课件：聚焦微量蛋白尿优化高血压伴糖尿病的心肾保护解析.ppt

* 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 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 (16.4%) developed new-onset microalbuminuria. A significant association was found between the achievement ofADAgoals, including HbA1c level less than 7% (hazard ratio [HR], 0.729;95%confidence interval [CI], 0.553-0.906; P=.03), systolic blood pressure less than 130mmHg(0.645; 0.491- 0.848; P=.002), and high-density lipoprotein cholesterol level greater than 50 mg/dL for women and greater than 40 mg/dL for men (0.715; 0.537-0.951; P=.02) and the development of new-onset microalbuminuria. Conclusions: Diabetic nephropathy can be delayed by tight simultaneous achievement of multiple ADArecommended targets. This multifactorial intervention should be started in patients with diabetes and norm