Tu Shih-Te, Chang Shun-Jen, Chen Jung-Fu, Tien Kai-Jen, Hsiao Jeng-Yueh, Chen Hung-Chun, Hsieh Ming-Chia
Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
Arch Intern Med. 2010 Jan 25;170(2):155-61. doi: 10.1001/archinternmed.2009.471.
No study to date has evaluated whether multifactorial intervention can prevent diabetic nephropathy in patients with type 2 diabetes mellitus and normoalbuminuria. We evaluated the effect of tightly controlling multiple factors recommended by the American Diabetes Association (ADA) on the development and prevention of diabetic nephropathy in Chinese patients with type 2 diabetes mellitus and normoalbuminuria during a 4(1/2)-year period.
A longitudinal cohort study enrolled 1290 patients with type 2 diabetes and normoalbuminuria who received intensified treatment to meet the following ADA recommended goals: hemoglobin A(1c )(HbA(1c)), less than 7%; systolic blood pressure, less than 130 mm Hg; diastolic blood pressure, less than 80 mm Hg; low-density lipoprotein cholesterol, less than 100 mg/dL; triglycerides, less than 150 mg/dL; and high-density lipoprotein cholesterol, greater than 40 mg/dL for men and greater than 50 mg/dL for women.
During the study period, 211 patients (16.4%) developed new-onset microalbuminuria. A significant association was found between the achievement of ADA goals, including HbA(1c) level less than 7% (hazard ratio [HR], 0.729; 95% confidence interval [CI], 0.553-0.906; P = .03), systolic blood pressure less than 130 mm Hg (0.645; 0.491-0.848; P = .002), and high-density lipoprotein cholesterol level greater than 50 mg/dL for women and greater than 40 mg/dL for men (0.715; 0.537-0.951; P = .02) and the development of new-onset microalbuminuria.
Diabetic nephropathy can be delayed by tight simultaneous achievement of multiple ADA-recommended targets. This multifactorial intervention should be started in patients with diabetes and normoalbuminuria.
迄今为止，尚无研究评估多因素干预能否预防2型糖尿病和正常白蛋白尿患者发生糖尿病肾病。我们评估了严格控制美国糖尿病协会（ADA）推荐的多种因素对中国2型糖尿病和正常白蛋白尿患者在4.5年期间糖尿病肾病发生和预防的影响。
一项纵向队列研究纳入了1290例2型糖尿病和正常白蛋白尿患者，这些患者接受强化治疗以达到以下ADA推荐目标：糖化血红蛋白（HbA1c）低于7%；收缩压低于130mmHg；舒张压低于80mmHg；低密度脂蛋白胆固醇低于100mg/dL；甘油三酯低于150mg/dL；男性高密度脂蛋白胆固醇高于40mg/dL，女性高于50mg/dL。
在研究期间，211例患者（16.4%）出现新发微量白蛋白尿。发现达到ADA目标，包括HbA1c水平低于7%（风险比[HR]，0.729；95%置信区间[CI]，0.553 - 0.906；P = 0.03）、收缩压低于130mmHg（0.645；0.491 - 0.848；P = 0.002）以及女性高密度脂蛋白胆固醇水平高于50mg/dL且男性高于40mg/dL（0.715；0.537 - 0.951；P = 0.02）与新发微量白蛋白尿的发生之间存在显著关联。
同时严格实现多个ADA推荐目标可延缓糖尿病肾病的发生。这种多因素干预应在糖尿病和正常白蛋白尿患者中尽早开始。
