Yonemura Katsuhiko, Sugiura Takeshi, Yamashita Fuyuki, Matsushima Hideki, Hishida Akira
Hemodialysis Unit, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Blood Purif. 2004;22(2):210-5. doi: 10.1159/000076855.
We have reported that vitamin D deficiency may be implicated in the pathogenesis of hypoalbuminemia observed in patients with end-stage renal disease, but the mechanism remains to be clarified. The aim of the present study was to determine whether supplementation with alfacalcidol might increase protein intake in hemodialyzed patients with hypoalbuminemia.
Twelve patients with hypoalbuminemia under 3.5 g/dl undergoing maintenance hemodialysis and not taking active forms of vitamin D were orally supplemented with 0.5 microg of alfacalcidol daily for 8 weeks. Normalized protein catabolic rate (nPCR), an index of protein intake, and serum concentrations of albumin, interleukin-6 (IL-6), IL-1beta, and soluble tumor necrosis factor-alpha receptor-II (sTNFR-II), an index of tumor necrosis factor-alpha activity, were determined before and after supplementation with alfacalcidol.
Supplementation with alfacalcidol increased nPCR from 0.96 +/- 0.20 to 1.16 +/- 0.15 g/kg/day (p < 0.005), thereby increasing serum albumin concentration from a baseline of 3.13 +/- 0.35 to 3.32 +/- 0.29 g/dl (p < 0.05). The baseline serum concentrations of sTNFR-II and IL-6 were markedly elevated, whereas those of IL-1beta were under the detection limit. Supplementation with alfacalcidol significantly decreased serum concentration of sTNFR-II from 23.8 +/- 4.38 to 19.7 +/- 3.93 ng/ml (p < 0.001) but did not alter serum IL-6 concentration.
Supplementation with alfacalcidol can increase protein intake and serum albumin concentration in hemodialyzed patients with hypoalbuminemia, probably through the suppressed tumor necrosis factor activity.
我们曾报道维生素D缺乏可能与终末期肾病患者低白蛋白血症的发病机制有关，但具体机制仍有待阐明。本研究的目的是确定补充阿法骨化醇是否能增加低白蛋白血症血液透析患者的蛋白质摄入量。
12名白蛋白水平低于3.5g/dl、正在接受维持性血液透析且未服用活性维生素D的低白蛋白血症患者，每天口服补充0.5μg阿法骨化醇，持续8周。在补充阿法骨化醇前后，测定作为蛋白质摄入指标的标准化蛋白分解代谢率（nPCR），以及白蛋白、白细胞介素-6（IL-6）、IL-1β的血清浓度，和作为肿瘤坏死因子-α活性指标的可溶性肿瘤坏死因子-α受体-II（sTNFR-II）的血清浓度。
补充阿法骨化醇使nPCR从0.96±0.20增加至1.16±0.15g/kg/天（p<0.005），从而使血清白蛋白浓度从基线水平3.13±0.35增加至3.32±0.29g/dl（p<0.05）。sTNFR-II和IL-6的基线血清浓度显著升高，而IL-1β的基线血清浓度低于检测限。补充阿法骨化醇使sTNFR-II的血清浓度从23.8±4.38显著降至19.7±3.93ng/ml（p<0.001），但未改变血清IL-6浓度。
补充阿法骨化醇可能通过抑制肿瘤坏死因子活性，增加低白蛋白血症血液透析患者的蛋白质摄入量和血清白蛋白浓度。
