Molitch M E
Center for Endocrinology, Metabolism and Molecular Medicine, Northwestern University Medical School, Chicago, IL 60611, USA.
Semin Nephrol. 1997 Mar;17(2):101-13.
Diabetic nephropathy is a major cause of morbidity and mortality in patients with diabetes and occurs in about one-third of such patients. The course of nephropathy has become better defined, with patients initially developing microalbuminuria (albumin excretion rates [AER] between 20 and 200 micrograms/min), then overt nephropathy (AER > or = 200 micrograms/min) and finally a decline in GFR eventuating in end-stage renal disease (ESRD). Although metabolic control has long been hypothesized as a contributor to the development of nephropathy, it is only in recent years that this hypothesis has been proven. A number of observational studies have shown correlations between glycemic control and the development of various levels of albuminuria and also declines in GFR. Several small, prospective, randomized, interventional studies and the Diabetes Control and Complications Trial (DCCT) have now definitely proven that improved metabolic control that achieves near-normoglycemia can significantly decrease the development and progression of early nephropathy as well as other long-term complications of diabetes, including retinopathy and neuropathy. It is now conceivable that the achievement of near-normoglycemia plus the addition of angiotensin-converting enzyme inhibitors if microalbuminuria develops may greatly decrease the numbers of patients eventually requiring renal replacement therapy.
糖尿病肾病是糖尿病患者发病和死亡的主要原因，约三分之一的糖尿病患者会发生该病。肾病的病程已变得更加明确，患者最初出现微量白蛋白尿（白蛋白排泄率[AER]在20至200微克/分钟之间），然后发展为显性肾病（AER≥200微克/分钟），最终肾小球滤过率下降，导致终末期肾病（ESRD）。尽管长期以来一直假设代谢控制是肾病发生的一个因素，但直到最近几年这一假设才得到证实。多项观察性研究表明血糖控制与不同程度白蛋白尿的发生以及肾小球滤过率下降之间存在关联。现在，几项小型前瞻性随机干预研究以及糖尿病控制与并发症试验（DCCT）已明确证实，实现接近正常血糖水平的改善代谢控制可显著降低早期肾病以及糖尿病其他长期并发症（包括视网膜病变和神经病变）的发生和进展。现在可以设想，如果出现微量白蛋白尿，实现接近正常血糖水平并加用血管紧张素转换酶抑制剂可能会大大减少最终需要肾脏替代治疗的患者数量。
