广州市荔湾区社区2型糖尿病肾病进展状况研究.docVIP

广州市荔湾区社区2型糖尿病肾病进展状况研究 　　doi：10.3969/j.issn.1007-614x.2013.19.19 　　摘 要 目的：观察2型糖尿病在常规治疗情况下，其肾脏病变的进展状况。方法：用前瞻性的研究方法，将480例符合2型糖尿病和糖尿病肾病患者分为正常白蛋白尿组、微量白蛋白尿组和临床肾病组，各组均用常规控制血糖、血压，以及糖尿病饮食、糖尿病教育和其他对症治疗。检测尿微量白蛋白排泄率（UAER）、尿白蛋白/肌酐比值（A/C）、内生肌酐清除率（Ccr）、糖化血红蛋白（HbA1C）、平均动脉血压等指标。结果：开始接受治疗时各组平均动脉压、糖化血红蛋白差异无统计学意义（P0.05）；试验结束时血压、糖化血红蛋白与试验前比较有显著下降（P0.05）；UAER和A/C，3组均升高，临床肾病组升高最快，差异具有统计学意义（P0.05）。结论：UAER和A/C比值的增加均伴随着肾功能的快速减退，除控制血压、血糖外，更要从肾脏病变的角度、需肾内科医生的及早临床干预，尤其是对蛋白尿的干预显得尤为重要。 　　关键词 糖尿病肾病 社区医疗 2型糖尿病 　　Abstract Objective：To observe progressive state of diabetic nephropathy with conventional therapy in type 2 diabetes mellitus.Methods：480 patients with diabetic nephropathy in type 2 diabetes mellitus were divided into normal albuminuria group，microalbuminuria group and clinical nephropathy group in random and prospective method.All patients were administrated by conventional therapy，included controlling blood glucose and blood pressure，diabetic diet，diabetic life style instruction and other symptomatic treatment.Theses indexes were determined，such as urinary albumin excretion rate（UAER），urinary albumin：creatinine ratio（A/C），creatinine clearance（Ccr），glycosylated hemoglobin（HbA1C），mean arterial blood pressure（MABD）.Results：There were no significant difference among three groups for HbA1C and MABD before the trial（P0.05）.The level of blood pressure and HbA1C descended significantly after the trial than those before the trial（P0.05）.UAER and A/C in three groups after the trial were higher than those before the trial respectively.The level of UAER，A/C，average descended Ccr and average heightened Cr per year in clinical nephropathy group were highest among three groups at the end of the trial（P0.05）.Conclusion：The increasing of UAER and A/C ratio are always followed by the fast decrescence of renal function in patients with diabetic nephropathy.This indicates we must interfere in it as soon as possible and search for effective therapy to decrease urinary albumin excretion early at point