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目的探讨1,25-二羟维生素D3[1,25-(OH)_2D_3]对糖尿病肾病(DN)患者血清炎症因子的影响。方法选择单纯2型糖尿病患者设为A组,DN微量白蛋白尿患者设为B组,DN大量蛋白尿患者设为C组,每组30例。将60例DN患者按性别、年龄配对,再随机分为治疗组和对照组,各30例。检测所有患者血1,25-(OH)_2D_3、C反应蛋白(CRP)、白细胞介素-6(IL-6)、IL-17、肿瘤坏死因子-α(TNF-α)、白细胞趋化因子(MCP-1)水平及尿白蛋白/尿肌酐(ACR)。治疗组给予骨化三醇胶丸治疗24周,并复查上述指标。结果血1,25-(OH)_2D_3水平A组患者最高,B组和C组明显下降(P<0.05),C组水平最低,与B组相比,差异有统计学意义(P<0.05)。与A组相比,B组和C组CRP,IL-6,IL-17,TNF-α,MCP-1明显上升(P<0.05);与B组相比,C组CRP,IL-6,IL-17,TNF-α水平显著升高(P<0.05)。治疗前后对照组血1,25-(OH)_2D_3,CRP,IL-6,IL-17,TNF-α,MCP-1无显著变化(P>0.05),ACR显著升高(P<0.05);治疗组治疗后CRP,IL-17,TNF-α,ACR水平显著下降(P<0.05),血1,25-(OH)2D3水平明显升高(P<0.05);与对照组治疗后相比,治疗组血1,25-(OH)_2D_3水平显著升高,IL-17,TNF-α,ACR水平明显下降(P<0.05);相关分析显示,1,25-(OH)_2D_3水平与CRP,IL-17,TNF-α水平呈负相关。结论 DN患者1,25-(OH)_2D_3缺乏,炎症因子水平高,补充骨化三醇胶丸可改善DN患者炎症状态,减少尿蛋白的产生。
Objective To investigate the effects of 1,25-dihydroxy vitamin D3 [1,25- (OH) _2D_3] on serum inflammatory factors in patients with diabetic nephropathy (DN). Methods The patients with type 2 diabetes mellitus were selected as group A, DN microalbuminuria patients as group B, and DN patients with massive proteinuria as group C (n = 30 in each group). Sixty patients with DN were matched by sex and age, then randomly divided into treatment group and control group, 30 cases in each. The blood levels of 1,25- (OH) 2D2, CRP, IL-6, IL-17, TNF- (MCP-1) and urine albumin / urine creatinine (ACR). The treatment group given calcitriol capsules for 24 weeks, and review the above indicators. Results The levels of 1,25- (OH) _2D_3 in blood were the highest in group A, the levels in group B and C were significantly lower than those in group B (P <0.05), while the level in group C was the lowest (P <0.05) . The levels of CRP, IL-6, IL-17, TNF-α and MCP-1 in group B and group C were significantly higher than those in group A (P <0.05) IL-17, TNF-α levels were significantly increased (P <0.05). There were no significant changes in blood 1,25- (OH) _2D_3, CRP, IL-6, IL-17, TNF-a and MCP-1 in the control group before and after treatment (P> 0.05) After treatment, the levels of CRP, IL-17, TNF-α and ACR in the treatment group were significantly decreased (P <0.05) and the levels of 1,25- (OH) 2D3 in the treatment group were significantly increased , The level of blood 1,25- (OH) _2D_3 in the treatment group was significantly increased, the levels of IL-17, TNF-α and ACR were significantly decreased (P <0.05). Correlation analysis showed that the level of 1,25- (OH) , IL-17, TNF-α levels were negatively correlated. Conclusions The deficiency of 1,25- (OH) _2D_3 in DN patients is high and the level of inflammatory cytokines is high. Supplementation of calcitriol capsules can improve the inflammatory state of DN patients and reduce the production of urinary protein.