糖尿病肾脏疾病综合管理——从防到治,从生物医学到转化医学

糖尿病是严重威胁人类健康和生命的重要疾病,发病率和患病率快速增长。糖尿病肾脏疾病(diabetic kidney disease,DKD)是糖尿病的严重微血管并发症。而目前DKD的临床防治和基础研究尚无重大突破。控制血糖、血压、血脂、肾素-血管紧张素-醛固酮系统抑制剂的使用、改善内皮功能、改善血液流变学等是其主要的综合治疗措施。但DKD一旦进入临床蛋白尿期,病情往往不可逆地进展至终末期肾衰,需要进行肾脏替代治疗,而心血管事件等合并症的高患病率及发病率致其预后较差。因此,应采取系列措施加以防治,如进一步开展DKD知识宣教,倡导早期筛查、早期诊治;倡导DKD临床结合病理的分期治疗规范,细化临床管理,进一步开展基础和临床研究;个体化选择肾脏替代治疗模式;践行转化医学,争取新理念、新方法、新技术、新器械的科学转化和临床应用;积极开展基础研究等应该是DKD综合管理的重要内容。

Integrated management of diabetic kidney disease: from prevention to treatment, from biomedicine to translation medicine

Diabetes Mellitus (DM) is a worldwide epidemic health and life threatening disease with rapidly increasing prevalence and incidence. Diabetic kidney disease (DKD) is one of the most critical microvascular complications of DM, acts as the leading cause of end stage renal disease (ESRD) in developed countries with less great break in the fields of prevention, treatment and research. The comprehensive therapy of DKD includes the management of blood glucose, blood pressure and lipid, the usage of rennin-angiotension-aldosterone system inhibitors, the improvement of endothelial dysfunction, hemorheology and so on. However, once macroproteinura is detected, the progression into ESRD is irreversible and renal replacement therapy is needed. Cardiovascular morbidity and other complications of DKD patients contribute greatly to the poor outcome. In west China, DKD patients are characterized with low disease awareness, late treatment, low treatment rates, severe status of the illness, long period of hospitalization, more complicated situation and higher mortality rate. Therefore, comprehensive management and care should play more important role in the prevention, treatment and research of DKD, which is composed of health education, guidelines implementation, early screening and diagnosis; standardizing the treatment of DKD according to clinical and pathologic characteristics; individualized renal replacement treatment modalities; practicing translational medicine, carrying out more clinical trials, applying new ideas, techniques and new equipment to the clinical practice and basic researches.