糖尿病肾病合并心血管疾病的治疗ppt课件.pptVIP

ACEI治疗糖尿病肾病的临床研究众多。 * ARB治疗糖尿病肾病的临床研究众多。 * * * 对于慢性肾病高血压患者而言，CCB除了是最便于联合使用的降压药物，还具备以上许多其他独到之处。 * 英国糖尿病前瞻性研究（ＵＫＰＤＳ）始于１９７７年，研究目的在于回答一个基本问题：在２型糖尿病患者中，强化血糖控制能否降低糖尿病并发症的危险。  * Twenty-seven eligible studies with 39,704 participants (21 with data for eGFR and 20 for proteinuria or albuminuria) were identified. Overall, the change in the weighted mean differences for eGFR was statistically significant (1.22 ml/min per yr slower in statin recipients; 95% confidence interval [CI] 0.44 to 2.00). In subgroup analysis, the benefit of statin therapy was statistically significant in studies of participants with cardiovascular disease (0.93 ml/min per yr slower than control subjects; 95% CI 0.10 to 1.76) but was NS for studies of participants with diabetic or hypertensive kidney disease or glomerulonephritis. The standardized mean difference for the reduction in albuminuria or proteinuria as a result of statin therapy was statistically significant (0.58 units of SD greater in statin recipients; 95% CI 0.17 to 0.98). Statin therapy seems to reduce proteinuria modestly and results in a small reduction in the rate of kidney function loss, especially in populations with cardiovascular disease. * “We anticipated that atorvastatin might provide a protective effect and slow the typical decline in kidney function in this patient population, but we didn’t expect to see this level of improvement.” – Dr. James Shepherd (University of Glasgow Medical School) * 在TNT-肾功能亚组分析中，评估了他汀治疗对估算肾小球滤过率的影响。无论阿托伐他汀80mg还是10mg均使估算肾小球滤过率显著增长（ P0.0001 ）。且阿托伐他汀80mg强化治疗与阿托伐他汀10mg相比，估算肾小球滤过率增长更显著（P0.0001）。这一结果表明，阿托伐他汀常规或强化治疗均可显著改善老年冠心病患者的肾功能。强化治疗使肾功能改善更明显。 测肾小球滤过率的公式计算方法： 1.MDRD公式GFR=1.86×（血肌酐）-1.164×[年龄（岁）]－0.203×[0.74（若为女性）]2.Cockcrft-Gault公式GFR=[（140-年龄）×体重×0.85（若为女性）]/[72×血肌酐（mg/dL）]，但是Cockcroft-Gault公式通常会低估肾小球滤过率。 利尿剂在糖尿病肾病中的作用 由于其对糖、脂肪及电解质代谢有潜在的不良作用, 如降低糖耐量, 增高甘油三脂及胆固醇, 降低血钾, 增加血尿酸, 故被列入糖尿病高血压病人慎用药物。 但一些研究表明, 小剂量的噻嗪类利尿剂（氢氯噻嗪＜25mg/d）比较适合用于糖尿病伴高血压病人中, 可减少心血管事件并延缓肾病进展。在这一剂量下对糖、脂代谢及电解质紊乱的不良作用较小。对肾功