Dab tsi ntawm vitamin D yuav tsum tau noj cov neeg mob CKD?

Raws li peb txhua tus paub, cov teeb meem tshwm sim ntawm tus kab mob raum ntev (CKD) yog kab mob raum tsis zoo thiab pob txha txawv txav (CKD-MBD), uas yog ib qho tseem ceeb ua rau muaj kev tsis taus, kev tuag thiab lwm yam tshwm sim tsis zoo ntawm cov neeg mob CKD. Cov kev tshawb fawb tau lees paub tias vitamin D tuaj yeem txo qis qib ntawm parathyroid hormone (PTH) thiab txo qhov kev pheej hmoo ntawm vascular calcification kev loj hlob hauv cov neeg mob CKD nrog vitamin D tsis txaus, yog li ncua kev loj hlob ntawm CKD-MBD thiab txhim kho qhov kawg prognosis. Txawm li cas los xij, vitamin D yog ib tsev neeg loj uas suav nrog cov tswv cuab xws li ntuj vitamin D, calcidiol, thiab calcitriol. Cov tswv cuab no puas muaj txiaj ntsig zoo rau cov neeg mob CKD/CKD-MBD uas tsis muaj vitamin D?

Nyem rau bioflavonoids ntsiav tshuaj rau mob raum

Thaum Lub Kaum Ib Hlis 11, 2022, pab pawg tshawb fawb los ntawm Tebchaws Meskas tau tshaj tawm txoj kev tshawb fawb hauv BMC Nephrology. Txoj kev tshawb no tau pom tias calcifediol ncua-tso tawm (ERG) tau ua haujlwm tau zoo hauv kev nce 25-hydroxyvitamin D ntau ntau thiab txo PTH qib piv nrog cov vitamin D thiab nws cov analogues (AVD) thiab kev noj zaub mov zoo vitamin D (NVD), thiab Tsis. nce ntshav calcium.

Cov txheej txheem

Qhov no yog kev tshawb fawb hauv ntiaj teb tiag tiag siv cov ntaub ntawv los ntawm cov ntaub ntawv kho mob ntawm cov chaw kho mob nephrology hauv 15 thaj chaw sib txawv hauv Tebchaws Meskas. Cov neeg mob cuv npe kawm tau raws li plaub yam hauv qab no: ① cov neeg mob laus nrog CKD theem 3-4, uas yog, qhov kwv yees glomerular filtration rate (eGFR) yog nyob nruab nrab ntawm 15-60ml/min/1.73㎡; ② cov neeg mob muaj cov kab mob parathyroid ua haujlwm Hyperactivity (SHPT) thiab vitamin D tsis txaus; ③ Cov neeg mob muaj keeb kwm ntawm ERC, NVD lossis AVD kev kho mob, thiab muaj cov ntaub ntawv kho mob rau ntau dua lossis sib npaug li 6 lub hlis ua ntej thiab tom qab tso npe kawm; ④ Tsis txhob tau txais kev kho mob raum. Tag nrho ntawm 1917 tus neeg mob tau kuaj xyuas, thiab thaum kawg, tag nrho ntawm 376 tus neeg mob tau suav nrog. Cov neeg mob tau muab faib ua ERC (n=174), AVD (n=55), thiab NVD (n=147) pawg raws li hom vitamin D uas lawv tau noj.

Cov ntsiab lus tseem ceeb ntawm txoj kev tshawb no yog kev hloov pauv hauv 25-hydroxyvitamin D thiab PTH qib. Cov ntsiab lus thib ob yog kev hloov pauv hauv cov ntshav calcium thiab phosphorus qib.

Cov txiaj ntsig

Lub hnub nyoog tseem ceeb ntawm txhua tus neeg mob yog 69.5 (SD: 13.2) xyoo, 185 tus neeg mob (49.2 feem pua) yog txiv neej, lub cev qhov hnyav (BMI) yog 32.8 (SD: 15.2) kg / ㎡, feem ntau (55.6 feem pua) ntawm cov neeg mob muaj CKD etiology Hypertension, ua raws li ntshav qab zib (38.9 feem pua). 204 (54.3 feem pua) cov neeg mob muaj CKD theem 3, thiab 172 (45.7 feem pua) cov neeg mob muaj CKD theem 4. Cov yam ntxwv ntawm cov neeg mob hauv txhua pab pawg thiab cov ntaub ntawv ntau npaum li cas ntawm cov vitamin D thiab nws cov analogs muaj nyob rau hauv cov lus hauv qab no (Table 1 ).

