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Том 23 №3 2021 год - Нефрология и диализ

Рецептор витамина D: новая терапевтическая мишень при заболевании почек

Волгина Г.В. Михайлова Н.А. Котенко О.Н.

DOI: 10.28996/2618-9801-2021-3-330-351

Аннотация: Витамин D - стероидный гормон (D-гормон) давно известен своей важной ролью в регуляции минерального обмена, минерализации костей и функционировании паращитовидных желез (ПЩЖ). Установлено, что дефицит витамина D (25(OH)D) является одним из факторов риска развития различных заболеваний, таких как сердечно-сосудистая патология, сахарный диабет, ожирение, злокачественные новообразования в общей популяции, но его связь с заболеваемостью и смертностью пациентов с хронической болезнью почек (ХБП) недостаточно изучена. Интерес нефрологов к активному метаболиту витамина D (VD) и его влиянию за пределами классических эффектов возрос за последние несколько лет, что обусловлено фактом обнаружения специфических рецепторов VD (VDR), локализованных в ядрах клеток многих органов и тканей, не связанных с минеральным обменом. Это резко изменило понимание роли, которую играют VDR, и последствия их активации. В ряде исследований были проанализированы отличия различных активаторов (агонистов) VDR и предложена новая концепция селективной активации VDR. Спектр опосредованных D-гормоном эффектов был расширен до плейотропных экстраскелетных действий. В настоящем обзоре мы подробно освещаем физиологию витамин D и влияние на неё многочисленных эндогенных и экзогенных факторов. Отдельно обсуждаются нарушения обмена витамина D при различных стадиях ХБП, тесная взаимосвязь активации VDR, секреции FGF23 и уровня α-Клото. В разделе, посвященном роли активаторов VDR в лечении вторичного гиперпаратиреоза, рассмотрены возможности всего спектра существующих метаболитов витамина D в подавлении секреции паратгормона и влиянии на уровни кальция и фосфора. Приведены результаты недавних метаанализов, сравнивающих эффективность и безопасность селективных и неселективных активаторов VDR (aVDR). Наконец, мы представили достижения в новых областях терапевтического применения селективного активатора VDR парикальцитола как рено- и кардиопротектора, а также привели доводы о потенциальной роли в профилактике различных хронических неинфекционных заболеваний у пациентов с ХБП.

Для цитирования: Волгина Г.В., Михайлова Н.А., Котенко О.Н. Рецептор витамина D: новая терапевтическая мишень при заболевании почек. Нефрология и диализ. 2021. 23(3):330-351. doi: 10.28996/2618-9801-2021-3-330-351

Весь текст

Ключевые слова: хроническая болезнь почек, минерально-костные нарушения, вторичный гиперпаратиреоз, D-гормон, активаторы рецепторов витамина D, парикальцитол, плейотропные эффекты, chronic kidney disease, mineral bone disorders, secondary hyperparathyroidism, D-hormone, vitamin D receptor activators, paricalcitol, pleiotropic effects

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