1,25-二羟维生素D_3对2型糖尿病肾病患者血管生成素样蛋白4水平的影响

Effects of 1,25-dihydroxy-vitamin D_3 on the ANGPTL 4 level of patients with diabetic nephropathy

目的探讨1,25-(OH)_2维生素D_3对2型糖尿病肾病患者血、尿血管生成素样蛋4(Angptl4)水平的影响。方法纳入单纯2型糖尿病患者(A组),糖尿病肾病微量白蛋白尿组(B组),糖尿病肾病大量蛋白尿组(C组),每组各30例。将60例DN患者按性别、年龄配对再随机分为接受1,25-(OH)_2D_3治疗组和对照组各30例。检测所有患者尿微量白蛋白/尿肌酐(ACR)、尿Angptl4,血1,25-(OH)_2D_3、血清白蛋白(Alb)、尿素氮(BUN)、肌酐(Cr)、胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、血钙(Ca)、空腹血糖(FBG)、糖化血红蛋白(Hb A1C)和血Angptl4,治疗组给予骨化三醇胶丸治疗12周,并复查上述指标。结果与A组患者相比,B组和C组患者ACR、尿Angptl4水平明显升高(P<0.05),血1,25-(OH)_2D_3、血Angptl4水平明显下降(P<0.05);与B组相比,C组患者ACR、尿Angptl4水平明显升高,(P<0.05),血1,25-(OH)_2D_3、血Angptl4水平明显下降(P<0.05);对照组治疗前后各项指标无明显变化(P>0.05)。治疗组治疗后与治疗前相比,ACR和尿Angptl4水平下降(P<0.05),血1,25-(OH)_2D_3、血Angptl4水平明显升高(P<0.05);相关分析显示血Angptl4水平与血1,25(OH)_2D_3的水平呈正相关(r=0.526,P<0.05),与尿Angptl4水平呈负相关(r=-0.656,P<0.05),与尿ACR水平呈负相关(r=-0.621,P<0.05)。结论 DN患者血Angptl4水平明显下降、尿Angptl4水平明显上升,而补充活性维生素D_3后,DN患者的血Angptl4水平有所提升,且蛋白尿减少。

Objective To investigate the effect of 1,25-dihydroxy-vitamin D3 on the Angptl4 levelof patients with diabetic nephropathy. Methods A total of 90 patients with type 2 diabetes mellitus were divided into diabetes mellitus group （group A, n=30） , early diabetic nephropathy group （group B, n=30）, clinical diabetic nephropathy group （group C, n=30）.DN patients were randomly divided into the treatment group receiving routine therapy plus 1,25 -dihydroxy- vitamin D3and control group receiving routine therapy.All patients were observed forl2 weeks to compare the changes of 1,25-dihydroxy-vitamin D3, ACR, Angpt14, Alb, BUN, Cr, TC , TG , LDL, Ca , FBG, HbA1C before and after therapy. Results Compared with group A, the level of ACR and urinar- yAngptl4 were higher in group B and group C （P 〈 0.05 ）, and serum Angptl4 and 1,25-dihydroxy-vitamin D3 were lower in group B and group C （P 〈 0.05）.Compared with patients in group B, ACR, urinary Angptl4 level increased significantly, P 〈 0.05, 1,25- （OH） 2 D3, serum Angptl4 levels of patients in group C significantly decreased （P 〈 0.05 ）. The indicatorsin the control groupshowed no significant changes before and after the treatment （P 〉 0.05 ）. Comparison before and after treatment in treatment group showed ACR and urinary Angptl4 levels de- creased （P 〈 0.05 ） , and serum Angptl4 level increased significantly （P 〈 0.05 ）. Correlation analysis showed that serum Angptl4 level and the level of blood 1, 25 （OH） 2 D3 werein positive correlation （r = 0.526, P 〈 0.05） , negatively correlated with urinary Angptl4 levels （r = -0.656, P 〈 0.05 ）, and negatively correlated with ACR level （r = -0.621, P 〈 0.05）. Conclusion The level of serum Angptl4 in patients with DN significantly decreased and the level of urinary Angptl4 significantly increased, while the level of serum Angptl4 in patients with DN increased after the treatment of active vitamin D3, and proteinuria decreased.