.67±3.67)μg/L,研究组患者为(3.69±3.70)μg/L,差异无统计学意义(t=1.259,P>0.05);治疗1年后,对照组患者1,25(OH)2D3水平为(4.87±2.92)μg/L,研究组患者为(19.58±12.12)μg/L,研究组明显高于对照组,差异有统计学意义(t=12.384,P<0.05)。血清1,25(OH)2D3水平跟血钙、血浆白蛋白、足细胞、TGF-β1呈正相关(r值分别为0.301、0.387、0.342、0.181,P<0.05);血清1,25(OH)2D3与患者体内的血磷含量、总胆固醇、24 h尿蛋白定量呈负相关(r值分别为-0.265、-0.033、-0.265,P<0.05)。血浆白蛋白是血清1,25(OH)2D3水平的独立影响因素(P<0.05)。结论膜性肾病患者体内血浆白蛋白是影响1,25(OH)2D3的独立危险因素,维生素D与蛋白尿水平呈负相关,活性维生素D治疗膜性肾病患者蛋白尿效果较好。Objective To investigate the level of vitamin D in patients with membranous nephropathy and its correlation with proteinuria.Methods Eighty patients with membranous nephropathy were selected from May 2012 to May 2017 in the Department of Nephrology,Shijiazhuang First Hospital.They were divided into two groups with 40 cases in each group.The control group was given prednisolone acetate orally,while the study group was given prednisolone acetate and active vitamin D orally.All patients were followed up for 1 year.Blood urea nitrogen(BUN),serum creatinine(Scr),C-reactive protein(CRP),cholesterol(TC),triglyceride(TG),calcium(Ca),phosphorus(P),parathyroid hormone(PTH),urinary protein,1,25-dihydroxyvitamin D3(1,25(OH)2D3)and transforming growth factor-beta(TG)were measured monthly.F-beta 1)and other related biochemical indicators were recorded.Results Before treatment,the level of 1,25(OH)2D3 in the control group was(3.67+3.67)μg/L,while that in the study group was(3.69+3.70)μg/L.There was no significant difference(t=1.259,P>0.05).One year after treatment,the level of 1,25(OH)2D3 in the control group was(4.87+2.92)μg/L,while that in the study group was(19.58+12.12)μg/L,which was significantly higher in the study group than in the control group(t=12.384,P<0.05).Serum 1,25(OH)2D3 levels were positively correlated with blood calcium,plasma albumin,podocyte and TGF-β1(r=0.301,0.387,0.342 and 0.181,respectively,P<0.05);serum 1,25(OH)2D3 levels were negatively correlated with blood phosphorus content,total cholesterol and 24 h urinary protein quantity(r value was-0.265,-0.033 and-0.265,respectively,P<0.05).Serum albumin was an independent factor of serum 1,25(OH)2D3(P<0.05).Conclusion The serum albumin is an independent risk factor for 1,25(OH)2D3 in patients with membranous nephropathy.Vitamin D is negatively correlated with proteinuria.Active vitamin D has a better effect on proteinuria in patients with membranous nephropathy.

关 键 词：膜性肾病 维生素D 蛋白尿 

分 类 号：R69[医药卫生—泌尿科学]