维生素D受体激动剂联合营养性维生素D治疗特发性膜性肾病的临床疗效研究

A study on clinical efficacy of vitamin D receptor activator combined with nutritional vitamin D in treatment of idiopathic membranous nephropathy

目的观察维生素D受体激动剂(VDRA)联合营养性维生素D(NVD)治疗特发性膜性肾病(IMN)的临床疗效,为临床治疗IMN提供参考。方法选择2017年9月至2019年9月广西壮族自治区人民医院肾内科收治的初发IMN且伴25-羟基维生素D[25(OH)D]<75 nmol/L患者60例。根据患者接受治疗方案的意愿将其分为VDRA组(34例)和VDRA联合NVD组(26例)。比较两组在治疗前、治疗3个月、治疗6个月的25(OH)D、24小时尿蛋白定量(24h up)、白蛋白(ALB)、肌酐(Cr)、估算肾小球过滤率(eGFR)、总胆固醇(TC)、甘油三酯(TG)、血钙(Ca)水平。比较两组临床疗效和不良事件发生情况。结果在治疗后,两组25(OH)D水平均呈上升趋势,且VDRA联合NVD组较VDRA组更显著(P<0.05)。在治疗3个月、治疗6个月,VDRA联合NVD组25(OH)D水平高于VDRA组,差异有统计学意义(P<0.05)。在治疗后,VDRA联合NVD组和VDRA组的24h up均呈下降趋势,且VDRA联合NVD组变化更显著(P<0.05)。VDRA联合NVD组ALB呈上升趋势,TC呈下降趋势,但VDRA组变化不大,两组变化差异有统计学意义(P<0.05)。VDRA联合NVD组和VDRA组Cr、Ca呈上升趋势,eGFR呈下降趋势,两组变化差异无统计学意义(P>0.05)。两组TG水平在治疗期间变化不大(P>0.05)。两组治疗期间均未出现复发病例。在治疗3个月和治疗6个月,VDRA联合NVD组的总缓解率均高于VDRA组,差异有统计学意义(P<0.05)。VDRA组在治疗期间出现乏力21例,VDRA联合NVD组有7例,比较差异有统计学意义(P<0.05)。结论VDRA联合NVD治疗IMN可有效降低患者24h up,提高25(OH)D水平,其临床疗效优于单独VDRA治疗方案,且安全性好。

Objective To observe the clinical efficacy of vitamin D receptor activator(VDRA)combined with nutritional vitamin D(NVD)in the treatment of idiopathic membranous nephropathy(IMN)and to provide reference for clinical treatment of IMN.Methods Sixty patients with new-onset IMN and 25-hydroxy vitamin D[25(OH)D]<75 nmol/L who were admitted to the Department of Nephrology,the People′s Hospital of Guangxi Zhuang Autonomous Region from September 2017 to September 2019 were selected.The patients were divided into VDRA group(34 cases)and VDRA combined with NVD group(26 cases)according to their willingness to accept different treatment regimens.The levels of 25(OH)D,24-hour urinary protein quantity(24h up),albumin(ALB),creatinine(Cr),estimated glomerular filtration rate(eGFR),total cholesterol(TC),triglyceride(TG)and blood calcium(Ca)were compared between the two groups before treatment,3 months of treatment,and 6 months of treatment.The clinical efficacy and the occurrence of adverse events were compared between the two groups.Results After treatment,the level of 25(OH)D showed an upward trend in both groups,and the level of 25(OH)D in the VDRA combined with NVD group increased more significantly than that in the VDRA group(P<0.05).After 3 months and 6 months of treatment,the level of 25(OH)D in the VDRA combined with NVD group was higher than that in the VDRA group,and the difference was statistically significant(P<0.05).After treatment,the 24h up of the VDRA combined with NVD group and the 24h up of VDRA group showed a downward trend,and the change of the VDRA combined with NVD group was more significant(P<0.05).ALB showed an upward trend,and TC showed a downward trend in the VDRA combined NVD group,but ALB and TC in the VDRA group did not change much,and the difference between the two groups was statistically significant(P<0.05).Cr and Ca showed an upward trend,and eGFR showed a downward trend in the VDRA combined NVD group and the VDRA group,and the difference between the two groups was not statistically significant(P>0.05).The level of TG did not change much in the two groups during the treatment period(P>0.05).There was no recurrence in both groups during the treatment period.In the treatment of 3 months and in the treatment of 6 months,the total remission rates of the VDRA combined with NVD group were higher than those of the VDRA group during the same period,and the differences were statistically significant(P<0.05).There were 21 cases of fatigue in the VDRA group during the treatment period,and 7 cases in the VDRA combined NVD group,and the difference was statistically significant(P<0.05).Conclusion VDRA combined with NVD in the treatment of IMN can effectively reduce the patients′24h up and increase the 25(OH)D level.Its clinical efficacy is better than that of VDRA alone,and its safety is good.