阿法骨化醇改善慢性肾脏病3期患者左心室肥厚和心脏舒张功能:一项开放标签的随机对照临床研究

Alfacalcidol improves left ventricular hypertrophy and cardiac diastolic function in patients with chronic kidney disease stage 3:an open-label and randomized controlled study

目的观察慢性肾脏病(CKD)3期患者应用阿法骨化醇治疗对左心室肥厚(LVH)和心脏舒张功能的影响。方法选择2016年1-12月在福建医科大学附属第一医院肾内科住院治疗的CKD 3期患者86例,随机分为治疗组(n=44,口服阿法骨化醇0.25μg/d,共24周)和对照组(n=42,不用阿法骨化醇)。两组患者在进入研究时(基线)和第24周分别检测血25-羟基维生素D、钙、磷、碱性磷酸酶、全段甲状旁腺激素(iPTH);并分别行心脏彩色多普勒超声检查,测量左心房内径(LAD)、左心室舒张末期内径(LVDd)、左心室收缩末期内径(LVDs)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT),计算左心室射血分数(LVEF)、左心室质量指数(LVMI)、二尖瓣口舒张早期血流速度/二尖瓣口舒张晚期血流速度(E/A)、舒张早期二尖瓣口血流峰值速度与二尖瓣环峰值速度比值(E/e’)。结果 CKD 3期患者血清25-羟基维生素D下降。与对照组比较,治疗组第24周血清25-羟基维生素D水平提高[(21.29±5.26)比(13.44±4.91)μg/L,P<0.01]。两组患者基线与第24周的血清钙、磷、碱性磷酸酶、iPTH比较差异无统计学意义(均P>0.05)。与对照组对比,治疗组LVMI[(139.70±22.93)比(149.95±27.16)g/m^2]、E/A(0.95±0.17比0.88±0.12)、E/e’(12.88±2.95比15.79±3.98)改善,差异有统计学意义(均P<0.05)。结论阿法骨化醇能够改善CKD 3期患者的LVH和心脏舒张功能。

Objective To evaluate the effect of alfacalcidol on left ventricular hypertrophy and cardiac diastolic function in patients with chronic kidney disease stage 3（CKD3）. Methods A total of 86 patients with CKD3 hospitalized in Department of Nephrology,the First Affiliated Hospital of Fujian Medical University between January 2016 and December 2016 were randomly assigned to 2 groups,including the treatment group（n=44,taking alfacalcidol0.25μg/d orally for 24 weeks）and the control group（n=42,without alfacalcidol）. The levels of serum 25-hydroxyvitamin D,calcium,phosphorus,alkaline phosphatase,and intact parathyroid hormone（iPTH）were detected in the both groups at baseline and at the 24 th week. Simultaneously,left atrium diameter（LAD）,left ventricular end diastolic diameter（LVDd）,left ventricular end systolic diameter（LVDs）,interventricular septum thickness（IVST）,left ventricular posterior wall thickness（LVPWT）were measured by cardiac color doppler ultrasound,and then left ventricular ejection fraction（LVEF）,left ventricular mass index（LVMI）,transmitral early diastolic peak flow velocity/transmitral late diastolic peak flow velocity（E/A）,and transmitral early diastolic peak flow velocity/peak velocities of mitral annulus（E/e＇）were calculated. Results The level of serum 25-hydroxyvitamin D was decreased in patients with CKD3. Compared with the control group,the level of serum 25-hydroxyvitamin D at the24 th week in the treatment group was increased[（21.29±5.26）vs（13.44±4.91）μg/L,P〈0.01]. There were no significant differences in serum calcium,phosphorus,alkaline phosphatase and iPTH at baseline and at the 24 th week between the two groups（all P〉0.05）. Compared with the control group,LVMI[（139.70±22.93）vs（149.95±27.16）g/m^2,P〈0.05],E/A（0.95±0.17 vs 0.88±0.12,P〈0.05）and E/e＇（12.88±2.95 vs15.79±3.98,P〈0.05）were improved in the treatment group. Conclusion Alfacalcidol intervention could improve left ventricular hypertrophy and cardiac diastolic function in patients with CKD3.