{"id":56510,"date":"2025-08-30T05:10:22","date_gmt":"2025-08-30T05:10:22","guid":{"rendered":"http:\/\/zydq.1006ss.com\/?p=56510"},"modified":"2025-08-30T05:10:22","modified_gmt":"2025-08-30T05:10:22","slug":"%e3%80%90%e8%a7%84%e8%8c%83%e4%b8%8e%e6%8c%87%e5%8d%97%e3%80%91%e7%b3%96%e5%b0%bf%e7%97%85%e8%82%be%e8%84%8f%e7%97%85%e6%97%a9%e6%9c%9f%e7%ad%9b%e6%9f%a5%e4%b8%8e%e7%ae%a1%e7%90%86%e4%b8%93%e5%ae%b6","status":"publish","type":"post","link":"http:\/\/zydq.1006ss.com\/?p=56510","title":{"rendered":"\u3010\u89c4\u8303\u4e0e\u6307\u5357\u3011\u7cd6\u5c3f\u75c5\u80be\u810f\u75c5\u65e9\u671f\u7b5b\u67e5\u4e0e\u7ba1\u7406\u4e13\u5bb6\u5171\u8bc6\uff082025\u7248\uff09"},"content":{"rendered":"

\u6587\u7ae0\u6765\u6e90\uff1a\u4e2d\u534e\u7cd6\u5c3f\u75c5\u6742\u5fd7, 2025, 17(7): 786-800.<\/p>\n

\u4f5c\u8005\uff1a\u300a\u7cd6\u5c3f\u75c5\u80be\u810f\u75c5\u65e9\u671f\u7b5b\u67e5\u4e0e\u7ba1\u7406\u4e13\u5bb6\u5171\u8bc6\u300b\u7f16\u5199\u7ec4<\/p>\n

\u901a\u4fe1\u4f5c\u8005\uff1a\u6768\u91d1\u594e\uff0c\u5317\u4eac\u5e02\u7cd6\u5c3f\u75c5\u7814\u7a76\u6240 \u9996\u90fd\u533b\u79d1\u5927\u5b66\u9644\u5c5e\u5317\u4eac\u540c\u4ec1\u533b\u9662\u5185\u5206\u6ccc\u79d1\uff0c\u5317\u4eac100730\uff0cEmail\uff1ajkyang@ccmu.edu.cn<\/p>\n

\u6458\u8981<\/p>\n

\u7cd6\u5c3f\u75c5\u80be\u810f\u75c5\uff08DKD\uff09\u662f\u7531\u7cd6\u5c3f\u75c5\u5f15\u8d77\u7684\u6162\u6027\u80be\u810f\u75be\u75c5\uff0c\u662f\u7cd6\u5c3f\u75c5\u60a3\u8005\u5e38\u89c1\u4e14\u4e25\u91cd\u7684\u6162\u6027\u5e76\u53d1\u75c7\u4e4b\u4e00\uff0c\u4e5f\u662f\u5bfc\u81f4\u7ec8\u672b\u671f\u80be\u75c5\uff08ESKD\uff09\u7684\u4e3b\u8981\u539f\u56e0\u3002\u5c3d\u65e9\u51c6\u786e\u5730\u8bca\u65adDKD\u5e76\u8bc4\u4f30\u5176\u8fdb\u5c55\u98ce\u9669\uff0c\u5bf9\u4e8e\u7cd6\u5c3f\u75c5\u60a3\u8005\u7684\u5206\u7c7b\u7ba1\u7406\u4e0e\u4e2a\u6027\u5316\u6cbb\u7597\u5177\u6709\u91cd\u8981\u7684\u4e34\u5e8a\u610f\u4e49\u3002\u76ee\u524d\uff0c\u5c3f\u767d\u86cb\u767d\/\u808c\u9150\u6bd4\u503c\uff08UACR\uff09\u548c\u4f30\u7b97\u80be\u5c0f\u7403\u6ee4\u8fc7\u7387\uff08eGFR\uff09\u662f DKD \u8bca\u65ad\u7684\u4e3b\u8981\u4f9d\u636e\u3002\u968f\u7740\u5206\u5b50\u751f\u7269\u5b66\u6280\u672f\u7684\u53d1\u5c55\uff0c\u63a2\u7d22\u5177\u6709\u66f4\u9ad8\u7075\u654f\u5ea6\u548c\u7279\u5f02\u5ea6\u7684\u65b0\u578b\u751f\u7269\u6807\u5fd7\u7269\u5bf9 DKD\u7684\u65e9\u671f\u7b5b\u67e5\u53ca\u9884\u540e\u8bc4\u4f30\u5177\u6709\u91cd\u8981\u7684\u4e34\u5e8a\u5e94\u7528\u4ef7\u503c\u3002\u4e3a\u4e86\u5e2e\u52a9\u4e34\u5e8a\u533b\u5e08\u548c\u5176\u4ed6\u533b\u7597\u4e13\u4e1a\u4eba\u5458\u66f4\u597d\u5730\u8bc6\u522b\u548c\u7ba1\u7406DKD\uff0c\u56fd\u5185\u591a\u4f4d\u7cd6\u5c3f\u75c5\u548c\u80be\u810f\u75c5\u9886\u57df\u4e13\u5bb6\u7ec4\u6210\u300a\u7cd6\u5c3f\u75c5\u80be\u810f\u75c5\u65e9\u671f\u7b5b\u67e5\u4e0e\u7ba1\u7406\u4e13\u5bb6\u5171\u8bc6\u300b\u7f16\u5199\u7ec4\uff0c\u53c2\u8003\u56fd\u5185\u5916\u6700\u65b0\u7684\u7814\u7a76\u6210\u679c\u548c\u6307\u5357\uff0c\u7ed3\u5408\u6211\u56fd\u7684\u5b9e\u9645\u60c5\u51b5\uff0c\u64b0\u5199\u4e86\u300a\u7cd6\u5c3f\u75c5\u80be\u810f\u75c5\u65e9\u671f\u7b5b\u67e5\u4e0e\u7ba1\u7406\u4e13\u5bb6\u5171\u8bc6\uff082025\u7248\uff09\u300b\u3002\u5185\u5bb9\u6db5\u76d6DKD\u7684\u5b9a\u4e49\u3001\u5371\u9669\u56e0\u7d20\u3001\u8bca\u65ad\u6807\u51c6\u3001\u4f20\u7edf\u7b5b\u67e5\u4e0e\u8bc4\u4f30\u6307\u6807\u3001\u65b0\u578b\u751f\u7269\u6807\u5fd7\u7269\u3001\u7b5b\u67e5\u6d41\u7a0b\u3001\u7b5b\u67e5\u540e\u7ba1\u7406\u7b49\u65b9\u9762\u7684\u5185\u5bb9\uff0c\u65e8\u5728\u4e3a\u4e34\u5e8a\u63d0\u4f9b\u8bca\u7597\u6307\u5bfc\uff0c\u4ee5\u671f\u63d0\u9ad8DKD\u7684\u65e9\u671f\u8bca\u65ad\u7387\uff0c\u4f18\u5316\u75be\u75c5\u7ba1\u7406\u7b56\u7565\uff0c\u6700\u7ec8\u6539\u5584\u60a3\u8005\u9884\u540e\u3002<\/p>\n

