Effect of calcitriol on oxidative stress and insulin resistance in patients with nonalcoholic fatty liver disease
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摘要: 目的 探讨骨化三醇补充对非酒精性脂肪性肝病(NAFLD)患者氧化应激和胰岛素抵抗的影响。方法 共筛查91例NAFLD患者,纳入68例。根据患者血清25(OH)D3水平将68例患者分为3组;维生素D缺乏组、维生素D不足组和维生素D正常组。对维生素D缺乏组和不足组的NAFLD患者补充骨化三醇0.25 μg/d,随访12周。最终,有57名受试者完成研究并被纳入分析(维生素D缺乏组、维生素D不足组和维生素D正常组分别为14例、19例和24例)。比较骨化三醇补充前后的各项指标的变化。结果 维生素D缺乏组和不足组NAFLD患者的超敏C反应蛋白(hs-CRP)、丙二醛(MDA)水平高于维生素D正常组,超氧化物歧化酶(SOD)水平低于维生素D正常组(P<0.05),校正混杂因素后,差异仍存在统计学意义(P<0.05)。此外,维生素D缺乏组和维生素D不足组胰岛素抵抗指数(HOMA-IR)显著高于维生素D正常组(P<0.05)。骨化三醇干预12周后,维生素D缺乏和维生素D不足NAFLD患者的血清25(OH)D3水平明显升高(P<0.01),hs-CRP、MDA水平明显下降(P<0.05),SOD活性明显升高(P<0.05),脂肪肝指数(FLI)明显降低(P<0.05),但骨化三醇干预前后的HOMA-IR无明显改变(P>0.05)。结论 补充骨化三醇可改善维生素D缺乏和不足NAFLD患者的氧化应激反应,但对胰岛素抵抗无明显影响。Abstract: Objective To investigate the effect of calcitriol supplementation on oxidative stress and insulin resistance in patients with nonalcoholic fatty liver disease (NAFLD). Methods A total of 91 patients with NAFLD were screened and 68 were included in this study. According to the level of serum 25 (OH) D3, 68 patients were divided into three groups: vitamin D deficiency group, vitamin D insufficiency group and vitamin D normal group. NAFLD patients in vitamin D deficiency group and vitamin D insufficiency group were given 0.25 μ g /d of calcitriol and were followed up for 12 weeks. Finally, 57 patients (there were 14 cases in vitamin D deficiency group, 19 cases in vitamin D insufficiency group and 24 cases in vitamin D normal group) completed the study and were included in the analysis. The changes of the various parameters before and after the supplementation of calcitriol were compared. Results The levels of high-sensitivity C-reactive protein (hs-CRP) and methylenedioxyamphetamine (MDA) of NAFLD patients in the vitamin D deficiency group and vitamin D insufficiency group were higher than those in the vitamin D normal group, while the level of superoxide dismutase (SOD) was lower than that in the vitamin D normal group (P<0.05). After correction of confounding factors, the difference was still statistically significant (P<0.05). In addition, the homeostasis model assessment of insulin resistance (HOMA-IR) in the vitamin D deficiency group and vitamin D insufficiency group was also significantly higher than that in the vitamin D normal group (P<0.05). After intervention with calcitriol for 12 weeks, the level of serum 25 (OH) D3 in the vitamin D deficiency and vitamin D insufficiency NAFLD patients increased significantly (P<0.01), the levels of hs-CRP and MDA decreased significantly (P<0.05), the level of SOD increased significantly (P<0.01), and fatty liver index (FLI) decreased significantly (P<0.05), but HOMA-IR did not show significant changes (P>0.05). Conclusions Calcitriol suplementation can improve the oxidative stress response of NAFLD patients with vitamin D deficiency and insufficiency, but has no significant effect on insulin resistance.
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