早期糖尿病肾病的综合治疗与5年随访结局*

应喜慧1曹东亮2金家贵3

(成都医学院附属新都中医院1.内分泌科，2.心血管科; 3．成都医学院检验医学院，四川 成都 610500)

【摘要】目的探讨早期诊断和综合治疗在延缓糖尿病肾病进展中的重要作用。方法将44例早期糖尿病肾病患者随机分为观察组22例和对照组22例，观察组采取综合治疗，对照组仅给予降糖治疗，疗程均为12周，分析比较两组的治疗效果，并进行5年临床追踪观察。结果两组患者的空腹血糖和尿素氮均较治疗前降低(P<0.05)，糖化血红蛋白和肌酐仅在观察组有降低(P<0.05)，两组的尿白蛋白排泄率和尿微量白蛋白较实验前均有明显降低(P<0.01)，观察组的尿白蛋白排泄率和尿微量白蛋白较对照组显著降低(P<0.01)。观察组12例患者病情明显好转，8例患者病情稳定，2例患者病情加重。对照组仅1例病情好转，5例病情稳定，10例病情加重，6例死亡。结论早期诊断和综合治疗能逆转部分糖尿病肾病患者的蛋白尿，延缓病情进展及降低死亡率，对提高患者生存质量具有重要临床意义。

【关键词】糖尿病肾病； 综合治疗； 早期诊断

【中图分类号】R 587.1

【文献标志码】A

doi：10.3969/j.issn.1672-3511.2015.10.018

Abstract【】ObjectiveTo investigate the importance of early diagnosis and complex treatment in delaying the progression of diabetic nephropathy. Methods44 patients with early diabetic nephropathy were randomly divided into observation group (n=22) and control group (n=22). The observation group was given complex treatments. The control group was given only reduction blood sugar. The treatment effects were observed. ResultsFasting blood glucose and blood urea nitrogen of the two groups after treatment were lower than that before treatment (P<0.05). The glycosylated hemoglobin and serum creatinine decreased in observation group, compared with that of control group (P<0.05). The urinary albumin excretion rate and urinary microalbumin in two groups after treatment were significantly lower than that before the treatment (P<0.01), and urinary albumin excretion rate and urinary microalbumin of observation group reduced significantly compared with control group(P<0.01). In the observation group, the disease improved significantly with 12 cases, and the disease had stabled in 7 cases, and the disease had aggravated on 2 cases. About the control group, 1 patient got better, 5 patients stabled, 10 patients became more serious, 6 patients had died. ConclusionEarly diagnosis and complex treatment can reverse proteinuria of some patients with diabetic nephropathy, delay the progress of disease and reduce mortality. There was important significance for improving the quality of life on patients.

基金项目：四川省教育厅科研项目(10ZA134，11ZB206)

通讯作者：金家贵，教授，《西部医学》常务编委，E-mail：jinjiagui2014@126.

收稿日期：(2015-04-29； 编辑： 陈舟贵)

The complex treatment of early diabetic nephropathy and the follow-up outcome of 5 yearsYING Xihui1,CAO Dongliang2,JIN Jiagui3

(1.DepartmentofEndocrinology,XinduTraditionalChineseHospitalAffiliatedtoChengduMedicalCollege,Chengdu610500,China;

2.DepartmentofCardiovascular,XinduTraditionalChineseHospitalAffiliatedtoChengduMedicalCollege,Chengdu610500,China;

3.SchoolofLaboratoryMedicine,ChengduMedicalCollege,Chengdu610500,China)

【Key words】Diabetic nephropathy; Complex treatment; Early diagnosis

糖尿病(diabetes mellitus, DM)是一组由多病因引起的以慢性高血糖为特征的代谢性疾病，是由于胰岛素分泌和/或作用缺陷引起的[1]。目前全球至少有3.82亿糖尿病患者，预计至2035年将上升至5.92亿[2]。糖尿病长期慢性高血糖可导致全身各重要器官损害及功能障碍，甚至带来不同器官衰竭。糖尿病肾病是糖尿病的慢性并发症[1]。糖尿病肾病(diabetic nephropathy, DN)又称糖尿病性肾小球硬化症，是糖尿病全身微血管并发症之一[3]。糖尿病肾病是决定糖尿病患者预后的重要因素之一，并已成为导致终末期肾病(end stage renal disase, ESRD)的最常见病因，严重威胁糖尿病患者的身体健康[4]。本文44例III期糖尿病肾病患者进行为期12周的治疗和5年跟踪随访观察分析，现将结果报告如下。

1资料与方法

1.1临床资料选择2007年1月～2010年4月我院接受治疗的早期糖尿病肾病患者44例，其中男24例，女20例，年龄37～70岁，平均年龄(50.8±9.1)岁。……