肾脏保护:糖尿病患者管理的关键目标。

Luis M Ruilope, Julian Segura
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引用次数: 1

摘要

预防2型糖尿病患者肾损害发展及其相关心血管风险增加的必要性已得到充分确认。早期干预以保持严格的血压控制和防止微量白蛋白尿的发展是强制性的,并且将构成糖尿病患者以及以存在心脏代谢风险为特征的前驱糖尿病患者干预的主要目的。如果已经存在微量白蛋白尿,则需要类似的血压控制和尿白蛋白排泄的正常化。如果确定有糖尿病肾病,则必须达到类似的血压和白蛋白目标。在这方面,ADVANCE研究的数据表明,培哚普利和吲达帕胺联合使用可以极大地帮助临床医生实现这些目标。在标准治疗的基础上,该联合治疗显著降低了21%的肾脏事件风险(P < 0.0001),使蛋白尿的进展降低了22% (P < 0.0001),并使蛋白尿的消退增加了16% (P = 0.002)。此外,肾脏事件的发生率随着随访血压的降低呈对数线性下降,直至收缩压低于110 mmHg。根据ADVANCE的研究结果,在当代心血管护理的基础上,使用培哚普利/吲达帕胺固定联合治疗可防止20例2型糖尿病患者在5年内发生一例肾脏事件。在主要的ADVANCE试验中,肾脏保护的证据被添加到总死亡率和心血管死亡率的降低中。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Kidney protection: a key target in the management of patients with diabetes.

The need to prevent the development of renal damage and its associated increase in cardiovascular risk in patients with type 2 diabetes is well established. Early intervention to maintain strict blood pressure control and to prevent the development of microalbuminuria is mandatory and will constitute the primary aim of intervention in patients with diabetes and also in prediabetes, characterized by the presence of cardiometabolic risk. If microalbuminuria is already present, similar blood pressure control and normalized urinary albumin excretion are required. If diabetic nephropathy is established, similar blood pressure and albumin targets must be achieved. In this regard, data from the ADVANCE study suggest that the combination of perindopril and indapamide can greatly help clinicians to achieve these targets. This combination on top of standard treatment significantly reduced the risk of renal events by 21% (P < 0.0001), the progression of albuminuria by 22% (P < 0.0001), and increased the regression of albuminuria by 16% (P = 0.002). Furthermore, the rate of renal events decreased log-linearly with decreasing follow-up blood pressure, down to systolic blood pressure below 110 mmHg. According to the ADVANCE results, treatment with the perindopril/indapamide fixed combination on top of contemporary cardiovascular care prevents one renal event in 20 patients with type 2 diabetes treated over 5 years. Evidence of renal protection is added to the reduction in total and cardiovascular mortality in the main ADVANCE trial.

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