骨化三醇联合西格列汀对2型糖尿病肾病患者骨代谢的影响

Effects of Calcitriol combined with Sitagliptin on bone metabolism in patients with type 2 diabetic nephropathy

目的分析骨化三醇联合西格列汀治疗2型糖尿病肾病对患者骨代谢与肌酐(SCr)、β2微球蛋白(β2-MG)、尿素氮(BUN)、白蛋白(ALB)水平、24 h尿蛋白定量(24 h UTP)、尿微量白蛋白/肌酐比值(ACR)的影响。方法按照随机数字表法将南方医科大学南方医院白云分院2021年1月至10月收治的96例2型糖尿病肾病患者分为两组,各48例。患者入院后均给予常规降压、健康宣教、饮食与运动指导等治疗,对照组患者在常规治疗的基础上联合西格列汀治疗,观察组患者在对照组的基础上联合骨化三醇治疗,两组患者均连续治疗1个月。比较两组患者治疗后临床疗效,治疗前后SCr、β_(2)-MG、BUN、ALB、24 h UTP、ACR及骨密度、血钙(Ca)、血磷(P)、全段甲状旁腺激素(iPTH)、骨生长蛋白(BGP)水平,治疗期间不良反应发生情况。结果治疗后,观察组患者的治疗总有效率高于对照组;治疗期间不良反应总发生率低于对照组,但经比较,差异均无统计学意义(均P>0.05);治疗后,两组患者骨密度、血Ca、血P、ALB水平均显著升高,且观察组显著高于对照组;iPTH、BGP、BUN、β_(2)-MG、24 h UTP水平均显著降低,且观察组显著低于对照组(均P<0.05)。结论骨化三醇联合西格列汀治疗2型糖尿病肾病,可提升临床治疗效果,改善骨代谢与肾功能,且安全性良好。

Objective To analyze the effect of Calcitriol combined with Sitagliptin in the treatment of patients with type 2 diabetic nephropathy on bone metabolism and creatinine(SCr),β_(2) microglobulin(β_(2)-MG),blood urea nitrogen(BUN),albumin(ALB),24 h urinary protein quantification(24 h UTP)and urinary microalbumin/creatinine ratio(ACR).Methods According to the random number table method,96 patients with type 2 diabetic nephropathy who were admitted to Southern Medical University Nanfang Hospital Baiyun Branch from January to October 2021 were divided into two groups,with 48 cases in each group.After admission,the patients were given routine antihypertensive,health education,diet and exercise guidance and other treatments,the patients in the control group were treated with Sitagliptin on the basis of conventional treatment,and the patients in the observation group were treated with Calcitriol on the basis of the control group,both groups were treated for 1 month.The clinical efficacy of the two groups of patients after treatment,SCr,β_(2)-MG,BUN,ALB,24 h UTP,ACR,bone mineral density,serum calcium(Ca),serum phosphorus(P),intact parathyroid hormone(iPTH),bone growth protein(BGP)levels before and after treatment,and occurrence of adverse reactions during treatment were compared.Results After treatment,the total effective rate of patients in the observation group was higher than that in the control group;the total incidence of adverse reactions during the treatment period was lower than that in the control group,but there was no significant difference after comparison(all P>0.05);after treatment,the bone mineral density,Ca,P and ALB levels of the two group significantly increased,and the observation group was significantly higher than the control group;iPTH,BGP,BUN,β_(2)-MG,24 h UTP levels significantly decreased,and the observation group was significantly lower than the control group(all P<0.05).Conclusion Calcitriol combined with Sitagliptin in the treatment of type 2 diabetic nephropathy can improve clinical therapeutic effect,improve bone metabolism and renal function,and has good safety.