强化降糖和降压对2型糖尿病患者微血管病变的影响  

Effects of intensive blood glucose control and blood pressure lowering on microvascular complications in patients with type 2 diabetes mellutis

作　　者：朱彩红[1] 张士胜 孔燕[2] 陈宇红[3] 张琼[1] 初少莉[3] 钱岳晟[2] 毕宇芳[3] 张连珍[3] 

机构地区：[1]上海交通大学医学院附属瑞金医院眼科,上海200025 [2]上海交通大学医学院附属瑞金医院高血压科,上海200025 [3]上海交通大学医学院附属瑞金医院内分泌科,上海200025 [4]上海瑞视眼科

出　　处：《中国实用眼科杂志》2009年第9期943-946,共4页Chinese Journal of Practical Ophthalmology

基　　金：Adrance基金项目（NCT00140925）和上海市重点学科建设项目（S30205）

摘　　要：目的观察强化降糖和降压对2型糖尿患者底微血管病变的影响。方法将入选的107例2型糖尿病患者随机分入强化组和标准组，强化组给予低剂量培哚普利-蚓哒帕胺联合降压和以格利齐特缓释片为基础的强化降糖治疗，标准组接受常规治疗或安慰剂治疗。定期检查患者尿微量白蛋白、尿肌苷水平，并通过直接眼底镜检查眼底和眼底七个视野彩色立体照相，比较5年后患者尿微量白蛋白，尿肌苷指数（UMA／UCR）、视力及眼底变化情况。结果强化组基线与5年UMMUCR比较无差异，而标准组则有上升（P=0．00）。两组患者基线时视力分布无统计学差异；治疗5年后强化组视力保持稳定，而标准组视力有所下降（P=0．04）。基线时两组眼底糖尿病病变无差异，治疗5年后强化组眼底病变无发展趋势，而标准组糖尿病视网膜病变有所加重（P=0．0006），并有1例患者新发生视网膜静脉分支阻塞。结论强化降糖和降压治疗能有效控制糖尿病患者微血管病变的发展，并能保持糖尿病患者视力稳定。Objective To evaluate the effects of intensive blood glucose control and blood pressure lowering on microvascular complications in patients with type 2 diabetes. Methods A total of 107 patients with type 2 diabetes were divided into intensive and standard group randomly. In intensive therapy, the combination ofperindopril and indapamide was used to lower the blood pressure, and the gliclazide MR was used to control the blood glucose. The patients in standard group accepted routine medications or matching placebo. The urinary microalbumin （UMA）, urinary creatinine （UCR）, UMA/UCR, visual acuity, fundus examination with direct ophthalmoscope, and seven-field stereoscopic retinal photographs were performed on the baseline and 5 years after treatment respectively. Results For the UMA/UCR, there was no obvious change in intensive group, whereas it increased significantly in standard group （P=0.00）. The difference of visual acuity on baseline between two groups was not significant. The visual acuity was stable in intensive group during the follow-up, and it decreased in standard group （P=0.04）. There was no progression of retinal diseases in intensive group, but the diabetic retinopathy deteriorated in standard group （P=0.0006）, and as well as the branch retinal vein occlusion occurred newly in 1 patient. Conclusions Intensive blood glucose control and blood pressure lowering can decrease the incidence or slow the progression of microvascular complications in patients with type 2 diabetes, and it also can keep the vision stable.

关 键 词：糖尿病 强化治疗 微血管病变 糖尿病视网膜病变 

分 类 号：R587.2[医药卫生—内分泌] R587.1[医药卫生—内科学]