课件：糖尿病肾脏疾病.ppt

* 糖尿病肾病最开始表现为微量白白尿，如果置之不理，可发展至ESRD，这就需要透析或肾移植。在整个糖尿病肾病的进展过程中，心血管患病率和死亡率的危险性也非常高。 * 新诊断的1型糖尿病患者常有急性代谢紊乱所致的暂时性白蛋白尿增多，但血糖控制后白蛋白水平能回到正常。大量纵向队列研究结果发现在发病5年后微量白蛋白尿的发生率急剧增加，因此1型糖尿病患者可以在发病5年后开始每年筛查。 UKPDS研究发现新诊断的2型糖尿病患者中有6.5%尿白蛋白浓度超过50mg/L，且2型糖尿病患者在确诊之前的平均血糖增高时间为8年，因而对2型糖尿病确诊时筛查糖尿病肾病十分必要。 * * * * * * * UKPDS Relative Risk Reduction for Intensive vs Less Intensive Glucose Control In the UK Prospective Diabetes Study (UKPDS), a total of 3,867 patients, median age 54 years, with newly diagnosed diabetes and who had a mean of two fasting plasma glucose (FPG) concentrations of 6.1-15.0 mmol/L were randomized to intensive glucose control with sulphonylurea (chlorpropamide or glibenclamide) or insulin (n=2,729), or conventional control with diet (n=1,138). The primary aggregate endpoints were diabetes-related endpoints, death-related to diabetes, and death from all causes. To assess the differences between chlorpropamide, glibenclamide, and insulin, the additional endpoint aggregates of myocardial infarction (fatal and non-fatal) and sudden death; stroke (fatal and non-fatal); amputation or death due to peripheral vascular disease; and microvascular complications (retinopathy requiring photocoagulation, vitreous hemorrhage, and or fatal or non-fatal renal failure) were used. Median follow-up for endpoint analysis was 10 years, and 11.1 years for the comparison of agents. The most significant impact of intensive control was seen in the risk reduction of microvascular complications. In the intensive glucose control group there was a 12% reduction in risk for any diabetes-related endpoint (P=0.03), which was mostly due to a reduction in microvascular endpoints of 25% (P0.01). In the surrogate endpoints, there was a significant reduction in risk for retinopathy (P=0.02), and for microalbuminuria at 12 years (P0.01). Reference: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabete