Martínez-Castelao A, Ramos R, González M T, Castiñeiras M J
Servicio de Nefrología Hospital de Bellvitge Príncipes de España, CSUB C/Feixa Llarga, s/n. 08907 Hospitalet de Llobregat, Universitat de Barcelona.
Nefrologia. 2002;22 Suppl 1:51-8.
Diabetes patients with concomitant diabetic nephropathy are especially destined to cardiovascular complications due to the presence of microalbuminuria or proteinuria, that are potent inductors of dyslipidaemia.
We have studied 98 type 2 diabetes mellitus patients, 61 male and 37 female, mean age 63 +/- 13 year old, all of them with overt proteinuria (above 500 mg/day), divided into 4 groups: G-I (n = 13): patients with t. cholesterol > 6.25 mmol/l treated with fibric-acid derivatives; G-II (n = 52): hypercholesterolemic patients treated with statins; G-III (n = 20): hypercholesterolemic patients with no lipid-lowering intervention; G-IV (n = 13): normocholesterolemic patients (control group). Lipidic profile, proteinuria and renal function have being compared after 1, 3 and 5 years.
Base-line characteristics of the patients were similar when regarding age, onset of diabetes or nephropathy. Only proteinuria was higher in statins-treated group (p < 0.05). Fibric-acid derivatives were more effective on hypertriglyceridaemia while statins were more effective lowering LDL cholesterol. A gemfibrocyl-treated patient presented a rhabdomyolysis episode. Statins were safe and well tolerated. Nine patients (19%) in G-II, 2 patients (10%) in G-III and 1 patient (7%) in G-IV achieved end-stage renal failure. Five-year cardiovascular mortality and all-cause mortality rate were 23%/23% in G-I, 13%/19% in G-II, 20%/25% in G-III and 31%/31% in G-IV. The difference was statistically significant when comparing normocolesterolemic versus statin-treated patients (p < 0.05).
Lipid-lowering therapy could probably delay but not avoid the progression of diabetic nephropathy. Since dyslipidaemia is closely related to the progression of cardiovascular disease and mortality, an aggressive lipid-lowering therapy is recommended, irrespectively of its potential effect on diabetic nephropathy.
伴有糖尿病肾病的糖尿病患者尤其容易发生心血管并发症，因为存在微量白蛋白尿或蛋白尿，这些都是血脂异常的有力诱导因素。
我们研究了98例2型糖尿病患者，其中男性61例，女性37例，平均年龄63±13岁，所有患者均有显性蛋白尿（超过500mg/天），分为4组：第一组（n = 13）：总胆固醇>6.25mmol/l的患者接受纤维酸衍生物治疗；第二组（n = 52）：高胆固醇血症患者接受他汀类药物治疗；第三组（n = 20）：高胆固醇血症患者未进行降脂干预；第四组（n = 13）：正常胆固醇血症患者（对照组）。在1年、3年和5年后比较了血脂谱、蛋白尿和肾功能。
在年龄、糖尿病或肾病发病方面，患者的基线特征相似。仅他汀类药物治疗组的蛋白尿较高（p < 0.05）。纤维酸衍生物对高甘油三酯血症更有效，而他汀类药物在降低低密度脂蛋白胆固醇方面更有效。一名接受吉非贝齐治疗的患者出现了横纹肌溶解症。他汀类药物安全且耐受性良好。第二组中有9例患者（19%）、第三组中有2例患者（10%）、第四组中有1例患者（7%）达到终末期肾衰竭。第一组的五年心血管死亡率和全因死亡率分别为23%/23%，第二组为13%/19%，第三组为20%/25%，第四组为31%/31%。比较正常胆固醇血症患者与他汀类药物治疗患者时，差异具有统计学意义（p < 0.05）。
降脂治疗可能会延迟但无法避免糖尿病肾病的进展。由于血脂异常与心血管疾病的进展和死亡率密切相关，因此建议进行积极的降脂治疗，无论其对糖尿病肾病的潜在影响如何。