\u7cd6\u5c3f\u75c5\u662f\u5371\u5bb3\u516c\u4f17\u5065\u5eb7\u7684\u6162\u6027\u4ee3\u8c22\u6027\u75be\u75c5 \uff3b <\/sup>1-2 \uff3d <\/sup>\uff0c\u7cd6\u5c3f\u75c5\u80be\u810f\u75c5\uff08diabetic kidney disease\uff0cDKD\uff09\u662f\u7cd6\u5c3f\u75c5\u60a3\u8005\u5e38\u89c1\u4e14\u4e25\u91cd\u7684\u6162\u6027\u5e76\u53d1\u75c7\u4e4b\u4e00\uff0c\u665a\u671f\u53ef\u80fd\u51fa\u73b0\u4e25\u91cd\u7684\u80be\u529f\u80fd\u8870\u7aed\u5371\u53ca\u60a3\u8005\u751f\u547d\u3002\u7814\u7a76\u7ed3\u679c\u663e\u793a\uff0c\u6162\u6027\u80be\u810f\u75c5\uff08chronic kidney disease\uff0c CKD\uff09\u5728\u7cd6\u5c3f\u75c5\u60a3\u8005\u4e2d\u7684\u53d1\u75c5\u7387\u8f83\u9ad8\u3002\u6839\u636e\u56fd\u9645\u7cd6\u5c3f\u75c5\u8054\u76df2021\u5e74\u7684\u62a5\u544a\uff0c\u9884\u8ba1\u52302045\u5e74\uff0c\u5168\u7403\u6210\u4eba\u7cd6\u5c3f\u75c5\u60a3\u8005\u4eba\u6570\u5c06\u4ece 5.37 \u4ebf\u589e\u52a0\u81f3 7.83 \u4ebf\uff0c20%~ 40% \u7684\u7cd6\u5c3f\u75c5\u60a3\u8005\u4f1a\u53d1\u5c55\u4e3a DKD <\/sup>\uff3b <\/sup>3 \uff3d <\/sup>\u3002\u81ea 2011 \u5e74\u4ee5\u6765\uff0c\u6211\u56fd\u4f4f\u9662\u60a3\u8005\u4e2dDKD\u5df2\u7ecf\u8d85\u8fc7\u80be\u5c0f\u7403\u80be\u708e\uff0c\u6210\u4e3a CKD \u7684\u9996\u8981\u75c5\u56e0 <\/sup>\uff3b <\/sup>4-5 \uff3d <\/sup>\u3002\u4e2d\u56fd\u80be\u810f\u75c5\u7f51\u7edc 2016 \u5e74\u5ea6\u6570\u636e\u62a5\u544a\u663e\u793a\uff0c\u6211\u56fd\u4f4f\u9662\u60a3\u8005\u4e2d CKD \u7684\u6700\u5e38\u89c1\u539f\u56e0\u662fDKD\uff0826.7%\uff09 <\/sup>\uff3b <\/sup>6 \uff3d <\/sup>\u3002\u4e2d\u56fd\u7814\u7a76\u6570\u636e\u670d\u52a1\u5e73\u53f0\u6570\u636e\u663e\u793a\uff0c2022\u5e74\u6211\u56fd\u65b0\u53d1\u8840\u6db2\u900f\u6790\u60a3\u8005\u4e2d\uff0cDKD\u5360\u6bd4\u5df2\u8d85\u8fc7\u4e86\u539f\u53d1\u6027\u80be\u5c0f\u7403\u80be\u708e\uff0c\u6210\u4e3a\u8840\u6db2\u900f\u6790\u7684\u7b2c\u4e00\u5927\u75c5\u56e0\u3002DKD \u7684\u5371\u5bb3\u4e0d\u5bb9\u5ffd\u89c6\uff0c\u4e0d\u4ec5\u4f1a\u5f15\u8d77\u6162\u6027\u80be\u529f\u80fd\u4e0d\u5168\uff0c\u5bfc\u81f4\u7ec8\u672b\u671f\u80be\u75c5\uff08end stage kidney disease\uff0cESKD\uff09\uff0c\u9700\u8981\u8fdb\u884c\u900f\u6790\u6cbb\u7597\u6216\u80be\u79fb\u690d\uff3b <\/sup>7 \uff3d <\/sup>\uff0c\u8fd8\u4f1a\u589e\u52a0\u60a3\u8005\u5fc3\u8111\u8840\u7ba1\u75be\u75c5\u53d1\u751f\u7684\u98ce\u9669\uff0c\u4e25\u91cd\u5f71\u54cd\u60a3\u8005\u751f\u6d3b\u8d28\u91cf\uff0c\u589e\u52a0\u6b7b\u4ea1\u7387\u3002\u56e0\u6b64\uff0c\u76ee\u524dDKD\u5df2\u7ecf\u6210\u4e3a\u6211\u56fdCKD\u9632\u6cbb\u7684\u91cd\u70b9\u3002 <\/p>\n

