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目的探讨1,25-二羟维生素D_3[1,25-(OH)_2D_3]对糖尿病肾病(DN)患者足细胞脱落和氧化应激状态的影响。方法选取深圳市龙岗区人民医院2014年1月—2016年7月收治的DN患者为研究对象,以患者尿清蛋白排泄率(UAER)水平为分组依据,随机抽取微量清蛋白尿(20~200μg/min)患者20例作为A组,20例大量清蛋白尿(>200μg/min)患者作为B组,均行常规治疗,两组患者均给予骨化三醇软胶囊0.25μg/d治疗,连续服用3个月。治疗3个月结束时检测并比较两组患者血清超氧化物歧化酶(SOD)、谷胱甘肽(GSH)水平变化,比较两组患者24h尿蛋白排泄量(24h UPE)、UAER及足细胞裂孔膜蛋白(Nephrin)水平变化。结果两组治疗后血清SOD、GSH水平均明显升高,且B组低于A组(P<0.05);两组患者治疗后24h UPE及UAER较本组治疗前降低,差异均有统计学意义(P<0.05);两组患者治疗后尿Nephrin水平均低于治疗前,差异有统计学意义(P<0.05)。结论 1,25-(OH)_2D_3可通过改善DN患者氧化应激状态,减少尿足细胞相关蛋白Nephrin丢失,从而减少足细胞脱落。
Objective To investigate the effects of 1,25-dihydroxyvitamin D_3 [1,25- (OH) _2D_3] on podocyte detachment and oxidative stress in patients with diabetic nephropathy (DN). Methods DN patients admitted from January 2014 to July 2016 in Longgang District People’s Hospital of Shenzhen City were selected as the research objects. Urine albumin excretion rate (UAER) was taken as the basis of the group, and serum albuminuria (20 ~ 200μg / min), 20 patients were treated as group A and 20 patients with albuminuria (> 200μg / min) as group B. All patients were treated with calcitriol soft capsule 0.25μg / d, continuous Take 3 months. At the end of 3 months of treatment, the levels of serum superoxide dismutase (SOD) and glutathione (GSH) in the two groups were detected and compared. 24h urinary protein excretion (24h UPE), UAER and podocyte Changes in the level of Nephrin. Results The levels of serum SOD and GSH in both groups were significantly increased after treatment, and the levels of serum SOD and GSH in group B were significantly lower than those in group A (P <0.05). The UPE and UAER in both groups were significantly lower than those before treatment (P <0.05). The urinary Nephrin levels in both groups were lower than those before treatment, the difference was statistically significant (P <0.05). Conclusions 1,25- (OH) _2D_3 can reduce the loss of podocyte-related protein Nephrin by reducing the oxidative stress in DN patients and thus reduce the podocyte shedding.