1例糖尿病腎病微量白蛋白尿期患者的循證治療_《中國循證醫學雜志》

作者：

左瑩 ,  李雙慶

四川大學華西金卡醫院（成都 610041）;

關鍵詞：

糖尿病腎病微量白蛋白尿循證治療

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目的　為1例伴微量白蛋白尿的2型糖尿病患者制定治療方案。
方法　根據患者臨床特點，提出“對糖尿病腎病微量白蛋白尿期患者進行針對可能導致病情加重的多個危險因素的強化治療是否能改善其預后”等5個臨床問題，檢索Cochrane圖書館（2005 年4期），ACP Journal Club（1991～2005），MEDLINE（1991～2005），納入糖尿病腎病治療的系統評價、Meta分析、隨機對照試驗和臨床指南，根據所獲最佳臨床證據為患者制定治療方案。
結果　共納入14個研究。現有證據顯示，對糖尿病腎病微量白蛋白尿期患者進行針對可能導致病情加重的多個危險因素的強化治療，包括嚴格控制血糖、血壓，調脂，限制蛋白的攝入，戒煙等能延緩或阻止糖尿病腎病的進展。
結論　影響糖尿病患者病情加重的因素包括生活方式（飲食、運動、戒煙）、血糖、血壓、血脂高低等，對其進行的干預，能有效緩解患者癥狀，提高患者長期生存質量。

引用本文： 左瑩,李雙慶. 1例糖尿病腎病微量白蛋白尿期患者的循證治療. 中國循證醫學雜志, 2006, 06(7): 533-536. doi: 復制

1.	Marshall SM. Recent advances in diabetic nephropathy. Postgrad Med J, 2004; 80(949): 624-633.
2.	Gross JL, de Azevedo MJ, Silveiro SP, et al. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care, 2005; 28(1): 164-176.
3.	American Diabetes Association (ADA). Standards of medical care in diabetes. Diabetes Care, 2006; 29(Suppl 1): 4-42.
4.	Dinneen SF, Griffin S. An intensive intervention reduced cardiovascular and microvascular events in type 2 diabetes and microalbuminuria. ACP Journal Club,2003; 139(2):29.
5.	UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes(UKPDS 33). Lancet, 1998; 352(9131): 837-853.
6.	Shichiri M, Kishikawa H, Ohkubo Y, et al. Long-Term Results of the Kumamoto Study on Optimal Diabetes Control in Type 2 Diabetic Patients. Diabetes Care, 2000; 23(Suppl 2): B21-29.
7.	Pistrosch F, Herbrig K, Kindel B, et al. Rosiglitazone improves glomerular hyperfiltration, renal endothelial dysfunction, and microalbuminuria of incipient diabetic nephropathy in patients. Diabetes, 2005; 54(7): 2206-2211.
8.	Strippoli GFM, Craig M, Craig JC. Antihypertensive agents for preventing diabetic kidney disease. In: The Cochrane Library, 2006,Issue 2.
9.	Lovell HG. Angiotensin converting enzyme inhibitors in normotensive diabetic patients with microalbuminuria. In: The Cochrane Library,2005, Issue 3.
10.	Ruggenenti P, Fassi A, Ilieva AP, et al; Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) Investigators. Preventing Microalbuminuria in Type 2 Diabetes. N Engl J Med, 2004; 351(19): 1941-1951.
11.	Rabbat CG. Losartan was renoprotective in diabetic nephropathy independent of its effect on blood pressure. ACP Journal Club,2002; 136(3): 82-84.
12.	Irbesartan reduced progression of nephropathy caused by type 2 diabetes independent of the effect on blood pressure. ACP Journal Club,2002; 136(3):82-84.
13.	Schjoedt KJ, Jacobsen P, Rossing K, et al. Dual blockade of the renin-angiotensin-aldosterone system in diabetic nephropathy: the role of aldosterone. Hormone and Metablic Research, 2005; 37(Suppl 1): 4-8.
14.	UK Prospective Diabetes Study (UKPDS) Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ, 1998; 317(7 160): 703-713.
15.	Ansquer JC, Foucher C, Rattier S, et al. Fenofibrate reduces progression to microalbuminuria over 3 years in a placebo-controlled study in type 2 diabetes: results from the Diabetes Atherosclerosis Intervention Study (DAIS). Am J Kidney Dis, 2005; 45(3): 485-493.
16.	Gross JL, Zelmanovitz T, Moulin CC, et al. Effect of a chicken-based diet on renal function and lipid profile in patient with type 2 diabetes: a randomized crossover trial. Diabetes Care, 2002; 25(4): 645-651.
17.	Ritz E, Ogata H, Orth SR. Smoking: a factor promoting onset and progression of diabetic nephropathy. Diabetes Metab, 2000; 26(Suppl 4): 54-63.

