Jódar-Gimeno Esteban, Muñoz-Torres Manuel
Servicio de Endocrinología y Nutrición Clínica, Hospital Universitario Quirón Madrid V, Madrid, España.
Endocrinol Nutr. 2013 Feb;60(2):87-95. doi: 10.1016/j.endonu.2012.04.005. Epub 2012 Jul 2.
The vitamin D hormone system has significant skeletal and extra-skeletal effects. Vitamin D receptor occurs in different tissues, and several cells other than renal cells are able to locally produce active vitamin D, which is responsible for transcriptional control of hundreds of genes related to its pleiotropic effects. There is increasing evidence relating vitamin D to development and course of type 1 and 2 diabetes mellitus. Specifically, influence of vitamin D on the renin-angiotensin-aldosterone system, inflammatory response, and urinary albumin excretion could explain the relevant impact of vitamin D status on diabetic nephropathy. Selective vitamin D receptor activators are molecules able to reproduce agonistic or antagonistic effects of active vitamin D depending on the tissue or even on the cell type. Specifically, paricalcitol has a beneficial profile because of its potency to reduce parathyroid hormone, with lower effects on serum calcium or phosphate levels. Moreover, in patients with diabetes and renal disease, paricalcitol decreases microalbuminuria, hospitalization rates, and cardiovascular mortality. Therefore, these molecules represent an attractive new option to improve prognosis of renal disease in patients with diabetes.
维生素D激素系统具有显著的骨骼和骨骼外效应。维生素D受体存在于不同组织中，除肾细胞外，其他几种细胞也能够局部产生活性维生素D，其负责对数百个与其多效性作用相关的基因进行转录控制。越来越多的证据表明维生素D与1型和2型糖尿病的发生发展及病程有关。具体而言，维生素D对肾素 - 血管紧张素 - 醛固酮系统、炎症反应及尿白蛋白排泄的影响可以解释维生素D状态对糖尿病肾病的相关影响。选择性维生素D受体激活剂是一类分子，根据组织甚至细胞类型的不同，能够重现活性维生素D的激动或拮抗作用。具体来说，帕立骨化醇具有有益的特性，因为它有降低甲状旁腺激素的效力，而对血清钙或磷水平的影响较小。此外，在糖尿病和肾病患者中，帕立骨化醇可降低微量白蛋白尿、住院率和心血管死亡率。因此，这些分子是改善糖尿病患者肾病预后的一个有吸引力的新选择。
