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目的研究骨化三醇治疗对糖尿病肾病(DN)维持性血液透析患者心脏结构和功能的影响。方法 41例DN维持性血液透析患者接受骨化三醇治疗(0.25μg口服,每天1次)共24周,观察治疗前后血清25(OH)D_3、25(OH)D_2、脑钠肽(BNP)、甲状旁腺素(iPTH)、Ca~(2+)水平、QT离散度/校正的QT离散度(QTd/QTed)、左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室后壁舒张期厚度(LVPWDT)、室间隔舒张期厚度(IVSDT)、左室射血分数(LVEF)及舒张早期和舒张晚期二尖瓣口最大血流速度之比(E/A)等的变化并对比分析。结果治疗后,血25(OH)D_3及血Ca~(2+)水平明显上升,BNP、iPTH水平明显下降,QTd及QTcd明显缩短,LVEDD、LVPWDT、LAD、IVSDT、LVEF、E/A均有明显改善(P<0.01,P<0.05);25(OH)D_3与血BNP、iPTH、QTd、QTcd、LAD、LVPWDT、IVSDT、LVEDD均呈负相关,(r=-0.39,r=-0.49,r=-0.65,r=-0.66,r=-0.48,r=-0.49,r=-0.50,r=-0.52,P<0.05,P<0.01),与LVEF及E/A呈正相关(r=0.47,r=0.46,P<0.01)。结论 25(OH)D_3治疗可改善DN维持性血液透析患者的心脏结构和功能,减轻心室肌复极不同步性及不稳定性。
Objective To study the effects of calcitriol treatment on cardiac structure and function in diabetic hemodialysis patients with diabetic nephropathy (DN). Methods 41 patients with DN maintenance hemodialysis received calcitriol (0.25μg orally once daily) for 24 weeks. Before and after treatment, serum 25 (OH) D 3, 25 (OH) D 2, , IPTH, Ca 2+, QTd / QTed, LAD, LVEDD, left ventricle (LVPWDT), interventricular septum thickness (IVSDT), left ventricular ejection fraction (LVEF), and early diastole mitral valve ratio (E / A) And comparative analysis. Results After treatment, the levels of blood 25 (OH) D 3 and blood Ca 2+ were significantly increased, the levels of BNP and iPTH were significantly decreased, QTd and QTcd were significantly shortened, and LVEDD, LVPWDT, LAD, IVSDT, LVEF and E / A (P <0.01, P <0.05). There was a negative correlation between 25 (OH) D_3 and BNP, iPTH, QTd, QTcd, LAD, LVPWDT, IVSDT and LVEDD (r = -0.39, r = -0.49, There was a positive correlation between LVEF and E / A (r = -0.65, r = -0.66, r = -0.48, r = -0.49, r = -0.50, r = -0.52, P < 0.47, r = 0.46, P <0.01). Conclusion 25 (OH) D_3 treatment can improve the cardiac structure and function of patients with DN maintenance hemodialysis and reduce the asynchronous and instability of ventricular repolarization.