Several pharmacological agents to prevent the progression of diabetic kidney disease(DKD)have been tested in patients with type 2 diabetes mellitus(T2DM)in the past two decades.With the exception of renin-angiotensin ...Several pharmacological agents to prevent the progression of diabetic kidney disease(DKD)have been tested in patients with type 2 diabetes mellitus(T2DM)in the past two decades.With the exception of renin-angiotensin system blockers that have shown a significant reduction in the progression of DKD in 2001,no other pharmacological agent tested in the past two decades have shown any clinically meaningful result.Recently,the sodium-glucose cotransporter-2 inhibitor(SGLT-2i),canagliflozin,has shown a significant reduction in the composite of hard renal and cardiovascular(CV)endpoints including progression of end-stage kidney disease in patients with DKD with T2DM at the top of reninangiotensin system blocker use.Another SGLT-2i,dapagliflozin,has also shown a significant reduction in the composite of renal and CV endpoints including death in patients with chronic kidney disease(CKD),regardless of T2DM status.Similar positive findings on renal outcomes were recently reported as a top-line result of the empagliflozin trial in patients with CKD regardless of T2DM.However,the full results of this trial have not yet been published.While the use of older steroidal mineralocorticoid receptor antagonists(MRAs)such as spironolactone in DKD is associated with a significant reduction in albuminuria outcomes,a novel non-steroidal MRA finerenone has additionally shown a significant reduction in the composite of hard renal and CV endpoints in patients with DKD and T2DM,with reasonably acceptable side effects.展开更多
Coronavirus disease 2019(COVID-19)is a disease that caused a global pandemic and is caused by infection of severe acute respiratory syndrome coronavirus 2 virus.It has affected over 768 million people worldwide,result...Coronavirus disease 2019(COVID-19)is a disease that caused a global pandemic and is caused by infection of severe acute respiratory syndrome coronavirus 2 virus.It has affected over 768 million people worldwide,resulting in approx-imately 6900000 deaths.High-risk groups,identified by the Centers for Disease Control and Prevention,include individuals with conditions like type 2 diabetes mellitus(T2DM),obesity,chronic lung disease,serious heart conditions,and chronic kidney disease.Research indicates that those with T2DM face a hei-ghtened susceptibility to COVID-19 and increased mortality compared to non-diabetic individuals.Examining the renin-angiotensin system(RAS),a vital regulator of blood pressure and pulmonary stability,reveals the significance of the angiotensin-converting enzyme(ACE)and ACE2 enzymes.ACE converts angiotensin-I to the vasoconstrictor angiotensin-II,while ACE2 counters this by converting angiotensin-II to angiotensin 1-7,a vasodilator.Reduced ACE2 exp-ression,common in diabetes,intensifies RAS activity,contributing to conditions like inflammation and fibrosis.Although ACE inhibitors and angiotensin receptor blockers can be therapeutically beneficial by increasing ACE2 levels,concerns arise regarding the potential elevation of ACE2 receptors on cell membranes,potentially facilitating COVID-19 entry.This review explored the role of the RAS/ACE2 mechanism in amplifying severe acute respiratory syndrome cor-onavirus 2 infection and associated complications in T2DM.Potential treatment strategies,including recombinant human ACE2 therapy,broad-spectrum antiviral drugs,and epigenetic signature detection,are discussed as promising avenues in the battle against this pandemic.展开更多
目的:探讨血管紧张素Ⅱ受体阻滞剂(ARB)联合钠-葡萄糖协同转运蛋白2(SGLT_(2))抑制剂治疗慢性肾小球肾炎(CGN)的临床效果。方法:选取2023年1—12月上饶市立医院肾内科收治的80例CGN患者为研究对象,通过抽签法将其分为观察组和对照组,每...目的:探讨血管紧张素Ⅱ受体阻滞剂(ARB)联合钠-葡萄糖协同转运蛋白2(SGLT_(2))抑制剂治疗慢性肾小球肾炎(CGN)的临床效果。方法:选取2023年1—12月上饶市立医院肾内科收治的80例CGN患者为研究对象,通过抽签法将其分为观察组和对照组,每组40例。对照组给予恩格列净治疗,观察组在对照组基础上加用缬沙坦。比较两组临床疗效、治疗前后肾功能指标[血肌酐(Scr)、血尿素氮(BUN)、血清白蛋白、24 h尿蛋白(24 h UP)]、免疫指标[白细胞介素-2(IL-2)、白细胞介素-4(IL-4)]及不良反应(腹胀、皮疹、低血糖、低血压、尿路感染)。结果:观察组总有效率显著高于对照组,差异有统计学意义(P<0.05)。治疗后,两组Scr、BUN、24 h UP均低于治疗前,且观察组均低于对照组,差异均有统计学意义(P<0.05)。治疗后,两组血清白蛋白、IL-2、IL-4均高于治疗前,且观察组均高于对照组,差异均有统计学意义(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论:缬沙坦联合恩格列净治疗CGN的效果确切,能明显改善肾小球的滤过状态,使其有效排出Scr、BUN,防止蛋白质通过尿液流失,调节免疫功能,且安全性可。展开更多
