1例糖尿病肾病微量白蛋白尿期患者的循证治疗

目的为1例伴微量白蛋白尿的2型糖尿病患者制定治疗方案。方法根据患者临床特点,提出“对糖尿病肾病微量白蛋白尿期患者进行针对可能导致病情加重的多个危险因素的强化治疗是否能改善其预后”等5个临床问题,检索Cochrane图书馆(2005年4期),ACP Journal Club (1991～2005),MEDLINE(1991～2005),纳入糖尿病肾病治疗的系统评价、Meta分析、随机对照试验和临床指南,根据所获最佳临床证据为患者制定治疗方案。结果共纳入14个研究。现有证据显示,对糖尿病肾病微量白蛋白尿期患者进行针对可能导致病情加重的多个危险因素的强化治疗,包括严格控制血糖、血压,调脂,限制蛋白的摄入,戒烟等能延缓或阻止糖尿病肾病的进展。结论影响糖尿病患者病情加重的因素包括生活方式(饮食、运动、戒烟)、血糖、血压、血脂高低等,对其进行的干预,能有效缓解患者症状,提高患者长期生存质量。

Evidence-based Treatment for a Patient with Type 2 Diabetes and Microalbuminuria

Objective To formulate an evidence-based treatment plan for a patient with type 2 diabetes and microalbuminuria. Methods According to the patient's clinical conditions, we put forward 5 clinical problems. We searched the Cochrane Library (Issue 4, 2005), ACP Journal Club (1991 to 2005), and MEDLINE (1991 to 2005) databases. Systematic review, meta-analysis and randomized controlled trials about the treatment of diabetic nephropathy were included. The treatment plan was developed accordingly. Results Thirteen eligible studies were included. Evidence indicated that an intensive intervention aimed at the multiple potential risk factors could be applied to delay or prevent the progression of diabetic nephropathy, which included intensive blood glucose control, tight blood-pressure control, lipid modulation, restriction of protein intake and smoking cessation. The individualized treatment plan was based on the high quality evidence as well as the patient's specific condition. The patient is still being followed-up. Conclusion Interventions for risk factors of type 2 diabetes like changing living style, decreasing serum glucose, blood pressure, and level of blood fat help to release the clinical symptom and better the long-term living quality of patients.