DKD \u65e9\u671f\u75c7\u72b6\u9690\u533f\uff0c\u4e00\u65e6\u8fdb\u5c55\u81f3\u5927\u91cf\u86cb\u767d\u5c3f\uff0c\u5373\u5c3f\u767d\u86cb\u767d\/\u808c\u9150\u6bd4\u503c\uff08urinary albumin\u2011to\u2011creatinine ratio\uff0cUACR\uff09\u2265300 mg\/g\uff0c\u53d1\u5c55\u81f3 ESKD \u7684\u901f\u5ea6\u660e\u663e\u589e\u52a0\uff0c\u7ea6\u4e3a\u5176\u4ed6\u80be\u810f\u75c5\u53d8\u7684 14 \u500d \uff3b <\/sup>8 \uff3d <\/sup>\u3002\u901a\u8fc7\u65e9\u671f\u7b5b\u67e5\uff0c\u65e9\u671f\u53d1\u73b0\u5e76\u53ca\u65f6\u5e72\u9884\u662f\u5ef6\u7f13 DKD \u8fdb\u5c55\u6700\u6709\u6548\u7684\u65b9\u5f0f\u3002\u76ee\u524d\u80be\u7a7f\u523a\u75c5\u7406\u68c0\u67e5\u662f\u80be\u75c5\u8bca\u65ad\u7684\u201c\u91d1\u6807\u51c6\u201d\uff0c\u7136\u800c\u5176\u5b58\u5728\u51fa\u8840\u3001\u611f\u67d3\u7b49\u98ce\u9669\uff0c\u4e0d\u5b9c\u5728\u7cd6\u5c3f\u75c5\u60a3\u8005\u4e2d\u8fdb\u884c\u5e7f\u6cdb\u7b5b\u67e5\u3002\u56e0\u6b64\uff0c\u8fd0\u7528\u65e0\u521b\u624b\u6bb5\u65e9\u671f\u53d1\u73b0\u548c\u8bca\u65ad DKD \u5e76\u53ca\u65f6\u5e72\u9884\uff0c\u5bf9\u4e8e\u6539\u5584\u60a3\u8005\u7684\u9884\u540e\u81f3\u5173\u91cd\u8981\u3002<\/p>\n

