| Objective:We aimed at investigating the efficacy and safety of irbesartan and alfacalciferol combined therapy in the treatment of type 2 diabetic kidney disease patients(phase ?-?)through randomized parallel controlled intervention studies.In order to provide new theoretical and experimental support for the early prevention and treatment of diabetic kidney disease,discussions about whether alfacalcidol supplementation can reduce the urinary albumin,delay the progression of kidney disease or inhibit the expression of inflammatory cytokines MCP-1 and TGF-?1 were made.Methods:Sixty patients with diabitic kidney disease(phase ?-?)were enrolled.All the cases met the World Health Organization(WHO)diagnostic criteria for diabetes which were issued in 1999 and adopt Mogensen's staging criteria.A randomized block randomized method was used to generate the randomized table in a ratio of 1:1 to irbesartan intervention group(irbesartan 150 mg / day),alfacalciferol and irbesartan combination group(alfacalciferol0.25 ug / day + irbesartan 150 mg / day).They were defined as group A and group B,and each group had 30 subjects.The subjects received continuous treatment for 24 weeks.To observe the changes of results of interventions,renal injury and inflammation status during the treatment of giving alphacalciferol,irbesartan individually and jointly,we carried out follow-up visit at week 0,12 and 24.The expression degree of 25(OH)D was detected by electrochemiluminescence immunoassay.Meanwhile,ELISA was used to measure the levels of MCP-1 andTGF-?1 in urine and serum.Results: 1.There was no significant difference in the serum 25(OH)D level between group A and group B at 0 week(p> 0.05).At 12 and 24 weeks,25(OH)D levels in Group B were higher than those in group A,the difference between the two groups was statistically significant(p <0.05).2.There was no significant difference in the 24-hour urinary protein quantitation between group A and B at 0 week(p> 0.05).At 12 and 24 weeks,the 24-hour urine protein level in group B was lower than that in group A,and the difference between the two groups was statistically significant(p <0.05).3.There were no significant difference in MCP-1 and TGF-?1 levels in both urine and serum,as well as blood CRP between group A and group B at 0 week(p> 0.05).Besides,the levels of the urine MCP-1,TGF-?1 were also not significantly different between the two groups at 12 weeks(p> 0.05).However,the levels of MCP-1 ?TGF-?1 and CRP in blood were lower than those in group A at 12 weeks.The two groups were statistically significant(p <0.05).At 24 week,the levels of the urine and serum MCP-1? TGF-?1 and blood CRP in group B were lower than those in group A,the difference between the two groups was statistically significant(p <0.05)as well as the levels between 0 and 24 weeks in group A.Conclusions: Using alphacalciferol combined with irbesartan to treat patients with type 2 diabetic kidney disease(phase ?-?)can effectively increase 25(OH)D levels,reduce urinary protein and inhibit the expression of inflammatory cytokines MCP-1 and TGF-?1.This therapeutic regimen may delay the progression of kidney disease,and is better than using irbesartan alone in curative effect. |
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