简略版-高血压与糖尿病患者微量白蛋白尿的筛查干预中国专家共识.ppt

Diabetologia. 1989 Apr;32(4):219-26. Albuminuria reflects widespread vascular damage. The Steno hypothesis. Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Kofoed-Enevoldsen A. Steno Memorial Hospital, Gentofte, Denmark. Albuminuria in Type 1 (insulin-dependent) diabetes is not only an indication of renal disease, but a new, independent risk-marker of proliferative retinopathy and macroangiopathy. The coincidence of generalised vascular dysfunction and albuminuria, advanced mesangial expansion, proliferative retinopathy, and severe macroangiopathy suggests a common cause of albuminuria and the severe renal and extrarenal complications associated with it. Enzymes involved in the metabolism of anionic components of the extracellular matrix (e.g. heparan sulphate proteoglycan) vulnerable to hyperglycaemia, seem to constitute the primary cause of albuminuria and the associated complications. Genetic polymorphism of such enzymes is possibly the main reason for variation in susceptibility. Background: No study to date has evaluated whether multifactorial intervention can prevent diabetic nephropathy in patients with type 2 diabetes mellitus and normoalbuminuria. We evaluated the effect of tightly controlling multiple factors recommended by the American Diabetes Association (ADA) on the development and prevention of diabetic nephropathy in Chinese patients with type 2 diabetes mellitus and normoalbuminuria during a 41?2-year period. Methods: A longitudinal cohort study enrolled 1290 patients with type 2 diabetes and normoalbuminuria who received intensified treatment tomeetthe followingADArecommended goals: hemoglobin A1c (HbA1c), less than 7%; systolicbloodpressure, lessthan130mmHg;diastolicblood pressure, less than80mmHg; low-density lipoprotein cholesterol, lessthan100mg/dL;triglycerides, lessthan150mg/ dL; and high-density lipoprotein cholesterol, greater than 40 mg/dL for men and greater than 50 mg/dL for women. Results: During the study period,211patients (