糖尿病肾病基础研究及诊断治疗的某些进展.ppt

**************Improvedsurvivalinpatientsobtainingremissionofnephroticrangealbuminuriaindiabeticnephropathy.P.Hovind1,L.Tarnow1,?.Rossing1,B.Carstensen1,H.-H.Parving12;^tenoDiabetesCenter,Gentofte,Denmark,facultyofHealthScience,UniversityofAarhus,Denmark.BackgroundandAims:Toevaluatetheimpactofremissionofnephroticrangealbuminuria(NRA)onendstagerenaldisease(ESRD)andmortalityintype1diabeticpatientswithdiabeticnephropathyweperformedaprospectivecohortstudy.MaterialsandMethods:Alltype1diabeticpatientswithNRA(n=126),whohadyearlyGFR(51Cr-EDTAplasmaclearance)measurementcarriedoutforatleast3years,werefollowedfromonsetofNRAuntildeathor2000.Nephroticrangealbuminuriawasdefinedaspersistentalbuminuriaabove2.5g/24h,andoccurredin91menand35women,age(mean(SD))34(8)years,durationofdiabetes22(8)years,followuptimefromonsetofNRA(median(range))8.7(3.0-20.9)years.Allpatientsbutonereceivedantihypertensivetreatment.RemissionofNRAwasdefinedassustainedalbuminuria0.6g/24hforatleastoneyear.Remissionwasinducedin28patients(22%),21predominantlytreatedwithACEinhibitors,7withnon-ACEinhibitors.Theremissionlasted3.6(1.0-18.1)years.Results:Attheendoffollowup,thecompositeendpointofESRDordeathwasreachedin21%intheremissiongroup(2ESRDand4dead)and59%inthenoremissiongroup(24ESRDand34dead).ACoxproportionalhazardregressionanalysiswithsexandageatonsetofNRAasfixedcovariatesandremissionastimedependentcovariatewasperformed:obtainingremissionwasassociatedwithalowerriskofESRDordeath,relativerisk(95%CI)0.35(0.16to0.80),p0.012,whereasolderageatonsetofNRA(per10yearsincrease)wasassociatedwithhigherriskofreachingtheendpoint,1.61(1.20to2.16),p0.001.Aspreviouslyshown,therateofdeclineinGFRduringthewh