\u4e3a\u4e86\u5e2e\u52a9\u4e34\u5e8a\u533b\u5e08\u548c\u5176\u4ed6\u533b\u7597\u4e13\u4e1a\u4eba\u5458\u66f4\u597d\u5730\u8bc6\u522b\u548c\u7ba1\u7406 DKD\uff0c\u56fd\u5185\u591a\u4f4d\u7cd6\u5c3f\u75c5\u548c\u80be\u810f\u75c5\u9886\u57df\u4e13\u5bb6\u7ec4\u6210\u300a\u7cd6\u5c3f\u75c5\u80be\u810f\u75c5\u65e9\u671f\u7b5b\u67e5\u4e0e\u7ba1\u7406\u4e13\u5bb6\u5171\u8bc6\u300b\u7f16\u5199\u7ec4\uff0c\u53c2\u8003\u56fd\u5185\u5916\u6700\u65b0\u7684\u7814\u7a76\u6210\u679c\u548c\u6307\u5357\uff0c\u7ed3\u5408\u6211\u56fd\u7684\u5b9e\u9645\u60c5\u51b5\uff0c\u64b0\u5199\u4e86\u300a\u7cd6\u5c3f\u75c5\u80be\u810f\u75c5\u65e9\u671f\u7b5b\u67e5\u4e0e\u7ba1\u7406\u4e13\u5bb6\u5171\u8bc6\uff082025 \u7248\uff09\u300b\uff0c\u529b\u6c42\u5177\u6709\u79d1\u5b66\u6027\u3001\u5b9e\u7528\u6027\u548c\u53ef\u64cd\u4f5c\u6027\u3002\u5185\u5bb9\u6db5\u76d6 DKD \u7684\u5b9a\u4e49\u3001\u5371\u9669\u56e0\u7d20\u3001\u8bca\u65ad\u6807\u51c6\u3001\u4f20\u7edf\u7b5b\u67e5\u4e0e\u8bc4\u4f30\u6307\u6807\u3001\u65b0\u578b\u751f\u7269\u6807\u5fd7\u7269\u3001\u7b5b\u67e5\u6d41\u7a0b\u3001\u7b5b\u67e5\u540e\u7ba1\u7406\u7b49\u65b9\u9762\u7684\u5185\u5bb9\uff0c\u65e8\u5728\u901a\u8fc7\u89c4\u8303 DKD \u65e9\u671f\u7b5b\u67e5\u6d41\u7a0b\u548c\u7ba1\u7406\u7b56\u7565\uff0c\u63d0\u4f9b\u4e00\u5957\u7cfb\u7edf\u7684\u3001\u79d1\u5b66\u7684\u8bca\u65ad\u6807\u51c6\u548c\u7b5b\u67e5\u65b9\u6cd5\uff0c\u63a8\u52a8DKD\u65e9\u671f\u7b5b\u67e5\u548c\u7ba1\u7406\u5de5\u4f5c\u7684\u89c4\u8303\u5316\u53d1\u5c55\u3002<\/p>\n

\u672c\u5171\u8bc6\u8bc1\u636e\u8d28\u91cf\u53ca\u63a8\u8350\u5f3a\u5ea6\u53c2\u8003\u4e34\u5e8a\u6307\u5357\u5236\u5b9a\u4e2d\u63a8\u8350\u610f\u89c1\u5206\u7ea7\u7684\u8bc4\u4f30\u3001\u5236\u5b9a\u53ca\u8bc4\u4ef7\uff08grading of recommendations assessment\uff0c development and evaluation\uff0cGRADE\uff09\u65b9\u6cd5 \uff3b <\/sup>9 \uff3d<\/sup> <\/sup>\uff0c\u8bc1\u636e\u8d28\u91cf\u7531\u9ad8\u5230\u4f4e\u5206\u4e3a A\u3001B\u3001C\u3001D\u51714\u4e2a\u7ea7\u522b\uff08\u88681\uff09\u3002<\/p>\n<\/p>\n

DKD\u6982\u8ff0<\/p>\n

\u8981\u70b9\u63d0\u793a\uff1a<\/p>\n

1.\u7cd6\u5c3f\u75c5\u80be\u810f\u75c5\uff08DKD\uff09\u662f\u6307\u7531\u7cd6\u5c3f\u75c5\u5f15\u8d77\u7684\u80be\u810f\u7ed3\u6784\u635f\u4f24\u548c\u529f\u80fd\u969c\u788d\uff0c\u4e3b\u8981\u8868\u73b0\u4e3a\u5c3f\u767d\u86cb\u767d\/\u808c\u9150\u6bd4\u503c\uff08UACR\uff09\u226530 mg\/g \u548c\uff08\u6216\uff09\u4f30\u7b97\u80be\u5c0f\u7403\u6ee4\u8fc7\u7387\uff08eGFR\uff09<60 ml\u00b7min\u207b\u00b9\u00b7\uff081.73 m\u00b2\uff09\u207b\u00b9 <\/sup><\/sup>\uff0c\u4e14\u6301\u7eed 3 \u4e2a\u6708\u4ee5\u4e0a\uff0c\u5e76\u6392\u9664\u5176\u4ed6\u539f\u56e0\u7684\u80be\u810f\u75be\u75c5\uff08A\uff09 <\/p>\n

