活性维生素D_3治疗对维持性血液透析患者微炎症的影响

Effects of activated Vitamin D3 treatment on microinflammation state in maintenance hemodialysis patients

目的:观察活性维生素D3治疗对维持性血液透析患者微炎症指标的影响。方法:33例血清全段甲状旁腺激素(iPTH)>300 pg/mL的维持性血液透析患者接受活性维生素D3冲击治疗12周,检测治疗前和治疗第4、12周的血清iPTH水平,血钙、磷水平以及炎症指标IL-6和C-反应蛋白(CRP)水平;治疗前后行超声心动图检查,观察心脏左室结构。结果:活性维生素D3治疗后第4、12周,患者血清炎症指标IL-6和CRP水平均较治疗前明显降低;治疗4周时血iPTH水平较治疗前无明显变化。治疗12周后血iPTH水平较治疗前显著下降,48.5%的患者iPTH<300 pg/mL。治疗后患者超声心动图左心室肥厚指标明显改善。结论:活性维生素D3治疗能减轻维持性血液透析患者的微炎症状态,改善左心室肥厚。提示其在血液透析患者中具有调节钙、磷代谢,抑制继发性甲状旁腺功能亢进之外的应用前景。

AIM： To explore the effect of activated Vitamin D3 treatment on microinflammation state in maintenance hemodialysis patients. METHODS： 33 maintenance hemodialysis patients with intact parathyroid hormone（iPTH） levels above 300 pg/mL were received activated Vitamin D3 orally pulse therapy for 12 weeks.Serum iPTH, calcium, phosphorus and inflammatory markers interleukin-6 （IL-6） and C-reactive protein （CRP） were tested before and 4, 12 weeks after the treatment. Echocardiographic parameters of left ventricular hypertrophy were examined before and after the the treatment. RUSULTS： Both 4 weeks and 12 weeks after 1,25（OH）2D3 treatment, serum IL-6 and CRP levels were reduced signifieantly. 4 weeks after the treatment, serum iPTH levels had no significant ehange. 12 weeks after the treatment, serum iPTH levels were deereased remarkably eompared to that before 1, 25 （OH）2D3 treatment. Compared with before treatment, the iPTH level was decreased after 12 weeks treatment, 48.5% of the patients reached end-point parameter （ iPTH 〈 300 pg/mL）. Left ventricular hypertrophy parameters determined by echocardiography were significantly improved after 12 weeks treatment. CONCLUSION： Activated vitamin D3 can attenuate the mieroin-flammation state in maintenance hemodialysis patients and improve left ventricular hypertrophy. These data suggest that activated vitamin D3 may have broad application other than modulating calcium, phosphorus metabolism and controlling iPTH in maintenance hemodialysis patients.