CAJ | 학술논문

目的评价临床干预对糖尿病性肾脏疾病(DKD)不同分期的治疗效果.方法选取蛋白尿＜0.5g/24h的DKD患者56例(早期组,ESG)和蛋白尿≥0.59/24h的患者48例(中期组,MSG).采用贝那普利与缬沙坦联合用药、糖尿病规范管理、降压、调脂等常规治疗3个月,测血糖、血压(BP)、HbA1c、尿总蛋白排泄率(UPER)、血清肌醉(Scr),内生肌酐清除率(Ccr)、尿素氮(BUN),随访12个月.结果 (1)治疗后两组FPG、2hPG、HbA1c、BP显著降低(P＜0.05).(2)在控制DKD病程和治疗前UPER因素后,ESG组、MSG组治疗后UPER分别是0.733g/24h(95%CI为0.690～0.777)和0.931g/24h(95%Cl为0.882～0.979)(P＜0.01).肾功能改善指数(RFPI)与治疗前UPER呈对数关系(P＜0.01),RFPI＝11.594-22.688ln(治疗前UPER).(3)ESG组Scr和BUN降低,Ccr升高(P＜0.01),治疗后两组Scr、Ccr、BUN净变化值差异有统计学意义(P＜0.01).(4)ESG组和MSG组肾脏1年生存率分别为97.8%和65.5%(P＜0.01).结论临床干预对早期DKD患者的获益较大.
목적 평개림상간예대당뇨병성신장질병(DKD)불동분기적치료효과.방법 선취단백뇨＜0.5g/24h적DKD환자56례(조기조,ESG)화단백뇨≥0.59/24h적환자48례(중기조,MSG).채용패나보리여힐사탄연합용약、당뇨병규범관리、강압、조지등상규치료3개월,측혈당、혈압(BP)、HbA1c、뇨총단백배설솔(UPER)、혈청기취(Scr),내생기항청제솔(Ccr)、뇨소담(BUN),수방12개월.결과 (1)치료후량조FPG、2hPG、HbA1c、BP현저강저(P＜0.05).(2)재공제DKD병정화치료전UPER인소후,ESG조、MSG조치료후UPER분별시0.733g/24h(95%CI위0.690～0.777)화0.931g/24h(95%Cl위0.882～0.979)(P＜0.01).신공능개선지수(RFPI)여치료전UPER정대수관계(P＜0.01),RFPI＝11.594-22.688ln(치료전UPER).(3)ESG조Scr화BUN강저,Ccr승고(P＜0.01),치료후량조Scr、Ccr、BUN정변화치차이유통계학의의(P＜0.01).(4)ESG조화MSG조신장1년생존솔분별위97.8%화65.5%(P＜0.01).결론 림상간예대조기DKD환자적획익교대.
Objective To evaluate the effect of clinical intervention on different stages of DKD. Methods The T2DM patients with proteinuria＜0.5 g/24 h(Early stage group,ESG,n=56）versus proteinuria≥0.5 g/24 h(Middle stage group, MSG, n=48) were enrolled. The patients were treated for 3 months with benazepril 5-10 mg QD combined with valsartan 80-160 mg QD based on the routine treatment of dyslipidemia, hyperglycemia and hypertension. Plasma levels of glucose, creatinine, BUN, and creatinine clearance rate, blood pressure，glycosylated hemoglobin A1c，urinary protein excretion rate were detected.All the patients were followed up for twelve months. Results After excluding the effects of differences in DKD course and proteinuria between groups of ESG and MSG, the post-treatment values of urinary protein excretion rate of early and middle stage group were 0.733g/24h（95% CI：0.690-0.777）and 0.931g/24h（95% CI：0.882-0.979） respectively (P＜0.01). Renal function improvement index was related with urinary protein excretion rate. The decrement of serum creatinine and blood urea nitrogen were more in ESG than in MSG group, and the creatinine clearance rate increment was more in ESG than in MSG group (all P＜0.05). Survival rate for one year were 97.8% in early stage group and 65.5% in middle stage group (P＜0.01). Conclusion It is more effective to treat T2DM patients with early nephropathy.