糖尿病肾病的诊断与治疗陆菊明.ppt

* * * * * * * * * * * * * * * * * * * Because hypertension and dyslipidaemia tend to be co-morbid with type 2 diabetes, true treatment to target is not a matter of glycaemic control only. A multifactorial intervention is needed. The study from the Steno Diabetes Center in Denmark proves that optimal management in type 2 diabetes includes control of BP to 130/80 mmHg and reduction of LDL cholesterol. Patients were randomised to either conventional (n = 80) or intensive treatment (n = 80). Intensive treatment included insulin to control HbA1C to 6.5%, a diuretic to control BP, and an ACE inhibitor, regardless of BP level. Additional therapies were as follows: Intensive treatment: an angiotensin II receptor blocker to control BP to  130/80 mmHg, dietary management of serum lipids (cholesterol: 190 mg/dl; fasting triglycerides: 150 mg/dl), and aspirin 150 mg/day. Conventional treatment: BP control to 135/85 mm Hg and serum lipid control (cholesterol 250 mg/dl; fasting triglycerides 180 mg/dl), with aspirin therapy reserved for patients with known ischaemia. Gaede P et al. N Engl J Med 2003; 348: 383–93. * * * * * * * * * * * * * DN肾病的形成是一个渐进的过程，早期特征性改变是肾小球、肾小管细胞肥大，肾小球毛细血管基底膜增厚，继之细胞外基质形成增多，肾小球硬化和小管间质纤维化。 * * * * Microalbuminuria is a strong predictor of all-cause mortality and cardiovascular morbidity and mortality in type 2 diabetes. The impact of microalbuminuria on mortality was investigated in a 10-year follow-up study of 503 predominantly type 2 diabetic patients.1 265 of the patients died, and 58% of the deaths were caused by cardiovascular (CV) disease. Compared with patients with normal morning urinary albumin concentration (UAC ? 15 μg/min), the relative risk of death for patients with UAC between 15 and 40 μg/min and for patients with UAC between 41 and 200 μg/min were 1.53 and 2.28, respectively. Thus, the probability of survival decreased with increasing levels of UAC within the microalbuminuria range. Microalbuminuria was demonstrated to be a m