维生素D_(2)肌注治疗IgA肾病患者维生素D缺乏的临床观察  

Clinical Observation of Intramuscular Vitamin D_(2) in Treatment of Vitamin D Deficiency in Patients with IgA Nephropathy

作　　者：苏长权 罗美华 尤燕华 梁萌 SU Changquan;LUO Meihua;YOU Yanhua(Department of Nephrology,Department of Infectious Diseases,Chenggong Hospital,Xiamen University,Xiamen(361000))

机构地区：[1]厦门大学附属成功医院肾内科,厦门361003 [2]厦门大学附属成功医院感染科,厦门361003

出　　处：《中国中西医结合肾病杂志》2022年第3期212-215,共4页Chinese Journal of Integrated Traditional and Western Nephrology

摘　　要：目的:观察维生素D_(2)肌注治疗对IgA肾病患者维生素D缺乏的影响。方法:针对我院2019年06月—2021年06月新接诊的71例IgA肾病患者,采用高效液相色谱串联质谱法检测空腹血清25(OH)D水平,根据血清25(OH)D水平分为严重缺乏组、缺乏组、不足组和正常组。分析血清25(OH)D水平与患者性别、年龄、血红蛋白、白蛋白、尿蛋白定量、血肌酐、肌酐清除率、矿物质代谢指标(血钙、血磷、全段甲状旁腺激素iPTH)的相关性。选取其中维生素D<30 ng/ml的60例患者作为研究对象,给予肌肉注射维生素D_(2)注射液(25(OH)D≤20 ng/ml,给予60万U,1次/4周,连续12周;20 ng/ml<25(OH)D≤30 ng/ml,单次肌注60万U),对比患者治疗前后血清25(OH)D水平、血红蛋白、白蛋白、尿蛋白定量、钙、磷、iPTH的变化。结果:71例IgA肾病患者血25(OH)D值平均水平(21±7.62)ng/ml,维生素D严重缺乏4例(5.6%),缺乏29例(40.9%),不足27例(38%),正常11例(15.5%)。男性组和女性组患者中25(OH)D水平差别无统计学意义。血清25(OH)D的不同水平,与年龄、白蛋白、血红蛋白、血钙、血磷、甲状旁腺激素、肌酐、肌酐清除率等方面差异无统计学意义。多元逐步回归分析发现血清25(OH)D与尿蛋白定量具有相关性(β为-0.250)。肌内注射维生素D_(2)注射液12周后25(OH)D_(2)、血白蛋白水平明显升高,25(OH)D_(3)、iPTH、尿蛋白水平较治疗前下降(P<0.05),对血钙、血磷无显著影响(P>0.05)。结论:IgA肾病患者维生素D缺乏患病率高,其血清25(OH)D水平与蛋白尿水平相关,肌内注射维生素D_(2)可明显改善IgA肾病患者维生素D缺乏,具有减少蛋白尿的作用。Objective:To observe the effect of intramuscular injection of vitamin D_(2) on vitamin D deficiency in patients with IGA nephropathy.Methods:The serum 25(OH)D level of 71 newly admitted patients with IgA nephropathy in our hospital from June 2019 to June 2021 was detected by Liquid chromatography tandem mass spectrometry Method,According to the serum 25(OH)D level,they were divided into severe deficiency group,deficiency group,insufficiency group and normal group.The correlation between serum 25(OH)D level and gender,age,hemoglobin,albumin,serum creatinine,creatinine clearance rate,urinary protein quantitation and mineral metabolism indexes(blood calcium,phosphorus and whole parathyroid hormone iPTH)was analyzed.60 IgA nephropathy patients were selected when the serum 25(OH)D level below 30 ng/ml as the research object,given intramuscular injection of vitamin D_(2) injection(600000 u,1/4 weeks)for 12 weeks when the serum 25(OH)D level below 20 ng/ml;given intramuscular injection of vitamin D_(2) injection(600000 u,single doses)when the serum 25(OH)D level between 20 ng/ml and 30 ng/ml;The changes of serum 25(OH)D level,hemoglobin,albumin,calcium,phosphorus and iPTH were compared before and after treatment.Results:The average level of 25(OH)D in 71 patients was(21±7.62)ng/ml.There were 4 cases(5.6%)of severe vitamin D deficiency,29 cases(40.9%)of deficiency,27 cases(38%)of insufficiency and 11 cases(15.5%)of normal.The level of 25(OH)D in male group was no significant than that in female group(P>0.05).There was no significant correlation between serum 25(OH)D and age,hemoglobin,albumin,blood calcium,blood phosphorus and parathyroid hormone(P>0.05).Multiple linear stepwise regression analysis showed that serum 25(OH)D was correlated with urinary protein quantitation(β-0.250).After intramuscular injection of vitamin D2 for 12 weeks,the concentration of 25(OH)D_(2) and serum albumin in IgA nephropathy patients increased significantly(P<0.05),while 25(OH)D_(3),iPTH and urinary protein depressed(P<0.05),and there was

关 键 词：IGA肾病 维生素D_(2)注射液 25(OH)D 蛋白尿 

分 类 号：R692.31[医药卫生—泌尿科学]