Hais txog qhov kawg ntawm qhov kawg, cov hauv paus ntsiab lus {{0}}hydroxyvitamin D thiab PTH theem ntawm cov neeg mob hauv pawg ERC yog 20.3±0.7ng/ml thiab 181.4 ± 7.4pg / ml, raws. Tom qab 23.4-28.8 lub lis piam tom qab, qhov 25-hydroxyvitamin D qib tau nce mus rau 23.7 ± 1.6ng / ml (P ＜ 0.001), thaum PTH poob los ntawm 34.1 ± 6.6pg / ml ( 18.8 feem pua, P ＜ 0.001). Nyob rau tib lub sijhawm, tsis muaj kev hloov pauv tseem ceeb hauv cov ntshav calcium thiab phosphorus qib ntawm cov neeg mob.

Cov theem pib ntawm {{0}}hydroxyvitamin D thiab PTH hauv AVD pawg yog 23.5±1.0ng/ml thiab 156.9±9.7pg/ml, raws li. Tom qab 21 lub lim piam tom qab. Txawm li cas los xij, qib PTH thiab ntshav phosphorus qib tsis hloov pauv loj. Qhov tseem ceeb, cov ntshav calcium tau nce siab los ntawm 0.2 ± 0.1 mg / dl (p <0.001).

Cov theem pib ntawm {{0}}hydroxyvitamin D thiab PTH hauv pawg NVD yog 18.6±0.6ng/ml thiab 134.8±6.8pg/ml, raws li. Tom qab 18.3-21.1 lub lis piam tom qab, tsuas yog 25-hydroxyvitamin D tau pom tias nce 9.7 ± 1.5ng / ml (p<0.001). However, PTH, blood calcium, and blood phosphorus levels had no significant changes.

Txawm hais tias feem pua ​​​​ntawm cov neeg mob uas muaj 25-hydroxyvitamin D > 30 ng/ml tom qab kev soj ntsuam, feem pua ​​​​ntawm cov neeg mob uas muaj PTH txo qis > 30 feem pua ​​, thiab cov feem pua ​​​​ntawm cov neeg mob uas muaj 25-hydroxyvitamin D > 30 ng / ml thaum kawg ntawm kev soj ntsuam tab sis < 20 ng / ml ntawm lub hauv paus, pawg ERC muaj qhov zoo.

Kev sib tham

Hauv qhov chaw kho mob hauv ntiaj teb tiag tiag, ERC tau pom tias tsuas yog kev kho mob nkaus xwb uas txo qis PTH hauv cov neeg mob uas tsis tau lim ntshav CKD. Qhov tseeb tias AVD tsis txo qis PTH yog qhov xav tau me ntsis thiab tej zaum yuav muaj feem cuam tshuam nrog kev sau npe qis. Nws xav tias NVD tsis txo qis PTH, thiab qhov laj thawj feem ntau cuam tshuam nrog ob lub ntsiab lus hauv qab no: thawj zaug, ntau qhov kev ntsuam xyuas Meta qhia tias NVD tsis tuaj yeem txo PTH, thiab qhov thib ob, nws nyuaj rau NVD los txhim kho {{4} }hydroxyvitamin D nyob rau hauv cov neeg mob rog rog / rog Qib. Hauv Tebchaws Meskas, cov neeg mob CKD feem ntau hnyav dhau, thiab qee cov neeg mob hauv qhov kev tshawb fawb no tau rog dhau / rog.

Nws yog ib qho tsim nyog sau cia tias qhov nruab nrab nce qib ntawm 25-hydroxyvitamin D hauv pawg ERC (23.7 ng / ml) yog qhov loj tshaj plaws, uas yog qhov zoo dua li hauv AVD (5.5 ng / ml) thiab NVD pawg ( 21.1 ng / ml). Nyob rau tib lub sijhawm, hauv txoj kev tshawb no, yog tias koob tshuaj ERC nce ntxiv, tsis yog yuav tsis muaj teeb meem kev nyab xeeb nkaus xwb, tab sis qhov ua tau zoo kuj tseem yuav txhim kho. Txawm hais tias kev nce koob tshuaj AVD tuaj yeem txhim kho kev ua tau zoo, cov neeg mob hauv AVD pawg tau nce me me ntawm cov calcium hauv cov ntshav, uas tuaj yeem ua rau muaj kev pheej hmoo ntawm CKD-MBD.

Cov txiaj ntsig kev tshawb fawb tam sim no qhia tau hais tias rau SHPT thiab vitamin D-tsis muaj theem 3-4 CKD cov neeg mob, ERC tuaj yeem nce qib ntawm 25-hydroxyvitamin D, txo qib ntawm PTH, thiab tsis muaj kev cuam tshuam loj rau cov homeostasis ntawm cov ntshav calcium thiab ntshav phosphorus.

Yog xav paub ntxiv: Ali.ma@wecistanche.com