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目的评价临床干预对糖尿病性肾脏疾病(DKD)不同分期的治疗效果。方法选取蛋白尿<0.5 g/24 h的DKD患者56例(早期组,ESG)和蛋白尿≥0.5 g/24 h的患者48例(中期组,MSG)。采用贝那普利与缬沙坦联合用药、糖尿病规范管理、降压、调脂等常规治疗3个月,测血糖、血压(BP)、HbA_1c、尿总蛋白排泄率(UPER)、血清肌酐(Scr),内生肌酐清除率(Ccr)、尿素氮(BUN),随访12个月。结果 (1)治疗后两组FPG、2hPG、HbA_1c、BP显著降低(P<0.05)。(2)在控制DKD病程和治疗前UP-ER因素后,ESG组、MSG组治疗后UPER分别是0.733 g/24 h(95%CI为0.690～0.777)和0.931 g/24h(95%CI为0.882～0.979)(P<0.01)。肾功能改善指数(RFPI)与治疗前UPER呈对数关系(P<0.01),RFPI=11.594-22.6881n(治疗前UPER)。(3)ESG组Scr和BUN降低,Ccr升高(P<0.01),治疗后两组Scr、Ccr、BUN净变化值差异有统计学意义(P<0.01)。(4)ESG组和MSG组肾脏1年生存率分别为97.8%和65.5%(P<0.01)。结论临床干预对早期DKD患者的获益较大。
Objective To evaluate the effect of clinical intervention on different stages of diabetic nephropathy (DKD). Methods Forty-eight patients (metaphase group, MSG group) were enrolled in this study. 56 patients with DKD <0.5 g / 24 h (ESG) and 0.5 g / 24 h proteinuria were enrolled in this study. Blood glucose, blood pressure (BP), HbA_1c, UPER and serum creatinine were measured by routine therapy such as benazepril combined with valsartan, diabetes mellitus management, blood pressure lowering and lipid- Scr, Ccr and BUN, followed up for 12 months. Results (1) After treatment, FPG, 2hPG, HbA_1c, BP in the two groups were significantly decreased (P <0.05). (2) The UPER of ESG group and MSG group were 0.733 g / 24 h (95% CI 0.690 ~ 0.777) and 0.931 g / 24h (95% CI 0.882 ~ 0.979) (P <0.01). The index of renal function improvement (RFPI) had a logarithmic relationship with UPER before treatment (P <0.01), and RFPI = 11.594-22.6881n (UPER before treatment). (3) Scr and BUN in ESG group decreased and Ccr increased (P <0.01). There was significant difference in net change value of Scr, Ccr and BUN between two groups after treatment (P <0.01). (4) The one-year survival rates of kidney in ESG group and MSG group were 97.8% and 65.5%, respectively (P <0.01). Conclusion Clinical interventions may benefit patients with early DKD.