帕立骨化醇联合缬沙坦对糖尿病肾病患者肾纤维化指标及高迁移率族蛋白B1、核转录因子-κB水平的影响

Effects of paricalcitol combined with valsartan on renal fibrosis indexes, high mobility group protein B1 and nuclear factor-κB in patients with diabetic nephropathy

目的 探讨帕立骨化醇联合缬沙坦对糖尿病肾病(diabetic nephropathy,DN)患者肾纤维化指标及高迁移率族蛋白(high mobility group protein,HMG)B1和核因子(nuclear factor,NF)-κB水平的影响。方法 选取2020年5月至2021年5月上海交通大学附属第六人民医院南院门诊收治的DN患者120例,按数字表法随机分为帕立骨化醇组(帕立骨化醇)、缬沙坦组(缬沙坦)和联合组(帕立骨化醇+缬沙坦),每组40例,均连续治疗1个月。比较各组临床疗效、肾功能[β2微球蛋白(β2-microglobulin,β2M)、肌酐(creatinine,Cr)]、肾纤维化指标[半胱氨酸蛋白酶抑制剂(cystatin,Cys)C、金属蛋白酶组织抑制物(tissue inhibitor of metalloproteinase,TIMP)-1]、HMGB1和NF-κB水平,记录各组治疗过程不良反应发生情况。结果 联合组治疗总有效率高于帕立骨化醇组(87.50%vs 65.00%,P <0.05)。联合组β2M、Scr、CysC、TIMP-1及HMGB1、NF-κB水平低于缬沙坦组和帕立骨化醇组(P <0.05)。结论 帕立骨化醇联合缬沙坦治疗DN,效果较帕立骨化醇单药更佳,可有效改善患者肾功能,延缓肾纤维化,较好调节HMGB1、NF-κB水平。

Objective To explore the effects of paricalcitol combined with valsartan on levels of renal fibrosis indexes,high mobility group protein(HMG)B1 and nuclear transcription factor(NF)-κB in patients with diabetic nephropathy(DN).Methods A total of 120 patients with DN admitted to the outpatient of Shanghai Jiao Tong university affiliated sixth people’s hospital south campus were enrolled from May 2020 to May 2021. According to random number table method, they were divided into paricalcitol group(paricalcitol), valsartan group(valsartan) and combination group(paricalcitol combined with valsartan), 40 cases in each group. After 1 month of continuous treatment, clinical curative effect and levels of renal function indexes[β2 microglobulin(β2M), creatinine(Cr)], renal fibrosis indexes[cystatin(Cys)C, tissue inhibitor of metalloproteinase(TIMP)-1], HMGB1 and NF-κB in different groups were compared. The occurrence of adverse reactions during treatment was recorded in each group. Results The total effective rate of combination group was higher than that in paricalcitol group(87.50% vs 65.00%, P<0.05). After treatment, the levels of β2M, Cr, CysC, TIMP-1, HMGB1 and NF-κB in combination group were lower than those in valsartan group and paricalcitol group(P<0.05). Conclusion Compared with paricalcitol monotherapy, paricalcitol combined with valsartan has better effect of on DN, which can effectively improve renal function, delay renal fibrosis and better regulate the levels of HMGB1 and NF-κB.