活性维生素D3对透析前慢性肾脏病患者肾脏保护作用研究

Renoprotective Role of Active Vitamin D3 in Predialysis Patients with Chronic Kidney Disease

目的:探讨活性维生素D3对透析前慢性肾脏病(CKD)患者的肾保护作用及安全性。方法:选择透析前3～4期慢性肾脏病患者200例,随机分为治疗组和对照组各100例。对照组给予优质低蛋白饮食、α-酮酸、血管紧张素转换酶抑制剂(ACEI)和(或)血管紧张素Ⅱ受体拮抗剂(ARB)和(或)钙通道拮抗剂以及抗血小板集聚等常规治疗,治疗组在常规治疗的基础上加用骨化三醇(0.5μg/d,疗程1年)。分别在治疗前和治疗后3,6,9和12月检测患者肾功能、血清白蛋白、甲状旁腺素、血钙、磷及24h尿蛋白定量等指标,并观察其副作用。结果:两组治疗后3月血肌酐、尿素氮、血尿酸和24h尿蛋白均明显下降(P<0.05),估算肾小球滤过率和血清白蛋白显著上升(P<0.05)。治疗组治疗12月后肾功能进一步改善(P<0.05),尿蛋白进一步减少(P<0.05),而对照组治疗12月后肾功能和尿蛋白与治疗3月相比无明显改变。对照组患者血钙降低,血磷升高,甲状旁腺素水平明显升高(P<0.05)。治疗组患者血钙升高,血磷降低,甲状旁腺素水平明显下降(P<0.05),但无明显高钙血症等副作用。结论:骨化三醇能显著改善透析前CKD患者的肾功能,减少蛋白尿,抑制继发性甲状旁腺素分泌,具有明显的肾脏保护作用,且无明显副作用。

Objective：To investigate the renoprotective effect and safety of oral calcitriol on predialysis patients with chronic kidney disease（CKD）.Methods：200 CKD stage 3 and 4 patients with secondary hyperparathyroidism（SHPT）were randomized to oral calcitriol（n=100）or control（n=100）and followed for up to 12 months.The control groups was given conventional therapy including high-quality low-protein diet,compound α-keto acid,angiotensin converting enzyme inhibitor（ACEI）and（or）angiotensinⅡreceptor blocker（ARB）,and（or）calcium channel antagonists,anti-platelet aggregation,and so on.The treatment groups accepted calcitriol（0.5 μg/d,for one year）on the basis of conventional therapy.The blood urea nitrogen（BUN）,serum creatinine,serum uric acid,serum parathyroid hormone,serum calcium,serum phosphorus and serum albumin and 24 hour urinary protein were detected respectively before and after 3,6,9,and 12 months of therapy,and the side effects were observed during the course of study.Results：Serum creatinine,BUN,serum uric acid and 24 h urinary protein decreased obviously,and estimated glomerular filtrationrate（eGFR）and serum albumin increased significantly in both control and treatment groups after 3 months of therapy（P0.05）.The renal function further improved（P0.05）,and urine protein further reduced in treatment group（P0.05）,while the renal function and urinary protein did not change significantly in control group after 12 months of therapy.Serum parathyroid hormone level increased evidently in control groups while decreased significantly in treatment group（P0.05）.Serum calcium decreased,and serum phosphorus increased in the control group（P0.05）.On the contrary,serum calcium increased,while serum phosphorus decreased in treatment groups（P0.05）.Although there was increasing in serum calcium,no evident side effects such as hypercalcemia were observed in treatment group.Conclusion：The calcitriol can improve the renal function,decrease 24 h urinary protein,and suppress parathyroid hormone secretion significantly in predialysis patients with CKD.Therefore,we believe that calcitriol has evident renoprotective effects,and no obvious side effects such as hypercalcemia.