维生素D_(2)对糖尿病肾病患者蛋白尿水平的影响

Effects of vitamin D_(2)on albuminuria in patients with diabetic kidney disease

目的探索维生素D_(2)软胶囊对伴有糖尿病肾病(diabetic kidney disease,DKD)的2型糖尿病(type 2 diabetes mellitus,T2DM)患者蛋白尿水平的影响。方法回顾性分析2020年10月至2022年3月在北京市某三级医院内分泌科住院治疗的估算肾小球滤过率(estimated glomerular filtration rate,eGFR)≥60 mL·(min·1.73 m^(2))^(-1)的伴DKD的95例T2DM患者。根据患者的治疗方案分为未使用维生素D制剂的对照组(CON组,n=33)、使用维生素D_(2)软胶囊的普通维生素D组(NVD组,n=31)和使用骨化三醇软胶囊的活性维生素D组(AVD组,n=31)。通过医院病例系统收集基线和治疗12周时患者的临床资料及维生素D和DKD相关指标,包括血清25羟维生素D(25-hydroxy vitamin D,25OHD)、血清甲状旁腺激素(parathyroid hormone,PTH)、血钙、尿钙和尿白蛋白与肌酐比值(urinary albumin-to-creatinine ratio,UACR)等。结果基线时CON组、NVD组和AVD组大量蛋白尿患者分别为8例(24.24%)、9例(29.03%)和7例(22.58%),差异无统计学意义(P=0.831)。治疗12周时,NVD组和AVD组ln(UACR)水平均显著降低(P均<0.001),两治疗组间差异无统计学意义(P=0.371)。NVD组和AVD组的总有效率分别为80.65%和74.19%,显著高于CON组(33.33%)(P<0.001和P=0.002)。NVD组和AVD组的疗效差异无统计学意义(P=0.245)。CON组出现1例血钙增高、1例高尿钙、1例高尿酸血症、1例肾结石、1例肌肉痉挛;NVD组出现1例高尿钙、1例高尿酸血症;AVD组出现1例血钙增高、1例高钙血症、1例低PTH、2例高尿钙、2例高尿酸血症。两治疗组均无停药事件发生。结论维生素D_(2)软胶囊与骨化三醇软胶囊均可显著降低肾功能正常的伴DKD的T2DM患者尿蛋白水平。普通维生素D与活性维生素D相比可能安全性更好。

Objective To explore the effects of vitamin D_(2) soft capsules and calcitriol soft capsules on albuminuria in type 2 diabetes mellitus(T2DM)patients with diabetic kidney disease(DKD).Methods Totally 95 T2DM patients with DKD and estimated glomerular filtration rate(eGFR)≥60 mL·(min·1.73 m 2)-1 who hospitalized in the department of endocrinology of a tertiary hospital in Beijing from October 2020 to March 2022 were analyzed retrospectively.According to the treatment protocols,the patients were divided into control group without vitamin D preparation(CON group,n=33),natural vitamin D group with vitamin D_(2) soft capsule(NVD group,n=31),and active vitamin D group with calcitriol soft capsule(AVD group,n=31).The clinical data and parameters of vitamin D and DKD,including serum 25-hydroxyvitamin D(25OHD),serum parathyroid hormone(PTH),blood calcium,urine calcium and urinary albumin-to-creatinine ratio(UACR)at baseline and after 12 weeks treatment were collected through the electronic medical records database system.Results In the baseline phase,there were 8 cases(24.24%),9 cases(29.03%),and 7 cases(22.58%)with macroalbuminuria in CON group,NVD group,and AVD group,respectively,with no significant difference(P=0.831)。After 12 weeks of treatment,the level of ln(UACR)decreased significantly(both P<0.001),with no significant difference between the two treatment groups(P=0.371).The total effective rates of NVD group and AVD group were 80.65%and 74.19%respectively,which were significantly higher than those of CON group(33.33%)(P<0.001 and P=0.002).There was no significant difference between NVD group and AVD group(P=0.245).There were 1 case of blood calcium increased,1 case of hypercalciuria,1 case of hyperuricemia,1 case of kidney stone,and 1 case of muscle spasm in CON group,1 case of hypercalciuria and 1 case of hyperuricemia in NVD group,1 case of blood calcium increased,1 case of hypercalcaemia,1 case of blood parathyroid hormone decreased,2 cases of hypercalciuria,and 2 cases of hyperuricemia in AVD group.No drug withdrawal occurred in both treatment groups.Conclusion The administration of both Vitamin D_(2) soft capsule and calcitriol soft capsule can effectively reduce albuminuria levels in T2DM patients with DKD with good renal function and significantly.Natural vitamin D may be safer compared with active vitamin D.