2.\u9ad8\u8840\u7cd6\u548c\u9ad8\u8840\u538b\u662fDKD\u53ef\u5e72\u9884\u7684\u4e3b\u8981\u5371\u9669\u56e0\u7d20\uff08B\uff09 <\/p>\n

3. \u63a7\u5236\u8840\u7cd6\u3001\u8840\u538b\u8fbe\u6807\u80fd\u591f\u964d\u4f4e\u60a3\u6162\u6027\u80be\u810f\u75c5\u7684\u98ce\u9669\u6216\u5ef6\u7f13\u75c5\u60c5\u53d1\u5c55\uff08A\uff09<\/p>\n

\u4e00\u3001DKD\u5b9a\u4e49<\/p>\n

DKD \u662f\u6307\u7531\u7cd6\u5c3f\u75c5\u5f15\u8d77\u7684\u80be\u810f\u7ed3\u6784\u635f\u4f24\u548c\u529f\u80fd\u969c\u788d\uff0c\u4e34\u5e8a\u4e0a\u4ee5\u6301\u7eed\u7684\u5c3f\u767d\u86cb\u767d\u5347\u9ad8\u548c\uff08\u6216\uff09\u80be\u529f\u80fd\u9010\u6e10\u4e0b\u964d\u4e3a\u4e3b\u8981\u7279\u5f81\uff0c\u5305\u62ec UACR\u226530 mg\/g \u548c\uff08\u6216\uff09\u4f30\u7b97\u80be\u5c0f\u7403\u6ee4\u8fc7\u7387\uff08estimated glomerular filtration rate\uff0ceGFR\uff09<60 ml\u00b7min\u207b\u00b9\u00b7\uff081.73 m\u00b2\uff09\u207b\u00b9 <\/sup><\/sup>\uff0c\u4e14\u6301\u7eed 3 \u4e2a\u6708\u4ee5\u4e0a\uff0c\u5e76\u6392\u9664\u5176\u4ed6\u539f\u56e0\u7684\u80be\u810f\u75be\u75c5 \uff3b <\/sup>10 \uff3d<\/sup> <\/sup>\u3002 DKD \u53ef\u53d1\u751f\u4e8e 1\u578b\u7cd6\u5c3f\u75c5\uff08type 1 diabetes mellitus\uff0c T1DM\uff09\u30012\u578b\u7cd6\u5c3f\u75c5\uff08type 2 diabetes mellitus\uff0cT2DM\uff09\u6216\u5176\u4ed6\u7c7b\u578b\u7684\u7cd6\u5c3f\u75c5\u60a3\u8005\u4e2d\uff0c\u662f\u7cd6\u5c3f\u75c5\u5e38\u89c1\u5e76\u53d1\u75c7\u4e4b\u4e00\uff0c\u4e5f\u662f\u5bfc\u81f4 ESKD \u7684\u4e3b\u8981\u539f\u56e0 \uff3b <\/sup>11 \uff3d<\/sup> <\/sup>\u3002\u503c\u5f97\u6ce8\u610f\u7684\u662f\uff0c\u7cd6\u5c3f\u75c5\u60a3\u8005\u4e5f\u53ef\u80fd\u51fa\u73b0\u7531\u5176\u4ed6\u539f\u56e0\u5f15\u8d77\u7684\u80be\u810f\u635f\u4f24\uff0c\u5373\u7cd6\u5c3f\u75c5\u5408\u5e76\u975e\u7cd6\u5c3f\u75c5\u80be\u810f\u75c5\u3002\u56e0\u6b64\uff0c\u5f53\u7cd6\u5c3f\u75c5\u60a3\u8005\u51fa\u73b0\u80be\u635f\u5bb3\u65f6\uff0c\u5e94\u7279\u522b\u6ce8\u610f\u8fdb\u884c\u75c5\u56e0\u7684\u533a\u5206\uff0c\u5fc5\u8981\u65f6\u5e94\u8003\u8651\u8fdb\u884c\u80be\u6d3b\u68c0\uff0c\u4ee5\u9632\u6b62\u6f0f\u8bca\u6216\u8bef\u8bca \uff3b <\/sup>12 \uff3d<\/sup> <\/sup>\u3002<\/p>\n

