维生素D_(3)在糖尿病肾病患者治疗中的作用研究

Effect of vitamin D_(3) in the treatment of patients with diabetic kidney disease

目的探讨维生素D_(3)在糖尿病肾病患者治疗中的作用。方法选取2019年1-12月在我院肾内科确诊的糖尿病肾病患者128例。随机分为观察组和对照组,每组64例。除常规治疗外,观察组每日给予维生素D_(3)4800 IU,随餐服用,治疗周期为4周。比较两组病例生化指标及炎症细胞因子的变化。结果经过4周维生素D_(3)治疗,观察组尿总蛋白(UTP)、尿微量白蛋白/尿肌酐(ACR)、超敏C-反应蛋白(hs-CRP)、血清胱抑素(CysC)水平显著低于对照组(P<0.05)。观察组炎症细胞因子TNF-α水平显著低于对照组[(24.92±3.65)ng/L vs.(27.09±9.34)ng/L],差异有统计学意义(P<0.05);观察组IL-6水平与对照组相比略有下降趋势[(24.85±3.59)ng/L vs.(26.08±3.86)ng/L],但差异无统计学意义(P=0.07)。结论维生素D活性制剂通过抑制TNF-α水平而降低炎症细胞因子对内皮细胞的损害,从而改善肾小球滤过膜通透性,减少蛋白渗出,对糖尿病肾病治疗有参考意义。

Objective To investigate the mechanism of vitamin D in the treatment of diabetic kidney disease.Methods A total of 128 patients with diabetic kidney disease diagnosed in the nephrology department of our hospital from January to December 2019 were selected and divided into observation group and control group,64 cases in each group.In addition to conventional treatment,the observation group was given 4800 IU of vitamin D_(3) with meals every day.the treatment period was four weeks.The changes in biochemical indicators and inflammatory cytokines were compared between the two groups.Results After four weeks of vitamin D_(3) treatment,the levels of urine total protein(UTP),urine microalbumin/urinary creatinine(ACR),high sensitivity C-reactive protein(hs-CRP)and serum cystatin(CysC)in observation group were significantly lower than those in control group(P<0.05).The level of inflammatory cytokine TNF-αin observation group was significantly lower than that in control group[(24.92±3.65)ng/L vs.(27.09±9.34)ng/L,P<0.05];the IL-6 level of the observation group had a downward trend compared with control group[(24.85±3.59)ng/L vs.(26.08±3.86)ng/L],but there was no significant difference between the two groups(P=0.07).Conclusion Vitamin D can reduce the damage of inflammatory cytokines to endothelial cells by inhibiting the level of TNF-α,thereby improving the permeability of glomerular filtration membrane and reducing protein exudation,which has reference significance for the treatment of diabetic kidney disease.