目的 探討骨化三醇聯(lián)合纈沙坦對糖尿病腎?。―N）患者腎素、血管緊張素Ⅱ（AngⅡ）、血管緊張素轉(zhuǎn)換酶（ACE）表達的影響。方法 按隨機數(shù)字表法將2014年1月-2017年7月北京懷柔醫(yī)院接診的60例DN患者分為兩組，對照組30例接受纈沙坦治療，觀察組30例接受骨化三醇聯(lián)合纈沙坦治療。連續(xù)用藥6個月后，比較兩組腎素、AngⅡ、血肌酐（Scr）、ACE、ACE2、糖代謝指標[糖化血紅蛋白（HbA1c）、空腹血糖（FPG）]、蛋白尿相關指標[24 h尿蛋白、尿蛋白排泄率（UAER）、尿微量白蛋白（mAlb）、尿α1-微球蛋白（α1-MG）]水平。結(jié)果 治療后觀察組Scr、AngⅡ、腎素水平分別為（72.15±7.19）μmol/L、（81.24±9.12）ng/L、（104.32±10.37）ng/L，對照組Scr、AngⅡ、腎素水平分別為（83.64±7.43）μmol/L、（86.36±10.09）ng/L、（117.69±8.75）ng/L，差異具有統(tǒng)計學意義（P<0.05）；觀察組24 h尿蛋白、UAER、mAlb、α1-MG水平低于對照組，差異具有統(tǒng)計學意義（P<0.05）；觀察組和對照組ACE水平分別為（7.79±2.31）pg/mL、（14.82±4.56）pg/mL，差異具有統(tǒng)計學意義（P<0.05）；兩組ACE2、Hb A1c、FPG水平比較，差異無統(tǒng)計學意義。結(jié)論 對DN患者采用骨化三醇聯(lián)合纈沙坦治療效果顯著，能有效抑制腎臟ACE表達，降低AngⅡ、腎素水平，改善蛋白尿癥狀，提高腎功能，對延緩DN病情發(fā)展起到重要的作用。

Objective To investigate the effect of valsartan combined with calcitriol on expression of renin, angiotensin Ⅱ (Ang Ⅱ) and angiotensin converting enzyme in patients with diabetic nephropathy (DN). Methods 60 DN patients admitted into our hospital from January 2014 to July 2017 were divided into two groups by random number table, 30 cases in each group. Control group was given valsartan, while research group was treated with valsartan combined with calcitriol. After six-month treatment, the renin, Ang Ⅱ, serum creatinine (Scr), ACE, ACE2, glucose metabolism indexes[haemoglobin A1C (HbA1c), fasting plasma glucose (FPG)], proteinuria-related indexes[24 h urinary protein, urine albumin excretion rate (UAER), microalbuminuria (mAlb), α1-microglobulin (α1-MG)] were compared between the two groups. Results After treatment, the levels of Scr, Ang Ⅱ, renin in research group[(72.15 ±7.19) μmol/L, (81.24 ±9.12) ng/L, (104.32 ±10.37) ng/L] and control group[(83.64 ±7.43) μmol/L, (86.36 ±10.09) ng/L, (117.69 ±8.75) ng/L] were compared, there was statistical difference (P<0.05). The levels of 24 h urinary protein, UAER, mAlb, α1-MG in research group were lower than those in control group (P<0.05). The levels of ACE in research group and control group were (7.79 ±2.31) pg/mL and (14.82 ±4.56) pg/mL, with statistical difference (P<0.05). There was no statistical difference in the levels of ACE2, Hb A1c, FPG between the two groups. Conclusion Valsartan combined with calcitriol in treatment of DN is effective, it can restrain renal ACE expression, decrease the levels of Ang Ⅱ and renin, improve proteinuria, increase renal function and delay the development of DN.

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