• 四川大學(xué)華西金卡醫(yī)院（成都 610041）;

目的 　為1例伴微量白蛋白尿的2型糖尿病患者制定治療方案。
方法 　根據(jù)患者臨床特點(diǎn)，提出“對(duì)糖尿病腎病微量白蛋白尿期患者進(jìn)行針對(duì)可能導(dǎo)致病情加重的多個(gè)危險(xiǎn)因素的強(qiáng)化治療是否能改善其預(yù)后”等5個(gè)臨床問(wèn)題，檢索Cochrane圖書(shū)館（2005 年4期），ACP Journal Club（1991～2005），MEDLINE（1991～2005），納入糖尿病腎病治療的系統(tǒng)評(píng)價(jià)、Meta分析、隨機(jī)對(duì)照試驗(yàn)和臨床指南，根據(jù)所獲最佳臨床證據(jù)為患者制定治療方案。
結(jié)果 　共納入14個(gè)研究?，F(xiàn)有證據(jù)顯示，對(duì)糖尿病腎病微量白蛋白尿期患者進(jìn)行針對(duì)可能導(dǎo)致病情加重的多個(gè)危險(xiǎn)因素的強(qiáng)化治療，包括嚴(yán)格控制血糖、血壓，調(diào)脂，限制蛋白的攝入，戒煙等能延緩或阻止糖尿病腎病的進(jìn)展。
結(jié)論 　影響糖尿病患者病情加重的因素包括生活方式（飲食、運(yùn)動(dòng)、戒煙）、血糖、血壓、血脂高低等，對(duì)其進(jìn)行的干預(yù)，能有效緩解患者癥狀，提高患者長(zhǎng)期生存質(zhì)量。

引用本文： 左 瑩,李雙慶. 1例糖尿病腎病微量白蛋白尿期患者的循證治療. 中國(guó)循證醫(yī)學(xué)雜志, 2006, 06(7): 533-536. doi: 復(fù)制