1. Marshall SM. Recent advances in diabetic nephropathy. Postgrad Med J, 2004; 80(949): 624-633.
2. Gross JL, de Azevedo MJ, Silveiro SP, et al. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care, 2005; 28(1): 164-176.
3. American Diabetes Association (ADA). Standards of medical care in diabetes. Diabetes Care, 2006; 29(Suppl 1): 4-42.
4. Dinneen SF, Griffin S. An intensive intervention reduced cardiovascular and microvascular events in type 2 diabetes and microalbuminuria. ACP Journal Club,2003; 139(2):29.
5. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes(UKPDS 33). Lancet, 1998; 352(9131): 837-853.
6. Shichiri M, Kishikawa H, Ohkubo Y, et al. Long-Term Results of the Kumamoto Study on Optimal Diabetes Control in Type 2 Diabetic Patients. Diabetes Care, 2000; 23(Suppl 2): B21-29.
7. Pistrosch F, Herbrig K, Kindel B, et al. Rosiglitazone improves glomerular hyperfiltration, renal endothelial dysfunction, and microalbuminuria of incipient diabetic nephropathy in patients. Diabetes, 2005; 54(7): 2206-2211.
8. Strippoli GFM, Craig M, Craig JC. Antihypertensive agents for preventing diabetic kidney disease. In: The Cochrane Library, 2006,Issue 2.
9. Lovell HG. Angiotensin converting enzyme inhibitors in normotensive diabetic patients with microalbuminuria. In: The Cochrane Library,2005, Issue 3.
10. Ruggenenti P, Fassi A, Ilieva AP, et al; Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) Investigators. Preventing Microalbuminuria in Type 2 Diabetes. N Engl J Med, 2004; 351(19): 1941-1951.
11. Rabbat CG. Losartan was renoprotective in diabetic nephropathy independent of its effect on blood pressure. ACP Journal Club,2002; 136(3): 82-84.
12. Irbesartan reduced progression of nephropathy caused by type 2 diabetes independent of the effect on blood pressure. ACP Journal Club,2002; 136(3):82-84.
13. Schjoedt KJ, Jacobsen P, Rossing K, et al. Dual blockade of the renin-angiotensin-aldosterone system in diabetic nephropathy: the role of aldosterone. Hormone and Metablic Research, 2005; 37(Suppl 1): 4-8.
14. UK Prospective Diabetes Study (UKPDS) Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ, 1998; 317(7 160): 703-713.
15. Ansquer JC, Foucher C, Rattier S, et al. Fenofibrate reduces progression to microalbuminuria over 3 years in a placebo-controlled study in type 2 diabetes: results from the Diabetes Atherosclerosis Intervention Study (DAIS). Am J Kidney Dis, 2005; 45(3): 485-493.
16. Gross JL, Zelmanovitz T, Moulin CC, et al. Effect of a chicken-based diet on renal function and lipid profile in patient with type 2 diabetes: a randomized crossover trial. Diabetes Care, 2002; 25(4): 645-651.
17. Ritz E, Ogata H, Orth SR. Smoking: a factor promoting onset and progression of diabetic nephropathy. Diabetes Metab, 2000; 26(Suppl 4): 54-63.

《中國循證醫學雜志》

1例糖尿病腎病微量白蛋白尿期患者的循證治療

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《中國循證醫學雜志》

1例糖尿病腎病微量白蛋白尿期患者的循證治療

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料