广州市荔湾区社区2型糖尿病肾病进展状况研究

目的:观察2型糖尿病在常规治疗情况下,其肾脏病变的进展状况。方法:用前瞻性的研究方法,将480例符合2型糖尿病和糖尿病肾病患者分为正常白蛋白尿组、微量白蛋白尿组和临床肾病组,各组均用常规控制血糖、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(HbA1C)、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),而其余各组间仍无统计学意义(P>0.05);UAER和A/C,3组均升高,临床肾病组升高最快,差异具有统计学意义(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20.00%、微量白蛋白尿组33.33%、临床肾病组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<0.01),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的快速减退,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。

Objective：To observe progres- sive state of diabetic nephropathy with con- ventional therapy in type 2 diabetes mellitus. Methods：480 patients with diabetic nephrop- athy in type 2 diabetes mellitus were divid- ed into normal albuminuria group,microal- buminuria group and clinical nephropathy group in random and prospective method.All patients were administrated by conventional therapy, included controlling blood glucose and blood pressure.diabetic diet,diabetic life style instruction and other symptomatic treatment.Theses indexes were determined, such as urinary, albumin excretion rate（UAER）,urinary albumin：creatinine ra- tio（A/C）,creatinine clearance（Ccr）,glycosyl- ated hemoglobin（HbA1c）,mean arterial blood pressure（MABD）.Results：There were no sig- nificant difference among three groups for HbAIC and MABD before the trial（P〉 0.05）.The level of blood pressure and HbA 1C descended significantly after the tri- al than those before the trial（P 〈 0.05）.These two indexes in clinical nephropathy group were higher than those in normal albumin uria group at the end of the trial（P〈 0.05）, but they were not significant between those in normal Mbuminuria group and those in microalbuminuria group,and between micro- albuminuria group and clinical nephropathy group（P〉O.05）.UAER and A/C in three groups after the trial were higher than those before the trim respectively.The level of UAER,A/C,average descended Ccr and av- erage heightened Cr per year in clinical ne- phropathy group were highest among three groups at the end of the trial（P〈0.01）. Twenty percent of patients in normal Mbu- minuria group was deteriorative,thirty-three point three percent in microalbuminuria group and forty percent in clinical nephrop- athy group.The diference was extremely significant between clinical nephropathy grmlp and normal albuminuria group（P=0.008〈 O.01）,but no diference between other each two groups（P〉0.05）.Conclusion：The in- creasing of UAER and A/C ratio are always followed by the fast decrescence of renal fnnction in patients with diabetic nephropa- thy.This indicates we must interfere in it as soon as possible and search fiw effective therapy to decrease urinary albumin excre- tion early at point of view of rennproteclion.