Intensified treatment of patients with type 2 diabetes mellitus and overt nephropathy.
Intensified treatment of patients with type 2 diabetes mellitus and overt nephropathy.
复制标题
2型糖尿病和明显肾病患者的强化治疗。
DOI：
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发表时间：
2004
期刊：
影响因子：
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通讯作者：
J. Boulton
中科院分区：
文献类型：
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作者：
N. Joss;C. Ferguson;C. Brown;C. Deighan;K. Paterson;J. Boulton
背景
糖尿病肾病是导致慢性肾功能衰竭需要透析的最常见原因。虽然存在有效的治疗方法，但没有临床审核或大型试验能像小范围集中管理的患者那样有效地降低肾功能损失率。
目标
目的：确定强化治疗与标准治疗对糖尿病肾病患者肾功能衰竭进展率的影响。
设计
前瞻性随机对照研究。
方法
2型糖尿病肾病患者随机分为强化组(n=47)和对照组(n=43)。两组的治疗目标是相同的，但强化组被视为达到目标所需的频率；对照组在其正常诊所被看到。主要终点是第二年肾脏疾病的进展率。
结果
在基线上，这两组人非常匹配。在随访期间，强化组的平均SBP、DBP和胆固醇水平较低。强化组肾功能衰竭进展的中位数从第一年的0.44毫升/分/月降至第二年的0.14毫升/分/月，而对照组分别为0.49毫升/分/月和0.53毫升/分/月(第二年p=0.04)。强化组患者住院时间明显减少。
讨论
强化治疗在2年内延缓了糖尿病肾病患者肾脏疾病的进展。试验开始时平均肌酐清除率为55ml/min，因此假设第二年末达到的进展速度持续下去，强化组与对照组相比，透析开始时间将推迟20年。
BACKGROUND
Diabetic nephropathy is the single most common cause of chronic renal failure requiring dialysis. Effective treatment exists, but no clinical audit or large trial has reduced the rate of loss of renal function as effectively as in small groups of intensively managed patients.
AIM
To determine the effect of intensive vs. standard medical management on the rate of progression of renal failure in patients with diabetic nephropathy.
DESIGN
Prospective randomized controlled study.
METHODS
Patients with type 2 diabetes and nephropathy were randomly allocated to an intensive group (n = 47) or control group (n = 43). Treatment targets were the same for both groups, but the intensive group were seen as often as required to meet the targets; controls were seen at their normal clinics. The primary end-point was the rate of progression of renal disease in the second year.
RESULTS
The groups were well matched at baseline. During follow-up, the intensive group had lower mean SBP, DBP and cholesterol. Median rate of progression of renal failure in the intensive group fell from 0.44 ml/min/month in the first year to 0.14 ml/min/month in the second year, compared to 0.49 ml/min/month and 0.53 ml/min/month in the control group (p = 0.04 for second year). Patients in the intensive group spent significantly less time in hospital.
DISCUSSION
Intensive treatment slowed progression of renal disease within 2 years in patients with established diabetic nephropathy. Mean creatinine clearance at the start of the trial was 55 ml/min, so assuming that the rates of progression achieved at the end of the second year persisted, onset of dialysis would be delayed by 20 years in the intensive group compared with the control group.
影响因子：
158.5
作者：
LEWIS, EJ;HUNSICKER, LG;ROHDE, RD
通讯作者：
ROHDE, RD