聚焦微量蛋白尿,优化高血压伴糖尿病的心肾保护精要.ppt

一季度考试点评 1.成绩令人鼓舞，后备力量成绩突出 2.有一份耕耘，有一份收获。 如囊萤，如映雪，家虽贫，学不辍； 如负薪，如挂角，身虽劳，犹苦卓。 3..学历只能说明过去曾经接受教育的水平 天道酬勤，勤能补拙 4.珍惜，珍重，端正工作态度。 ABI 踝臂指数（ankle-brachial index，ABI）是踝部动脉收缩压与双侧肱动脉收缩压的最高值之比，它是诊断外周动脉缺血的一种准确、简便、无创的方法。 正常：1.0~1.3 轻度闭塞：0.71~0.9 中度闭塞：0.41~0.7 重度闭塞：＜0.4 ABI﹥1.3：提示动脉钙化 lvef lvef 正常值 射血分数：心室收缩时并不能将心室的血液全部射入动脉，正常成人静息状态下，心室舒张期的容积左心室约为145ml，右心室约为137ml，博出量为60-80ml，即射血完毕时心室尚有一定量的余血，把博出量占心室舒张期容积的百分比称为射血，射血分数是指心脏收缩期与舒张期的比值,一般50%以上属于正常范围 肾小球滤过率 肾小球滤过率 GFR，glomeruar filtration rate 是指单位时间内两肾生成滤液的量，正常成人为125ml/min左右。肾小球滤过率与肾血浆流量的比值称为滤过分数。每分钟肾血浆流量约660ml，故滤过分数为125/660×100％≈19％。这一结果表明，流经肾的血浆约有1/5由肾小球滤入囊腔生成原尿。肾小球滤过率和滤过分数是衡量肾功能的指标。 蛋白尿与肾小管损伤 应用角蛋白抗体免疫酶标技术对原发性肾病综合征尿单个核细胞的研究 见：中华肾脏病杂志，1988， 4 3 :140~141. 见：王海燕主编 肾脏病学 第3版， 2008，947~957页. CKD-CRF患者血糖、血压、蛋白尿治疗目标 Background: 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 41?2-year period. Methods: A longitudinal cohort study enrolled 1290 patients with type 2 diabetes and normoalbuminuria who received intensified treatment tomeetthe followingADArecommended goals: hemoglobin A1c HbA1c , less than 7%; systolicbloodpressure, lessthan130mmHg;diastolicblood pressure, less than80mmHg; low-density lipoprotein cholesterol, lessthan100mg/dL;triglycerides, lessthan150mg/ dL; and high-density lipoprotein cholesterol, greater than 40 mg/dL for men and greater than 50 mg/dL for women. Results: During the study period,211patients 16.4% developed new-onset microalbuminuria. A significant association was found between the achievement ofADAgoals, including HbA1c level less than 7% hazard ratio [HR], 0.729;95%confidence interval [CI], 0.553-0.906; P .03 , systolic blood press