240例社区糖尿病肾病的进展状况分析

目的观察2型糖尿病常规治疗情况下其肾脏病变的进展状况。方法用前瞻性的研究方法，将240例符合2型糖尿病和糖尿病肾病的患者分为：正常白蛋白尿组、微量白蛋白尿组和临床肾病组，各组患者均予常规控制血糖、血压，以及糖尿病饮食、糖尿病教育和其他对症治疗。检测尿微量白蛋白排泄率（UAER）、尿白蛋白／肌酐比值（A／C）、内生肌酐清除率（CCr）、糖化血红蛋白（HbAlC）、平均动脉血压等指标。结果开始接受治疗时各组平均动脉压、糖化血红蛋白差异均无统计学意义（P〉0．05）；试验结束时血压、糖化血红蛋白与试验前比较有显著下降（P〈0．05）；临床肾病组均高于正常蛋白尿组（P〈0．05），而其余各组间差异仍无统计学意义（P〉0．05）；UAER和A／C三组均升高，临床肾病组升高最快（P〈0．01）。平均每年CCr下降值和Cr升高值以临床肾病组最多；正常白蛋白尿组有20．00％、微量白蛋白尿组有33．33％、临床肾病组有40．00％的病例有进展，临床肾病组与正常蛋白尿组差异有统计学意义（P=0．008〈0．01），其余各组间差异无统计学意义（P〉0．05）。结论UAER和A／C比值的增加均伴随着肾功能快速减退，除控制血压、血糖外，更要从肾脏病变的角度，需肾内科医生的及早临床干预，尤其是对蛋白尿的干预显得尤为重要。

State Analysis of 240 Patients With Diabetic Nephropathy in Community

Objective To observe the progress of diabetic nephropathy in type 2 diabetes mellitus （DM） patients who were treated by routine therapy. Methods 240 patients with diabetic nephropathy and type 2 diabetes mellitus were divided into normal albuminuria group,microalbuminuria group and clinical nephropathy group randomly. All patients were treated by routine therapy, included controlling blood glucose and blood pressure, diabetic diet, diabetes education and other symptomatic treatment. The following indexes were detected,such as urinary albumin excretion rate （UAER）,urinary albumin/creatinine ratio （A/C）, creatinine clearance （Ccr） ,glycosylated hemoglobin （HbA1C） ,mean arterial blood pressure （MABD）. Results There were no significant difference among three groups for HbA1C and MABD before the trial （P 〉 0.05 ）. The level of blood pressure and HbA1C decreased significantly after the trial than those before the trial （ P 〈 0.05）. These two indexes in clinical nephropathy group were higher than those in normal albuminuria group at the end of the trial（ P 〈 0.05 ） ,but they were not significant between those in normal albuminuria group and those in microalbuminuria group, and between microalbuminuria group and clinical nephropathy group（P 〉0.05）. UAER and A/C in three groups after the trial were higher than those before the trial respectively. The decrease of Ccr and increase of Cr per year in clinical nephropathy group were highest among three groups at the end of the trial（ P 〈 0.01 ）. 20% patients in normal albuminuria group,33.3 % in mlcroalbuminuria group and 40% in clinical nephropathy group were deteriorative. The difference was significant between clinical nephropathy group and normal albuminuria group （ P 〈 0.01 ） ,but no difference between other each two groups（ P 〉 0.05）. Conclusions The increasing of UAER and A/C ratio are always followed by the fast decrease of renal function in patients with diabetic nephropathy. This indicates that we must