Schwarz C, Oberbauer R
Abteilung für Nephrologie und Dialyse, Universitätsklinik für Innere Medizin III, Wien, Osterreich.
Wien Klin Wochenschr. 2000 Nov 10;112(21):907-11.
Although diabetic nephropathy is a slowly progressing, well studied disease, it is the most common cause of end stage renal disease in industrialized countries. Recently the first randomized controlled long term trials about microvascular complications in patients with type 2 diabetes have been published. Only seven years ago the first hallmark papers about metabolic control and ACE inhibition emerged. This review highlights the current status of prevention and therapy of diabetic nephropathy by metabolic and blood pressure control in type 1 and type 2 diabetic patients, depending on their stage of nephropathy (normo-, micro-, or macroalbuminuria). In patients with type 1 diabetes and normo- or microalbuminuria, strict metabolic control has been shown to slow the progression of nephropathy. In macroalbuminuric patients an aggressive antihypertensive treatment, preferably with an ACE inhibitor, is more important than the metabolic control. ACE inhibitor therapy has also been proven beneficial in microalbuminuric patients, but not yet in normotensive, non-albuminuric type 1 patients. Because of the high prevalence of hypertension in patients with type 2 diabetes, a strict antihypertensive treatment is more important than metabolic control for the prevention of progression of microvascular disease. Since most patients need a combination of antihypertensive medications a recommendation for a single substance class can not be given.
尽管糖尿病肾病是一种进展缓慢且研究充分的疾病，但它却是工业化国家终末期肾病最常见的病因。最近，关于2型糖尿病患者微血管并发症的首批随机对照长期试验已发表。仅仅在七年前，关于代谢控制和ACE抑制的首批标志性论文才出现。本综述重点介绍了1型和2型糖尿病患者根据其肾病阶段（正常白蛋白尿、微量白蛋白尿或大量白蛋白尿）通过代谢和血压控制来预防和治疗糖尿病肾病的现状。在1型糖尿病且有正常白蛋白尿或微量白蛋白尿的患者中，严格的代谢控制已被证明可减缓肾病进展。在大量白蛋白尿患者中，积极的抗高血压治疗，最好使用ACE抑制剂，比代谢控制更为重要。ACE抑制剂治疗在微量白蛋白尿患者中也已被证明有益，但在血压正常、无白蛋白尿的1型患者中尚未得到证实。由于2型糖尿病患者中高血压的患病率很高，严格的抗高血压治疗对于预防微血管疾病进展比代谢控制更为重要。由于大多数患者需要联合使用抗高血压药物，因此无法给出单一药物类别的推荐。
