阿法骨化醇对2型糖尿病肾病患者微炎症状态的影响

摘要

目的 探讨阿法骨化醇对2型糖尿病肾病患者微炎症状态的影响.方法 选取70例2型糖尿病肾病患者,将其随机分为对照组(35例)和观察组(35例),对照组给予常规药物治疗,不使用血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂以及他汀类药物,观察组在治疗组治疗的基础上加用阿法骨化醇片0.5 μg/d口服治疗.均治疗12周.另选择20例健康者作为正常组.观察治疗前后患者24 h尿蛋白排泄率、血清肌酐(SCr)、空腹血糖(FBS)、血清炎症因子[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(清蛋白、前清蛋白)的变化.结果 与正常组比较,治疗前观察组和对照组患者的炎症因子hs-CRP、IL-6、TNF-α水平均显著升高(P＜0.05),而营养学指标(前清蛋白)显著降低(P＜0.05).阿法骨化醇治疗3个月后,与治疗前以及对照组治疗后比较,观察组患者CRP、IL-6、TNF-α水平显著降低,前清蛋白水平显著升高,差异均有统计学意义(P＜0.05).治疗组和观察组患者治疗前后SCr、FBS、清蛋白水平与治疗前比较,差异无统计学意义(P＞0.05).结论 2型糖尿病肾病患者存在微炎症状态,阿法骨化醇治疗可以显著改善2型糖尿病肾病患者微炎症状态,减轻蛋白尿,改善营养状态.%Objective To investigate the effect of Alfacalcidol on microinflammation in the patients with type 2 diabetic nephropathy. Methods Totally 70 type 2 diahetic nephropathy patients in our hospital were enrolled. All patients were randomly divided into treatment group ( 21 males and 14 females ) and control group ( 22 males and 13 females ) . While twenty healthy adults were selected as healthy group. Patients in treatment group received Alfacalcidol and routine drug therapy for 12 weeks while patients in control group took routine drug therapy only. Healthy control group took no medicines. Serum hs - CRP, IL - 6, TNF -α. albumin, prealbumin, fasting blood sugar ( FBS ), creatinine , and 24 - hour urine protein were measured at baseline and 12 weeks later. Results Compared with the healthy group, the serum hs - CRP, 11 -6, TNF - α level and 24 h urine protein were significantly increased ( P ＜ 0. 05 ) and serum prealbumin significantly decreased ( P ＜ 0. 05 ) both in treatment group and control group. Compared to the baseline values, the hs - CRP, IL - 6, TNF - α level and 24 h urine protein were significantly decreased ( P ＜0. 05 ) and serum prealbumin significantly increased ( P ＜ 0. 05 ) in treatment group after 12 weeks, and there were significant differences between treatment group and control group ( P ＜ 0. 05 ) . Serum creatinine, FBS, and albumin showed no significant difference between treatment group and control group either at baseline or after 12 weeks ( P ＞0. 05 ). Conclusion Microinflammation exists in the patients with type 2 diabetic nephropathy. Alfacalcidol can ohviously improve the microinflammation, alleviate proteinuria, and improve nutrition status.