\u4e8c\u3001DKD\u7684\u5371\u9669\u56e0\u7d20<\/p>\n

DKD \u7684\u53d1\u75c5\u673a\u5236\u590d\u6742\uff0c\u6d89\u53ca\u7cd6\u4ee3\u8c22\u7d0a\u4e71\u3001\u8102\u4ee3\u8c22\u7d0a\u4e71\u3001\u80be\u5c0f\u7403\u8840\u6d41\u52a8\u529b\u5b66\u5f02\u5e38\u3001\u708e\u75c7\u53cd\u5e94\u53ca\u9057\u4f20\u56e0\u7d20\u7b49\u591a\u4e2a\u65b9\u9762\uff0c\u4e86\u89e3\u5371\u9669\u56e0\u7d20\u5bf9\u65e9\u671f\u8bc6\u522b\u548c\u5e72\u9884\u81f3\u5173\u91cd\u8981\u3002<\/p>\n

1. \u9ad8\u8840\u7cd6\uff1a\u662f DKD \u6700\u91cd\u8981\u7684\u81f4\u75c5\u56e0\u7d20\u3002\u957f\u671f\u8840\u7cd6\u6c34\u5e73\u63a7\u5236\u4e0d\u4f73\u4f1a\u5bfc\u81f4\u80be\u5c0f\u7403\u57fa\u5e95\u819c\u589e\u539a\u3001\u7cfb\u819c\u6269\u5c55\u53ca\u80be\u5c0f\u7ba1\u95f4\u8d28\u7ea4\u7ef4\u5316\uff0c\u6700\u7ec8\u5bfc\u81f4\u80be\u529f\u80fd\u4e0b\u964d \uff3b <\/sup>13-14 \uff3d<\/sup> <\/sup>\u3002<\/p>\n

2. \u9ad8\u8840\u538b\uff1a\u662f\u7cd6\u5c3f\u75c5\u60a3\u8005\u5e38\u89c1\u7684\u5408\u5e76\u75c7\uff0c\u4e5f\u662f DKD \u7684\u72ec\u7acb\u5371\u9669\u56e0\u7d20\u3002\u9ad8\u8840\u538b\u8fdb\u4e00\u6b65\u4f7f\u7cd6\u5c3f\u75c5\u60a3\u8005\u80be\u5c0f\u7403\u5185\u201c\u9ad8\u538b\u529b\u201d\u201c\u9ad8\u6ee4\u8fc7\u201d\u7b49\u8840\u6d41\u52a8\u529b\u7d0a\u4e71\u6076\u5316\uff0c\u52a0\u901f\u4e86\u80be\u810f\u635f\u4f24\u7684\u8fdb\u7a0b\u3002\u957f\u671f\u7684\u9ad8\u8840\u538b\u4f1a\u5bfc\u81f4\u80be\u5c0f\u7403\u786c\u5316\u3001\u80be\u5c0f\u7ba1\u95f4\u8d28\u7ea4\u7ef4\u5316\u548c\u80be\u52a8\u8109\u786c\u5316 \uff3b <\/sup>15 \uff3d <\/sup>\u3002<\/p>\n

3. \u9ad8\u8102\u8840\u75c7\uff1a\u5c24\u5176\u662f\u603b\u80c6\u56fa\u9187\uff08total cholesterol\uff0cTC\uff09\u3001\u4f4e\u5bc6\u5ea6\u8102\u86cb\u767d\u80c6\u56fa\u9187\uff08low density lipoprotein cholesterol\uff0cLDL\u2011C\uff09\u6c34\u5e73\u5347\u9ad8\u662f DKD \u7684\u91cd\u8981\u5371\u9669\u56e0\u7d20\u3002\u9ad8\u8102\u8840\u75c7\u53ef\u901a\u8fc7\u8102\u8d28\u4ee3\u8c22\u7d0a\u4e71\u5bfc\u81f4\u80be\u5c0f\u7403\u7cfb\u819c\u7ec6\u80de\u589e\u751f\u3001\u57fa\u5e95\u819c\u589e\u539a\u548c\u786c\u5316\uff0c\u5f71\u54cd\u80be\u810f\u7684\u6b63\u5e38\u529f\u80fd\u3002<\/p>\n

4.\u9057\u4f20\u56e0\u7d20\uff1aDKD\u5177\u6709\u663e\u8457\u7684\u9057\u4f20\u503e\u5411\u3002\u5982\u679c\u60a3\u8005\u7684\u76f4\u7cfb\u4eb2\u5c5e\u6709 DKD \u75c5\u53f2\uff0c\u60a3\u8005\u53d1\u751f DKD \u7684\u98ce\u9669\u8f83\u9ad8\u3002\u6b64\u5916\uff0c\u4e00\u4e9b\u7279\u5b9a\u7684\u57fa\u56e0\u53d8\u5f02\uff08\u5982 APOL1\u57fa\u56e0\u3001ACE\u57fa\u56e0\u7b49\uff09\u53ef\u80fd\u4e0eDKD\u7684\u6613\u611f\u6027\u76f8\u5173\u3002<\/p>\n

