AIIA在糖尿病肾病的治疗.ppt

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1、AIIA在糖尿病肾病的治疗北大医院内分泌科贾培红副教授亚洲糖尿病和糖尿病肾病发病率剧增糖尿病患者心血管/肾脏并发症的重要性RENAAL研究亚洲人群的解析－关注降压治疗和控制蛋白尿AIIA在糖尿病肾病的治疗地位：－WhoWhen,How在过去10年中，糖尿病发病率分别增加了88%,37%,12%Diabetologia.2003Sep;46(9):1190-8在35－74岁的糖尿病患者中,2000年IFG达6005万Diabetologia.2003Sep;46(9):1190-8糖尿病和高血压:导致ESRD主要原因进入透析的患者的初步诊断分类Diabetes50.1%Hypertensio

2、n27%Glomerulonephritis13%Other10%UnitedStatesRenalDataSystem.Annualdatareport.2000.No.ofpatientsProjection95%CI198419861988199019921994199619982000200220042006200820100100200300400500600700R2=99.8%243,524281,355520,240No.ofdialysispatients糖尿病患者的死亡原因-女性(WHOMSVDD-7yrFU)MorrishNJetal,Diabetologia2001;

3、44(suppl2)S14-S21慢性肾病的负担血肌酐mg/dl估计的GFRml/min/1.73m2美国中国全部人口250million1.2billion>1.5<40-6010.9million54.5million>1.7<20-403million16.5million>2<200.8million4millionAJKD2000心血管病危险因素和肾脏病糖尿病肾功能不全CytokinesInflammationMalnutrition氧化应激贫血症骨代谢异常VascularcalcificationLVH动脉粥样硬化心血管病和心血管死亡SepsisPecoits-Filho,Re

4、talNephroDialysisTransplantation2004荟萃分析：SBP降低减缓GFR下降（糖尿病/非糖尿病患者）130134138142146150154170180r=0.69;P<0.05SBP(mmHg)GFR(mL/min/y)未治疗高血压0-2-4-6-8-10-12-14ParvingHHetal.BrMedJ.1989.VibertiGCetal.JAMA.1993.KlahrSetal.NEngJMed.1994.HebertLetal.KidneyInt.1994.LebovitzHetal.KidneyInt.1994.MoschioGetal.NEng

5、lJMed.1996.BakrisGLetal.KidneyInt.1996.BakrisGL.Hypertension.1997.GISENGroup.Lancet.1997.Bakrisetal.AmJKidneyDis.2000;36:646.UKPDS=UnitedKingdomProspectiveDiabetesStudy;MDRD=ModificationofDietinRenalDisease;HOT=HypertensionOptimalTreatment;AASK=AfricanAmericanStudyofKidneyDisease;RENAAL=Reductiono

6、fEndpointsinNIDDMwiththeAngiotensinIIAntagonistLosartan;IDNT=IrbesartanDiabeticNephropathyTrial;MAP=meanarterialpressure.Bakrisetal.AmJKidneyDis.2000;36:646-661;Brenneretal.NEnglJMed.2001;345:861-869;Lewisetal.NEnglJMed.2001;345:851-860.高危高血压患者:使用降压药物的数量降压药物的数量UKPDS(<85mmHg,diastolic)4321MDRD(92mm

7、Hg,MAP)HOT(<80mmHg,diastolic)AASK(<92mmHg,MAP)RENAAL(<140/90mmHg)IDNT(135/85mmHg)AdaptedfromBreyerJAetal.AmJKidDis1992;20(6):535.时间(年)052030糖尿病开始蛋白尿开始V期：终末期肾病结构改变(肾小球基底膜增厚，系膜扩展)高血压全面干预糖尿病肾病的自然进程IV期：明显肾病(Sc