慢性肾脏病患者活性维生素D_3与颈动脉粥样硬化的相关性研究

Correlation study of active vitamin D_3 and carotid atherosclerosis in patients with chronic kidney disease

目的探讨慢性肾脏病(CKD)患者活性维生素D3、微炎症、颈动脉粥样硬化之间的关系,活性维生素D3是否可以改善颈动脉粥样硬化及可能的机制。方法选择2014年7月~2015年7月在我院确诊为CKD的非透析患者96例,按肾小球滤过率(GFR)分为三组,A组为CKD3期,B组为CKD4期,C组为CKD5期,每组32例,每组予骨化三醇0.25μg/d,疗程1年。三组治疗前后测定25羟维生素D_3[25(OH)_2D_3]、超敏C反应蛋白(hs-CRP)、颈动脉中内膜厚度(IMT)。结果三组治疗前25(OH)_2D_3下降、hs-CRP升高、IMT值下降,与CKD的进展相关,骨化三醇干预治疗后,hs-CRP、IMT值下降(P<0.05),hs-CRP、IMT值下降程度与25(OH)_2D_3上升成正相关(P<0.05)。结论25(OH)_2D_3水平、微炎症状态是CKD患者的颈动脉粥样硬化的相关性因素,骨化三醇可通过改善患者的微炎症状态,进而改善颈动脉粥样硬化。

Objective To investigate the relationship between active vitamin D3,micro-inflammation and carotid atherosclerosis in patients with chronic kidney disease（CKD）,and whether active vitamin D3 could improve carotid atherosclerosis and the possible mechanism.Methods 96 non-dialysis patients diagnosed as CKD in our hospital from July 2014 to July 2015 were divided into three groups according to the glomerular filtration rate（GFR）,group A was CKD3 stage,group B was CKD4 stage,group C was CKD5 stage,and each group had 32 cases.Each group was given Calcitriol of 0.25 μg/d for 1 year.25 hydroxyvitamin D3[25（OH）2D3],hypersensitivity C reactive protein（hs-CRP） and carotid intima-media thickness（IMT） before and after treatment in the three groups were measured.Results 25（OH）2D3was decreased,hs-CRP increased and IMT decreased before treatment in the three groups which was associated with the progress of CKD,then after Calcitriol treatment,hs-CRP and IMT decreased（P〈0.05）.The decrease degree of hs-CRP and IMT was positively correlated with the increase of 25（OH）2D3（P〈0.05）.Conclusion 5（OH）2D3 level and micro-inflammatory status are the factors of carotid atherosclerosis in patients with CKD,Calcitriol can improve carotid atherosclerosis by improving the Micro inflammation.