5. \u5176\u4ed6\uff1a\u7cd6\u5c3f\u75c5\u75c5\u7a0b\u3001\u9ad8\u9f84\u3001\u80a5\u80d6\u548c\u4ee3\u8c22\u7efc\u5408\u5f81\u3001\u6162\u6027\u708e\u75c7\u3001\u5438\u70df\u4ee5\u53ca\u4e0d\u826f\u7684\u751f\u6d3b\u65b9\u5f0f\u7b49\u4e5f\u4e0e DKD\u7684\u53d1\u751f\u548c\u8fdb\u5c55\u5bc6\u5207\u76f8\u5173 \uff3b <\/sup>15 \uff3d<\/sup> <\/sup>\u3002<\/p>\n

\u63a7\u5236\u76f8\u5173\u5371\u9669\u56e0\u7d20\u5bf9\u4e8e\u9884\u9632\u548c\u5ef6\u7f13 DKD\u7684\u8fdb\u5c55\u81f3\u5173\u91cd\u8981\u3002\u9ad8\u8840\u7cd6\u548c\u9ad8\u8840\u538b\u662fDKD\u53ef\u5e72\u9884\u7684\u4e3b\u8981\u5371\u9669\u56e0\u7d20 \uff3b <\/sup>13 \uff3d<\/sup> <\/sup>\uff0c\u63a7\u5236\u8840\u7cd6\u3001\u8840\u538b\u8fbe\u6807\u80fd\u591f\u964d\u4f4e\u60a3 CKD \u7684\u98ce\u9669\u6216\u5ef6\u7f13\u75c5\u60c5\u8fdb\u5c55 \uff3b <\/sup>16-19 \uff3d<\/sup> <\/sup>\u3002\u4e34\u5e8a\u5927\u578b\u968f\u673a\u5bf9\u7167\u8bd5\u9a8c\u7ed3\u679c\u663e\u793a\uff0c\u901a\u8fc7\u5f3a\u5316\u8840\u7cd6\u63a7\u5236\u8fbe\u5230\u63a5\u8fd1\u6b63\u5e38\u8840\u7cd6\u6c34\u5e73\u53ef\u4ee5\u5ef6\u7f13T1DM \uff3b <\/sup>20-21 \uff3d<\/sup> <\/sup>\u548cT2DM \uff3b <\/sup>22-24 \uff3d<\/sup> <\/sup> \u60a3\u8005\u767d\u86cb\u767d\u5c3f\u7684\u53d1\u751f\u548c\u8fdb\u5c55\uff0c\u5e76\u964d\u4f4e\u80be\u529f\u80fd\u7684\u4e0b\u964d\u901f\u5ea6\u3002\u63a7\u5236\u8840\u538b\u4e5f\u80fd\u964d\u4f4e\u80be\u810f\u5e76\u53d1\u75c7\u7684\u53d1\u751f\u98ce\u9669\uff0c\u6536\u7f29\u538b\u2265140 mmHg\uff081 mmHg=0.133 kPa\uff09\u7684\u60a3\u8005\uff0c\u8840\u538b\u6bcf\u964d\u4f4e 10 mmHg\uff0c\u767d\u86cb\u767d\u5c3f\u7684\u53d1\u751f\u98ce\u9669\u4e0b\u964d 17% \uff3b <\/sup>25 \uff3d<\/sup> <\/sup>\u3002\u56e0\u6b64\uff0c\u7cd6\u5c3f\u75c5\u60a3\u8005\u5e94\u901a\u8fc7\u5e72\u9884\u4e0a\u8ff0\u5371\u9669\u56e0\u7d20\uff0c\u6700\u5927\u7a0b\u5ea6\u5730\u9884\u9632\u548c\u5ef6\u7f13DKD\u7684\u53d1\u751f\u4e0e\u8fdb\u5c55\u3002<\/p>\n

DKD\u7684\u8bca\u65ad<\/p>\n

\u8981\u70b9\u63d0\u793a\uff1a<\/p>\n

1. \u7cd6\u5c3f\u75c5\u60a3\u8005\u5728\u6392\u9664\u5e72\u6270\u56e0\u7d20\u7684\u60c5\u51b5\u4e0b\uff0c\u5728 3~ 6 \u4e2a\u6708\u5185\u7684 3 \u6b21\u68c0\u6d4b\u4e2d\u81f3\u5c11 2 \u6b21\u5c3f\u767d\u86cb\u767d\/\u808c\u9150\u6bd4\u503c\uff08UACR\uff09\u226530 mg\/g \u4f5c\u4e3a\u7cd6\u5c3f\u75c5\u80be\u810f\u75c5\uff08DKD\uff09\u7684\u4e3b\u8981\u8bca\u65ad\u4f9d\u636e\uff08A\uff09<\/p>\n

