目的 探讨1,25-(OH)2维生素D3对2型糖尿病肾病患者血、尿血管生成素样蛋4(Angptl4)水平的影响.方法 纳入单纯2型糖尿病患者(A组),糖尿病肾病微量白蛋白尿组(B组),糖尿病肾病大量蛋白尿组(C组),每组各30例.将60例DN患者按性别、年龄配对再随机分为接受1,25-(OH)2D3治疗组和对照组各30例.检测所有患者尿微量白蛋白/尿肌酐(ACR)、尿Angptl4,血1,25-(OH)2D3、血清白蛋白(Alb)、尿素氮(BUN)、肌酐(Cr)、胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、血钙(Ca)、空腹血糖(FBG)、糖化血红蛋白(HbA1C)和血Angptl4,治疗组给予骨化三醇胶丸治疗12周,并复查上述指标.结果 与A组患者相比,B组和C组患者ACR、尿Angptl4水平明显升高(P<0.05),血1,25-(OH)2D3、血Angptl4水平明显下降(P<0.05);与B组相比,C组患者ACR、尿Angptl4水平明显升高,(P<0.05),血1,25-(OH)2D3、血Angptl4水平明显下降(P<0.05);对照组治疗前后各项指标无明显变化(P>0.05).治疗组治疗后与治疗前相比,ACR和尿Angptl4水平下降(P<0.05),血1,25-(OH)2D3、血Angptl4水平明显升高(P<0.05);相关分析显示血Angptl4水平与血1,25(OH)2D3的水平呈正相关(r=0.526,P<0.05),与尿Angptl4水平呈负相关(r=-0.656,P<0.05),与尿ACR水平呈负相关(r=-0.621,P<0.05).结论 DN患者血Angptl4水平明显下降、尿Angptl4水平明显上升,而补充活性维生素D3后,DN患者的血Angptl4水平有所提升,且蛋白尿减少.%Objective To investigate the effect of 1,25-dihydroxy-vitamin D3 on the Angptl4 levelof pa-tients with diabetic nephropathy. Methods A total of 90 patients with type 2 diabetes mellitus were divided into diabetes mellitus group(group A,n=30),early diabetic nephropathy group(group B,n=30),clinical diabetic ne-phropathy group(group C,n=30).DN patients were randomly divided into the treatment group receiving routine therapy plus 1,25-dihydroxy-vitamin D3and control group receiving routine therapy.All patients were observed for12 weeks to compare the changes of 1,25-dihydroxy-vitamin D3,ACR,Angptl4,Alb,BUN,Cr,TC ,TG , LDL,Ca ,FBG,HbA1C before and after therapy. Results Compared with group A,the level of ACR and urinar-yAngptl4 were higher in group B and group C(P<0.05),and serum Angptl4 and 1,25-dihydroxy-vitamin D3 were lower in group B and group C(P < 0.05).Compared with patients in group B,ACR,urinary Angptl4 level in-creased significantly,P<0.05,1,25-(OH)2 D3,serum Angptl4 levels of patients in group C significantly de-creased(P<0.05). The indicatorsin the control groupshowed no significant changes before and after the treatment (P>0.05). Comparison before and after treatment in treatment group showed ACR and urinary Angptl4 levels de-creased(P<0.05),and serum Angptl4 level increased significantly(P<0.05). Correlation analysis showed that serum Angptl4 level and the level of blood 1,25(OH)2 D3 werein positive correlation(r = 0.526,P < 0.05), negatively correlated with urinary Angptl4 levels(r=-0.656,P<0.05),and negatively correlated with ACR lev-el(r =-0.621,P < 0.05). Conclusion The level of serum Angptl4 in patients with DN significantly decreased and the level of urinary Angptl4 significantly increased,while the level of serum Angptl4 in patients with DN in-creased after the treatment of active vitamin D3,and proteinuria decreased.
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