课件：聚焦微量蛋白尿,优化高血压伴糖尿病的心肾保护.ppt

* 糖尿病患者有40-50%患有高血压，高血压会加速糖尿病患者肾脏病的进展。从单纯高血压进展到终末期肾病要将经历3个阶段，高血压和糖尿病均可导致肾脏高高灌注和高滤过，肾小球通透性增加，患者出现微量蛋白尿。若不去除病因，有效控制血压和蛋白尿，肾脏病变可进一步进展，出现大量蛋白尿。若再未及时治疗，则可发展至肾小球硬化和肾小管纤维化，肾脏功能衰竭需要透析或肾移植，也就是终末期肾病（肾脏终点事件）。2型糖尿病患者进展更为迅速，很多患者在确诊糖尿病时就已经存在肾脏损害。因此，糖尿病肾病治疗的靶点是降低血压和蛋白尿，最终目标是降低终末期肾病和死亡风险。强效降压和控制蛋白尿是延缓肾病进展的关键。 Developing Education on Microalbuminuria for Awareness of reNal and cardiovascular risk in Diabetes Developing Education on Microalbuminuria for Awareness of reNal and cardiovascular risk in Diabetes Developing Education on Microalbuminuria for Awareness of reNal and cardiovascular risk in Diabetes 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. * Figure 1—The individual degree of proteinuria lowering (after several weeks of therapy) is a predictor for long-term (years) renal protection: the more proteinuria is lowered, the less the glomerular filtration rate (GFR) will decline during follow-up, both in diabetic and nondiabetic renal disease patients. Background: No study to date has evaluated whether multifactorial intervention