不同分期糖尿病性肾脏疾病的干预效果评价

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≥0．5g／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）、血清肌酐（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、BID显著降低（P〈0．05）。（2）在控制DKD病程和治疗前UP—ER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％CI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—22．6881n（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。

Evaluation of intervention effect on patients with different stages of diabetic kidney disease(DKD)

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.