中西医诊断糖尿病肾病标准近十年变迁

Diabetic Nephropathy Western Diagnostic Criteria Change Thinking in Recent Decades

国内外均以MA作为诊断DN主要依据被普遍认同,不仅反映肾脏损害,也反应全身血管内皮损害,临床试验已证实。2007年KDOQI糖尿病肾病、ADA指南中均推荐ACR为筛查MA的首选方法。除MA、ACR、GFR、血肌酐等常用指标外,又提出尿液足细胞及nephfin检测、Tamm-Horsfall蛋白(THP)、铜兰蛋白(Cp)等,基因易感性成为近年研究热点,基因诊断未来可能成为DN早期诊断的重要指标。目前仍需寻找更敏感、稳定、准确的监测指标,最大限度排除内源性、外源性因素干扰,可采用多种指标联合检测如核素、彩色多普勒、肾穿刺病检辅助诊断以提高DN诊断率。中医诊断参照王永炎、吕仁和、赵进喜、仝小林的诊断标准,各医家均认为DN以本虚为主。王永炎详述本虚证;吕仁和、赵进喜围绕本虚丰富了标实证;仝小林细化兼证、变证,DN辨证是一次新飞跃,诸家对证型不断拓展,辨证分型既交叉渗透,又各有迥异,充分发挥辨证论治、整体观及三因制宜的中医特色。以本虚标实贯穿始终,具体辨证有异同。

MA abroad are the main basis for diagnosis DN is widely recognized,not only reflects kidney damage,but also reflects systemic vascular endothelial damage,clinical trials have confirmed.2007 KDOQI diabetic nephropathy,ADA guidelines are recommended ACR is the preferred method of screening for MA.In addition to MA,ACR,GFR,serum creatinine and other commonly used indicators,also proposed podocytes and nephfin urine testing,Tamm-Horsfall protein(THP),ceruloplasmin(Cp),etc.,genetic predisposition to become research hotspot in recent years,genetic diagnosis the future may become an important indicator of early diagnosis of DN.Currently still looking for more sensitive,stable and accurate monitoring indicators,the maximum exclusion of endogenous,exogenous factors interfere,can be combined detection of a variety of indicators,such as radionuclides,color Doppler,renal biopsy pathology diagnosis to DN improve diagnostic yield.TCM diagnosis reference TRADITIONAL Lu Renhe,Zhao Jinxi,with Kobayashi diagnostic criteria,all physicians are considered virtual DN to the main.TRADITIONAL details the deficiency;Lu Renhe,Zhao Jinxi around the virtual enriched standard empirical;refinement with Kobayashi and permits,change card,DN syndrome is a new leap forward,expanding various home-based cross-checks,both cross-penetration syndrome type,they all have different,give full play to diagnosis and treatment,the overall concept and the system should be the result of three Chinese characteristics.In the vacuity throughout,there are similarities and differences between the specific syndrome.