文摘Several pharmacological agents to prevent the progression of diabetic kidney disease(DKD)have been tested in patients with type 2 diabetes mellitus(T2DM)in the past two decades.With the exception of renin-angiotensin system blockers that have shown a significant reduction in the progression of DKD in 2001,no other pharmacological agent tested in the past two decades have shown any clinically meaningful result.Recently,the sodium-glucose cotransporter-2 inhibitor(SGLT-2i),canagliflozin,has shown a significant reduction in the composite of hard renal and cardiovascular(CV)endpoints including progression of end-stage kidney disease in patients with DKD with T2DM at the top of reninangiotensin system blocker use.Another SGLT-2i,dapagliflozin,has also shown a significant reduction in the composite of renal and CV endpoints including death in patients with chronic kidney disease(CKD),regardless of T2DM status.Similar positive findings on renal outcomes were recently reported as a top-line result of the empagliflozin trial in patients with CKD regardless of T2DM.However,the full results of this trial have not yet been published.While the use of older steroidal mineralocorticoid receptor antagonists(MRAs)such as spironolactone in DKD is associated with a significant reduction in albuminuria outcomes,a novel non-steroidal MRA finerenone has additionally shown a significant reduction in the composite of hard renal and CV endpoints in patients with DKD and T2DM,with reasonably acceptable side effects.
文摘Coronavirus disease 2019(COVID-19)is a disease that caused a global pandemic and is caused by infection of severe acute respiratory syndrome coronavirus 2 virus.It has affected over 768 million people worldwide,resulting in approx-imately 6900000 deaths.High-risk groups,identified by the Centers for Disease Control and Prevention,include individuals with conditions like type 2 diabetes mellitus(T2DM),obesity,chronic lung disease,serious heart conditions,and chronic kidney disease.Research indicates that those with T2DM face a hei-ghtened susceptibility to COVID-19 and increased mortality compared to non-diabetic individuals.Examining the renin-angiotensin system(RAS),a vital regulator of blood pressure and pulmonary stability,reveals the significance of the angiotensin-converting enzyme(ACE)and ACE2 enzymes.ACE converts angiotensin-I to the vasoconstrictor angiotensin-II,while ACE2 counters this by converting angiotensin-II to angiotensin 1-7,a vasodilator.Reduced ACE2 exp-ression,common in diabetes,intensifies RAS activity,contributing to conditions like inflammation and fibrosis.Although ACE inhibitors and angiotensin receptor blockers can be therapeutically beneficial by increasing ACE2 levels,concerns arise regarding the potential elevation of ACE2 receptors on cell membranes,potentially facilitating COVID-19 entry.This review explored the role of the RAS/ACE2 mechanism in amplifying severe acute respiratory syndrome cor-onavirus 2 infection and associated complications in T2DM.Potential treatment strategies,including recombinant human ACE2 therapy,broad-spectrum antiviral drugs,and epigenetic signature detection,are discussed as promising avenues in the battle against this pandemic.
文摘目的:探讨血管紧张素Ⅱ受体阻滞剂(ARB)联合钠-葡萄糖协同转运蛋白2(SGLT_(2))抑制剂治疗慢性肾小球肾炎(CGN)的临床效果。方法:选取2023年1—12月上饶市立医院肾内科收治的80例CGN患者为研究对象,通过抽签法将其分为观察组和对照组,每组40例。对照组给予恩格列净治疗,观察组在对照组基础上加用缬沙坦。比较两组临床疗效、治疗前后肾功能指标[血肌酐(Scr)、血尿素氮(BUN)、血清白蛋白、24 h尿蛋白(24 h UP)]、免疫指标[白细胞介素-2(IL-2)、白细胞介素-4(IL-4)]及不良反应(腹胀、皮疹、低血糖、低血压、尿路感染)。结果:观察组总有效率显著高于对照组,差异有统计学意义(P<0.05)。治疗后,两组Scr、BUN、24 h UP均低于治疗前,且观察组均低于对照组,差异均有统计学意义(P<0.05)。治疗后,两组血清白蛋白、IL-2、IL-4均高于治疗前,且观察组均高于对照组,差异均有统计学意义(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论:缬沙坦联合恩格列净治疗CGN的效果确切,能明显改善肾小球的滤过状态,使其有效排出Scr、BUN,防止蛋白质通过尿液流失,调节免疫功能,且安全性可。
