伴尿微量白蛋白增高的2型糖尿病肾病患者的循证治疗(附2例报告)

Evidence-based Clinical Treatment of Diabetic Nephropathy with Albuminuria

目的为两例尿微量白蛋白增高的2型糖尿病肾病患者制定治疗方案。方法根据循证临床实践的方法,提出问题,检索证据,对所获证据进行评价,并结合患者意愿为患者制定治疗方案。结果共纳入14个随机对照试验,2个系统评价,2个Meta分析和41个临床指南。证据结果表明:①尿白蛋白增高是糖尿病患者心血管事件的独立危险因素;②血管紧张素受体拮抗剂能降低2型糖尿病肾病患者尿白蛋白水平。③降糖降压治疗能使此类患者获益。结合患者情况,应用证据治疗1月后,2例患者血肌酐恢复正常,尿白蛋白转阴性。结论以高质量证据,结合患者情况制定治疗方案,能明显保护肾脏及心脏,降低尿白蛋白,但远期预后尚需要更长时间的随访观察。

Objective To make individualized evidence-based treatment for patients with diabetic nephropathy with albuminuria. Methods Based on the clinical questions we raised, evidence was collected and critically assessed. Patients＇ willingness was also taken into consideration in the decision-making treatment Results Seventy studies were retrieved and finally 14 randomized controlled trials, 2 systematic reviews, 2 meta-analyses and 41 clinical guidelines were considered eligible. The evidence indicated that albuminuria was an independent cardiovascular risk factor of diabetic patients; angiotensin receptor antagonists might decrease the level of urinary albumin excretion in patients with type 2 diabetic nephropathy; and such patients might benefit from blood glucose and blood pressure control. The individualized treatment plans were developed based on the available evidence. After 1 month of treatment, the serum creatinine returned to normal and albuminuria became negative. Conclusion The individualized treatment plans based on the high quality evidence were optimal in reducing cardiovascular complications and urinary albumin excretion. However, long-term prognostic benefits need to be confirmed by further follow-up.