Effect Of 1,25-dihydroxy-vitamin D₃ On Inflammation In Early Stage Of Type 2 Diabetic Kidney Disease

Background:Diabetic kidney disease（DKD）is the most common microvascular complication in diabetes mellitus and one of the main causes of end-stage renal disease.At present,there is no specific treatment for DKD,mainly by lowering blood glucose,blood pressure,regulating blood lipid,reducing urinary protein and other treatments to delay the progression and deterioration of DKD.However,it has been clinically found that despite the adoption of a variety of active interventions,DKD still has a trend of progressive deterioration,and DKD has become an important cause of end-stage renal disease.Therefore,seeking effective treatment to delay the progression of DKD is one of the focuses in this field.Objective:To investigate the effect of 1,25-dihydroxyvitamin D₃on the improvement of urinary protein in early stage of type 2 diabetic kidney disease,and to further verify whether it is related to its immune regulation and anti-inflammatory effect,so as to provide a method for the prevention and treatment of diabetic nephropathy.Methods:According to the diagnostic criteria and inclusion criteria,76 out-patients were recruited at the period from July 2017 to January 2020.After drug-eluting treatment for 2 weeks,the patients were randomly allocated to drug intervention group and control group,by using a random number table method.At the end of the study,a total of 66 cases finished the whole research and 10 lost,among them 32 cases in the control group and 34 cases in the drug intervention group.The control group was given routine treatment of diabetic nephropathy,and the drug intervention group was given 0.25μg 1,25-dihydroxy-vitamin D₃（calcitriol capsule）on the basis of the control group.The follow-up period was 24 weeks.24 h urinary albumin,tumor necrosis factor-α,interleukin-6,C-reactive protein,blood glucose and blood biochemical changes were detected in 2 groups during the study period.Results:1.There was no significant difference in male to female ratio（12:20 vs.16:18）,average age（58.22±17.01 vs.52.35±19.51 years）,body mass index（23.1±1.7 vs.23.8±2.1kg/m2）,hypertension population（22:10 vs.24/10）and average duration of diabetes（7.1±1.4 vs.6.9±2.3 years）between the control group and the drug intervention group.2.At week 0（the starting point of drug intervention）,there was no statistically significant difference in 24-hour urinary albumin quantitation between the drug intervention group and the control group（P>0.05）.After 24 weeks of treatment,there was a statistically significant difference in 24-hour urinary albumin quantification between the two groups（P=0.04<0.05）.With the extension of treatment time,the 24-hour urinary protein quantification in the drug intervention group had a gradually decreasing trend（P<0.01）.3.There was no statistical significance in serum creatinine and serum urea nitrogen levels between the drug intervention group and the control group at week 0（the starting point of drug intervention）and the follow-up observation period（8,16 and 24 weeks）（P>0.05）.4.There was no statistically significant difference in the levels of tumor necrosis factor,interleukin-6 and C-reactive protein in serum of patients in both of the drug intervention group and the control group at week 0（the starting point of drug intervention）and week 8.After 24weeks of intervention,there were statistically significant differences in serum tumor necrosis factor concentration and serum interleukin-6 concentration between the drug intervention group and the control group（P<0.05）.It can be seen from intra-group comparison that with the extension of treatment time,the levels of tumor necrosis factor and interleukin-6 in serum decreased significantly in the drug intervention group.There was no significant difference in C-reactive protein level between the two groups（P>0.05）,and there was no significant decrease in C-reactive protein level in the drug intervention group with the extension of treatment time.5.At week 0（the starting point of drug intervention）,there was no statistically significant difference in the level of 1,25-dihydroxy-vitamin D₃in serum between the drug intervention group and the control group（P>0.05）.After 24 weeks of intervention,there was a statistically significant difference in the level of 1,25-dihydroxyvitamin D₃between the two groups（P<0.05）,and in the drug intervention group,with the extension of treatment time,the level of 1,25-hydroxy-vitamin D₃in the serum had a gradually increasing trend.6.At week 0（the starting point of drug intervention）,week 8,week 16 and week 24,there were no statistically significant differences in serum fasting glucose and Hb A1c levels between the drug intervention group and the control group（P>0.05）.In the drug intervention group,fasting blood glucose and blood Hb A1c were significantly decreased at week 24 compared with week 0,with statistically significant differences.7.At week 0（the starting point of drug intervention）,week 8,week 16 and week 24,blood biochemical indexes were detected between the drug intervention group and the control group.There was no significant difference in serum total protein,serum albumin,ALT,AST,triglyceride,total cholesterol,HDL-C,LDL-C and calcium,magnesium,phosphorus and other electrolytes between two groups.Conclusion:Interventional treatment with 1,25-dihydroxy-vitamin D₃in patients with early stage of type 2 diabetic kidney disease could reduce the levels of serum tumor necrosis factor-αand interleukin-6 inflammatory indicators,as well as 24-hour urinary albumin quantification,and might delay the progression of diabetic nephropathy.