骨化三醇对1～2期慢性肾脏病患者微炎症状态的影响

摘要

目的 探讨慢性肾脏病1～2期患者是否存在微炎症状态以及骨化三醇对其影响.方法 选取诊断明确的门诊或住院的1～2期慢性肾脏病患者78例,按照随机数字表分为对照组和观察组,对照组采用常规药物治疗,观察组在常规药物治疗的基础上加用骨化三醇治疗,0.5 μg/次,1次/d,疗程均为12周;另选择体检中心20例健康者作为正常组,治疗前后比较3组受检者的血清超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)以及营养学指标(血清清蛋白、前清蛋白、血红蛋白)及24 h尿蛋白定量、血清肌酐、尿素氮、钙离子、甲状旁腺激素(PTH)水平的变化.结果 与正常组比较,1～2期慢性肾脏病患者(观察组和对照组)血清hs-CRP、IL-6、TNF-α水平均明显升高,而营养学指标(血清清蛋白、血红蛋白)降低,差异均有统计学意义(P＜0.05).经骨化三醇治疗后,观察组患者的hs-CRP、IL-6、TNF-α水平与治疗前及对照组治疗后相比,均明显降低,血清清蛋白、前清蛋白升高,差异均有统计学意义(P＜0.05),而对照组患者治疗前后上述各指标比较,差异均无统计学意义(P＞0.05).3组受检者的血肌酐、血红蛋白、PTH水平治疗前、治疗后比较,差异均无统计学意义(P＞0.05).结论 慢性肾脏病1～2期患者存在微炎症状态,骨化三醇治疗可以显著改善其微炎症状态和营养状态、降低尿蛋白量.%Objective To investigate whether there is microinflammatory state among patients with stage 1 or 2 chronic kidney disease ( CKD ), and the effect of calcitriol on the microinflammation state. Methods A total of 78 CKD ( stage 1 or 2 ) patients were selected and evenly divided into a study group and a control group with random number table. Patients in the control group ( 23 males and 16 females ) received routine drugs, while patients in the study group ( 24 males and 15 females ) received routine drugs plus calcitriol ( 0. 5 μg/d ). The period of treatment for both groups was 12 weeks. Another 20 healthy people for health check - ups were assigned into the normal group. The serum hs - CRP, IL - 6 , TNF - α., serum albumin, prealbumin, hemoglobin, 24 h urine protein, creatinine, BUN, PTH, and calcium ion were measured before and after the treatment. Results The serum hs - CRP, IL - 6, TNF - α levels were significantly higher, and the serum albumin, hemoglobin were significantly lower in the control group and the study group than that in the normal group ( P <0. 05 ) . After 12 weeks of treatment, the serum hs - CRP, IL -6, and TNF - α levels were significantly lower, and albumin and prealbumin were significantly higher in the study group than that before the treatment or that in the control group ( P < 0. 05 ) . These indices in the control group did not show significant difference before and after the treatment ( P > 0. 05 ) . There was no significant difference in serum creatinine, PTH and hemoglobin among the three groups before and after the treatment ( P > 0. 05 ) . Conclusion There is microinflammatory state among stage 1 and 2 CKD patients, and calcitriol can alleviate the microinflammatory state, improve the nutritional state, and decrease 24 h urine protein in these patients.