ACEI和ARB类药物在糖尿病肾病中应用.ppt

显著降低到达血肌酐翻倍的危险性33% 显著降低到达ESRD的危险性23% 提示： ①Irbesartan风险低 ②明显延缓主要终点事件的发生 ③是早期控制蛋白尿的重要手段 ④甚至部分病人能完全逆转 厄贝沙坦是糖尿病伴高血压或蛋白尿 治疗的理想选择 更强RAS阻断 更强降压 全程保护 厄贝沙坦对AT1的阻断作用比缬沙坦和氯沙坦强，时间也更持久 Burnier M. Circulation. 2001;103;904-912 Kassler-Taub K, et al. Am J Hypertens. 1998 ;11(4 Pt 1):445-453 Mancia G, et al. Blood Pressure Monitoring. 2002;7:135-142 总 结 肾脏是调节血压的重要器官 肾素-血管紧张素系统（RAS）在肾脏疾病中扮演重要角色 心肾疾病能相互影响 糖尿病肾病危害很大需要早期防治 阻断肾素-血管紧张素系统（RAS）至关重要 厄贝沙坦是医生理想的选择 谢谢 Table 1. Inclusion and exclusion criteria  I. Inclusion criteria A. Age 30–70; (<30 in patients with biopsy-proven diabetic nephropathy) B. Clinical history of type II diabetes 1. Hyperglycaemia not requiring insulin 2. Hyperglycaemia requiring insulin with either a. the period between diagnosis and insulin usage >1 year; or b. elevated fasting or stimulated C-peptide level C. Diabetic nephropathy 1. 24-h urine protein excretion ?900 mg 2. Serum creatinine between 90 and 265 μmol/l (1.0–3.0 mg/dl) in women and between 110 and 265 μmol/l (1.2–3.0 mg/dl) in men D. Hypertension 1. Seated SBP >135 mmHg and/or seated DBP >85 mmHg untreated; or 2. Receiving antihypertensive medication II. Exclusion criteria A. Age of onset of type II diabetes <20 years B. Type I diabetes C. Absolute requirement for an ACEI, AIIRA or CCB D. Cardiovascular disease 1. Unstable angina, myocardial infarction,, coronary artery bypass graf surgery or percutaneous transluminal coronary angioplasty within 3 months of study entry 2. New York Heart Association class III or IV heart failure 3. Transient ischaemic attack within 6 months of study entry 4. Stroke within 3 months of study entry E. Serum potassium outside of normal range * 1.3 如果出现以下情况，大多数糖尿病病人是因为糖尿病导致慢性肾脏病： ●出现大量蛋白尿或 ●出现微量蛋白尿同时 ⊙存在糖尿病视网膜病变 ⊙Ⅰ型糖尿病至少10年 2007 KDOQI CPG and CPR for Diabetes and CKD from American Journal of Kidney Diseases VOL 49, NO 2, SUPPL 2, FEBRUARY 2007 1.4 出现任何下列情况，应该考虑CKD的其他病因： ●无糖尿病视网膜病变 ●GFR低或GFR迅速降低 ●蛋白尿迅速增多或