胆钙化醇、骨化三醇与 CKD 患者血管功能：一项随机、双盲试验。
Cholecalciferol, Calcitriol, and Vascular Function in CKD: A Randomized, Double-Blind Trial.
机构信息
Divisions of Renal Diseases and Hypertension and.
Department of Medicine, Denver Health Medical Center, Denver, Colorado; and.
出版信息
Clin J Am Soc Nephrol. 2017 Sep 7;12(9):1438-1446. doi: 10.2215/CJN.01870217. Epub 2017 Aug 7.
BACKGROUND AND OBJECTIVES
High circulating vitamin D levels are associated with lower cardiovascular mortality in CKD, possibly by modifying endothelial function. We examined the effect of calcitriol versus cholecalciferol supplementation on vascular endothelial function in patients with CKD.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a prospective, double-blind, randomized trial of 128 adult patients with eGFR=15-44 ml/min per 1.73 mand serum 25-hydroxyvitamin D level <30 ng/ml at the University of Colorado. Participants were randomly assigned to oral cholecalciferol (2000 IU daily) or calcitriol (0.5 g) daily for 6 months. The primary end point was change in brachial artery flow-mediated dilation. Secondary end points included changes in circulating markers of mineral metabolism and circulating and cellular markers of inflammation.
RESULTS
One hundred and fifteen patients completed the study. The mean (SD) age and eGFR of participants were 58±12 years old and 33.0±10.2 ml/min per 1.73 m, respectively. There were no significant differences between groups at baseline. After 6 months, neither calcitriol nor cholecalciferol treatment resulted in a significant improvement in flow-mediated dilation (mean±SD percentage flow-mediated dilation; calcitriol: baseline 4.8±3.1%, end of study 5.1±3.6%; cholecalciferol: baseline 5.2±5.2%, end of study 4.7±3.6%); 25-hydroxyvitamin D levels increased significantly in the cholecalciferol group compared with the calcitriol group (cholecalciferol: 11.0±9.5 ng/ml; calcitriol: -0.8±4.8 ng/ml; <0.001). Parathyroid hormone levels decreased significantly in the calcitriol group compared with the cholecalciferol group (median [interquartile range]; calcitriol: -22.1 [-48.7-3.5] pg/ml; cholecalciferol: -0.3 [-22.6-16.9] pg/ml; =0.004).
CONCLUSIONS
Six months of therapy with calcitriol or cholecalciferol did not improve vascular endothelial function or improve inflammation in patients with CKD.
背景与目的
高循环维生素 D 水平与 CKD 患者心血管死亡率降低有关，可能是通过改善内皮功能。我们研究了骨化三醇与胆钙化醇补充对 CKD 患者血管内皮功能的影响。
设计、设置、参与者和测量：我们在科罗拉多大学进行了一项前瞻性、双盲、随机试验，纳入了 128 名 eGFR=15-44 ml/min/1.73m2 且血清 25-羟维生素 D 水平<30ng/ml 的成年患者。参与者被随机分配接受口服胆钙化醇（2000IU/天）或骨化三醇（0.5g/天）治疗 6 个月。主要终点是肱动脉血流介导的扩张变化。次要终点包括循环矿物质代谢标志物以及循环和细胞炎症标志物的变化。
结果
115 名患者完成了研究。参与者的平均（标准差）年龄和 eGFR 分别为 58±12 岁和 33.0±10.2ml/min/1.73m2。基线时两组间无显著差异。6 个月后，骨化三醇和胆钙化醇治疗均未显著改善血流介导的扩张（平均±标准差%血流介导的扩张；骨化三醇：基线 4.8±3.1%，研究结束时 5.1±3.6%；胆钙化醇：基线 5.2±5.2%，研究结束时 4.7±3.6%）；与骨化三醇组相比，胆钙化醇组 25-羟维生素 D 水平显著升高（胆钙化醇：11.0±9.5ng/ml；骨化三醇：-0.8±4.8ng/ml；<0.001）。与胆钙化醇组相比，骨化三醇组甲状旁腺激素水平显著降低（中位数[四分位数范围]；骨化三醇：-22.1[-48.7-3.5]pg/ml；胆钙化醇：-0.3[-22.6-16.9]pg/ml；=0.004）。
结论
6 个月的骨化三醇或胆钙化醇治疗并未改善 CKD 患者的血管内皮功能或炎症。
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