维生素D2对糖尿病肾病患者蛋白尿水平的影响

doi:10.3969/j.issn.1006-7795.2024.03.008

摘要/Abstract

摘要： 目的探索维生素D₂软胶囊对伴有糖尿病肾病(diabetic kidney disease，DKD)的2型糖尿病（type 2 diabetes mellitus，T2DM）患者蛋白尿水平的影响。方法回顾性分析2020年10月至2022年3月在北京市某三级医院内分泌科住院治疗的估算肾小球滤过率(estimated glomerular filtration rate, eGFR）≥60 mL·（min·1.73 m2）^-1的伴DKD的95例T2DM患者。根据患者的治疗方案分为未使用维生素D制剂的对照组（CON组，n=33）、使用维生素D2软胶囊的普通维生素D组（NVD组，n=31）和使用骨化三醇软胶囊的活性维生素D组（AVD组，n=31）。通过医院病例系统收集基线和治疗12周时患者的临床资料及维生素D和DKD相关指标，包括血清25羟维生素D(25-hydroxy vitamin D，25OHD)、血清甲状旁腺激素（parathyroid hormone，PTH）、血钙、尿钙和尿白蛋白与肌酐比值（urinary albumin-to-creatinine ratio，UACR）等。结果基线时CON组、NVD组和AVD组大量蛋白尿患者分别为8例（24.24% ）、 9例（29.03 %）和7例（22.58% ），差异无统计学意义（P=0.831）。治疗12周时，NVD组和AVD组ln（UACR）水平均显著降低（P均<0.001），两治疗组间差异无统计学意义（P=0.371）。NVD组和AVD组的总有效率分别为80.65%和74.19%，显著高于CON组（33.33% ）（P<0.001和P=0.002）。NVD组和AVD组的疗效差异无统计学意义（P=0.245）。CON组出现1例血钙增高、1例高尿钙、1例高尿酸血症、1例肾结石、1例肌肉痉挛；NVD组出现1例高尿钙、1例高尿酸血症；AVD组出现1例血钙增高、1例高钙血症、1例低PTH、2例高尿钙、2例高尿酸血症。两治疗组均无停药事件发生。结论维生素D₂软胶囊与骨化三醇软胶囊均可显著降低肾功能正常的伴DKD的T2DM患者尿蛋白水平。普通维生素D与活性维生素D相比可能安全性更好。

关键词: 2型糖尿病, 维生素D₂, 骨化三醇, 糖尿病肾病, 蛋白尿

Abstract: Objective To explore the effects of vitamin D₂ soft capsules and calcitriol soft capsules on albuminuria in type 2 diabetes mellitus(T2DM) patients with diabetic kidney disease(DKD). Methods Totally 95 T2DM patients with DKD and estimated glomerular filtration rate (eGFR)≥60 mL·(min·1.73 m2)^-1 who hospitalized in the department of endocrinology of a tertiary hospital in Beijing from October 2020 to March 2022 were analyzed retrospectively. According to the treatment protocols, the patients were divided into control group without vitamin D preparation (CON group, n=33), natural vitamin D group with vitamin D2 soft capsule (NVD group, n=31), and active vitamin D group with calcitriol soft capsule (AVD group, n=31). The clinical data and parameters of vitamin D and DKD, including serum 25-hydroxyvitamin D (25OHD), serum parathyroid hormone (PTH), blood calcium, urine calcium and urinary albumin-to-creatinine ratio (UACR) at baseline and after 12 weeks treatment were collected through the electronic medical records database system. Results In the baseline phase, there were 8 cases (24.24% ), 9 cases (29.03% ), and 7 cases (22.58% ) with macroalbuminuria in CON group, NVD group, and AVD group, respectively, with no significant difference（P=0.831）。After 12 weeks of treatment, the level of ln(UACR) decreased significantly（both P<0.001）, with no significant difference between the two treatment groups（P=0.371）. The total effective rates of NVD group and AVD group were 80.65% and 74.19% respectively, which were significantly higher than those of CON group（33.33% ）（P<0.001 and P=0.002）. There was no significant difference between NVD group and AVD group（P=0.245）. There were 1 case of blood calcium increased, 1 case of hypercalciuria, 1 case of hyperuricemia, 1 case of kidney stone, and 1 case of muscle spasm in CON group, 1 case of hypercalciuria and 1 case of hyperuricemia in NVD group, 1 case of blood calcium increased, 1 case of hypercalcaemia, 1 case of blood parathyroid hormone decreased, 2 cases of hypercalciuria, and 2 cases of hyperuricemia in AVD group. No drug withdrawal occurred in both treatment groups. Conclusion The administration of both Vitamin D₂ soft capsule and calcitriol soft capsule can effectively reduce albuminuria levels in T2DM patients with DKD with good renal function and significantly. Natural vitamin D may be safer compared with active vitamin D.

Key words: type 2 diabetes mellitus, vitamin D₂, calcitriol, diabetic kidney disease, albuminuria

中图分类号:

R587.1

郑晓敏, 刘梦扬, 肖新华, 崔丽梅, 刘翠平. 维生素D₂对糖尿病肾病患者蛋白尿水平的影响[J]. 首都医科大学学报, 2024, 45(3): 420-428.

Zheng Xiaomin, Liu Mengyang, Xiao Xinhua, Cui Limei, Liu Cuiping. Effects of vitamin D₂ on albuminuria in patients with diabetic kidney disease[J]. Journal of Capital Medical University, 2024, 45(3): 420-428.

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维生素D₂对糖尿病肾病患者蛋白尿水平的影响

Effects of vitamin D₂ on albuminuria in patients with diabetic kidney disease

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