目的 探讨骨化三醇联合缬沙坦对糖尿病肾病（DN）患者肾素、血管紧张素Ⅱ（AngⅡ）、血管紧张素转换酶（ACE）表达的影响。方法 按随机数字表法将2014年1月-2017年7月北京怀柔医院接诊的60例DN患者分为两组，对照组30例接受缬沙坦治疗，观察组30例接受骨化三醇联合缬沙坦治疗。连续用药6个月后，比较两组肾素、AngⅡ、血肌酐（Scr）、ACE、ACE2、糖代谢指标[糖化血红蛋白（HbA1c）、空腹血糖（FPG）]、蛋白尿相关指标[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。结果 治疗后观察组Scr、AngⅡ、肾素水平分别为（72.15±7.19）μmol/L、（81.24±9.12）ng/L、（104.32±10.37）ng/L，对照组Scr、AngⅡ、肾素水平分别为（83.64±7.43）μmol/L、（86.36±10.09）ng/L、（117.69±8.75）ng/L，差异具有统计学意义（P<0.05）；观察组24 h尿蛋白、UAER、mAlb、α1-MG水平低于对照组，差异具有统计学意义（P<0.05）；观察组和对照组ACE水平分别为（7.79±2.31）pg/mL、（14.82±4.56）pg/mL，差异具有统计学意义（P<0.05）；两组ACE2、Hb A1c、FPG水平比较，差异无统计学意义。结论 对DN患者采用骨化三醇联合缬沙坦治疗效果显著，能有效抑制肾脏ACE表达，降低AngⅡ、肾素水平，改善蛋白尿症状，提高肾功能，对延缓DN病情发展起到重要的作用。

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.

R969