1. Marshall SM. Recent advances in diabetic nephropathy. Postgrad Med J, 2004; 80(949): 624-633.
2. Gross JL, de Azevedo MJ, Silveiro SP, et al. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care, 2005; 28(1): 164-176.
3. American Diabetes Association (ADA). Standards of medical care in diabetes. Diabetes Care, 2006; 29(Suppl 1): 4-42.
4. Dinneen SF, Griffin S. An intensive intervention reduced cardiovascular and microvascular events in type 2 diabetes and microalbuminuria. ACP Journal Club,2003; 139(2):29.
5. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes(UKPDS 33). Lancet, 1998; 352(9131): 837-853.
6. Shichiri M, Kishikawa H, Ohkubo Y, et al. Long-Term Results of the Kumamoto Study on Optimal Diabetes Control in Type 2 Diabetic Patients. Diabetes Care, 2000; 23(Suppl 2): B21-29.
7. Pistrosch F, Herbrig K, Kindel B, et al. Rosiglitazone improves glomerular hyperfiltration, renal endothelial dysfunction, and microalbuminuria of incipient diabetic nephropathy in patients. Diabetes, 2005; 54(7): 2206-2211.
8. Strippoli GFM, Craig M, Craig JC. Antihypertensive agents for preventing diabetic kidney disease. In: The Cochrane Library, 2006,Issue 2.
9. Lovell HG. Angiotensin converting enzyme inhibitors in normotensive diabetic patients with microalbuminuria. In: The Cochrane Library,2005, Issue 3.
10. Ruggenenti P, Fassi A, Ilieva AP, et al; Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) Investigators. Preventing Microalbuminuria in Type 2 Diabetes. N Engl J Med, 2004; 351(19): 1941-1951.
11. Rabbat CG. Losartan was renoprotective in diabetic nephropathy independent of its effect on blood pressure. ACP Journal Club,2002; 136(3): 82-84.
12. Irbesartan reduced progression of nephropathy caused by type 2 diabetes independent of the effect on blood pressure. ACP Journal Club,2002; 136(3):82-84.
13. Schjoedt KJ, Jacobsen P, Rossing K, et al. Dual blockade of the renin-angiotensin-aldosterone system in diabetic nephropathy: the role of aldosterone. Hormone and Metablic Research, 2005; 37(Suppl 1): 4-8.
14. UK Prospective Diabetes Study (UKPDS) Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ, 1998; 317(7 160): 703-713.
15. Ansquer JC, Foucher C, Rattier S, et al. Fenofibrate reduces progression to microalbuminuria over 3 years in a placebo-controlled study in type 2 diabetes: results from the Diabetes Atherosclerosis Intervention Study (DAIS). Am J Kidney Dis, 2005; 45(3): 485-493.
16. Gross JL, Zelmanovitz T, Moulin CC, et al. Effect of a chicken-based diet on renal function and lipid profile in patient with type 2 diabetes: a randomized crossover trial. Diabetes Care, 2002; 25(4): 645-651.
17. Ritz E, Ogata H, Orth SR. Smoking: a factor promoting onset and progression of diabetic nephropathy. Diabetes Metab, 2000; 26(Suppl 4): 54-63.
  1. 1. Marshall SM. Recent advances in diabetic nephropathy. Postgrad Med J, 2004; 80(949): 624-633.
  2. 2. Gross JL, de Azevedo MJ, Silveiro SP, et al. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care, 2005; 28(1): 164-176.
  3. 3. American Diabetes Association (ADA). Standards of medical care in diabetes. Diabetes Care, 2006; 29(Suppl 1): 4-42.
  4. 4. Dinneen SF, Griffin S. An intensive intervention reduced cardiovascular and microvascular events in type 2 diabetes and microalbuminuria. ACP Journal Club,2003; 139(2):29.
  5. 5. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes(UKPDS 33). Lancet, 1998; 352(9131): 837-853.
  6. 6. Shichiri M, Kishikawa H, Ohkubo Y, et al. Long-Term Results of the Kumamoto Study on Optimal Diabetes Control in Type 2 Diabetic Patients. Diabetes Care, 2000; 23(Suppl 2): B21-29.
  7. 7. Pistrosch F, Herbrig K, Kindel B, et al. Rosiglitazone improves glomerular hyperfiltration, renal endothelial dysfunction, and microalbuminuria of incipient diabetic nephropathy in patients. Diabetes, 2005; 54(7): 2206-2211.
  8. 8. Strippoli GFM, Craig M, Craig JC. Antihypertensive agents for preventing diabetic kidney disease. In: The Cochrane Library, 2006,Issue 2.
  9. 9. Lovell HG. Angiotensin converting enzyme inhibitors in normotensive diabetic patients with microalbuminuria. In: The Cochrane Library,2005, Issue 3.
  10. 10. Ruggenenti P, Fassi A, Ilieva AP, et al; Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) Investigators. Preventing Microalbuminuria in Type 2 Diabetes. N Engl J Med, 2004; 351(19): 1941-1951.
  11. 11. Rabbat CG. Losartan was renoprotective in diabetic nephropathy independent of its effect on blood pressure. ACP Journal Club,2002; 136(3): 82-84.
  12. 12. Irbesartan reduced progression of nephropathy caused by type 2 diabetes independent of the effect on blood pressure. ACP Journal Club,2002; 136(3):82-84.
  13. 13. Schjoedt KJ, Jacobsen P, Rossing K, et al. Dual blockade of the renin-angiotensin-aldosterone system in diabetic nephropathy: the role of aldosterone. Hormone and Metablic Research, 2005; 37(Suppl 1): 4-8.
  14. 14. UK Prospective Diabetes Study (UKPDS) Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ, 1998; 317(7 160): 703-713.
  15. 15. Ansquer JC, Foucher C, Rattier S, et al. Fenofibrate reduces progression to microalbuminuria over 3 years in a placebo-controlled study in type 2 diabetes: results from the Diabetes Atherosclerosis Intervention Study (DAIS). Am J Kidney Dis, 2005; 45(3): 485-493.
  16. 16. Gross JL, Zelmanovitz T, Moulin CC, et al. Effect of a chicken-based diet on renal function and lipid profile in patient with type 2 diabetes: a randomized crossover trial. Diabetes Care, 2002; 25(4): 645-651.
  17. 17. Ritz E, Ogata H, Orth SR. Smoking: a factor promoting onset and progression of diabetic nephropathy. Diabetes Metab, 2000; 26(Suppl 4): 54-63.