2.\u7cd6\u5c3f\u75c5\u60a3\u8005\u51fa\u73b0\u4f30\u7b97\u80be\u5c0f\u7403\u6ee4\u8fc7\u7387\uff08eGFR\uff09< 60 ml\u00b7min\u207b\u00b9\u00b7\uff081.73 m\u00b2\uff09\u207b\u00b9 <\/sup>\uff0c\u4e14\u6301\u7eed3\u4e2a\u6708\u4ee5\u4e0a\u4f5c\u4e3aDKD\u7684\u4e3b\u8981\u8bca\u65ad\u4f9d\u636e\uff08A\uff09<\/p>\n

3. \u6839\u636e eGFR \u548c UACR \u5bf9 DKD \u60a3\u8005\u8fdb\u884c\u75be\u75c5\u5206\u671f\u548c\u9884\u540e\u98ce\u9669\u5206\u5c42\uff08C\uff09<\/p>\n

4. \u80be\u6d3b\u68c0\u75c5\u7406\u662f DKD \u8bca\u65ad\u7684\u91d1\u6807\u51c6\uff0c\u5f53\u4e0d\u80fd\u4f9d\u636e\u75c5\u53f2\u3001\u4e34\u5e8a\u7279\u5f81\u505a\u51fa\u8bca\u65ad\u6216\u96be\u4ee5\u6392\u9664\u5176\u4ed6\u539f\u56e0\u5f15\u8d77\u7684 CKD \u65f6\uff0c\u5efa\u8bae\u884c\u80be\u6d3b\u68c0\u75c5\u7406\u68c0\u6d4b\u660e\u786e\u8bca\u65ad\uff08B\uff09<\/p>\n

\u4e00\u3001\u4e34\u5e8a\u8bca\u65ad<\/p>\n

\u76ee\u524dDKD\u7684\u4e34\u5e8a\u8bca\u65ad\u662f\u4f9d\u636e\u75c5\u53f2\u3001\u4f53\u683c\u68c0\u67e5\u548c\u5b9e\u9a8c\u5ba4\u6307\u6807\u505a\u51fa\u7684\u8bca\u65ad\uff0c\u540c\u65f6\u6392\u9664\u5176\u4ed6\u539f\u56e0\u5f15\u8d77\u7684CKD\u3002\u5728T2DM\u786e\u8bca\u65f6\u53caT1DM\u8bca\u65ad5\u5e74\u540e\uff0c\u81f3\u5c11\u5177\u5907\u4e0b\u5217\u4e00\u9879\u8005\u53ef\u8bca\u65ad\u4e3aDKD \uff3b <\/sup>26 \uff3d<\/sup> <\/sup>\u3002\u5177\u4f53\u5305\u62ec\uff1a\uff081\uff09\u6392\u9664\u5e72\u6270\u56e0\u7d20\u7684\u60c5\u51b5\u4e0b\uff0c\u57283~6\u4e2a\u6708\u5185\u76843\u6b21\u68c0\u6d4b\u4e2d\u81f3\u5c112\u6b21UACR\u2265 30 mg\/g\uff1b\uff082\uff09eGFR<60 ml\u00b7min\u207b\u00b9\u00b7\uff081.73 m\u00b2\uff09\u207b\u00b9 <\/sup>\uff0c\u4e14\u6301\u7eed 3 \u4e2a\u6708\u4ee5\u4e0a\u3002\u56fd\u5185\u5916\u6307\u5357\u5747\u5efa\u8bae\u6839\u636e eGFR \u548c UACR \u5bf9 DKD \u60a3\u8005\u8fdb\u884c\u75be\u75c5\u5206\u671f\u548c\u9884\u540e\u98ce\u9669\u5206\u5c42 \uff3b <\/sup>26-31 \uff3d<\/sup> <\/sup>\uff0c\u4f9d\u636e 2022 \u5e74\u6539\u5584\u5168\u7403\u80be\u810f\u75c5\u9884\u540e\u7ec4\u7ec7\u6307\u5357 \uff3b <\/sup>28 \uff3d<\/sup> <\/sup>\uff0c\u6309\u7167 eGFR \u5212\u5206\u4e3a G1~G5 \u671f\uff0c\u6309\u7167\u5c3f\u767d\u86cb\u767d\u6c34\u5e73\u5206\u4e3aA1~A3\u671f\uff08\u88682\uff09\u3002<\/p>\n<\/p>\n

\u4e8c\u3001\u75c5\u7406\u8bca\u65ad<\/p>\n

\u80be\u6d3b\u68c0\u75c5\u7406\u662f\u8bca\u65ad DKD\u7684\u91d1\u201c\u6807\u51c6\u201d\u3002\u5f53\u4e0d\u80fd\u4f9d\u636e\u75c5\u53f2\u3001\u4e34\u5e8a\u7279\u5f81\u4f5c\u51fa\u8bca\u65ad\u6216\u96be\u4ee5\u6392\u9664\u5176\u4ed6\u539f\u56e0\u5f15\u8d77\u7684 CKD\u65f6\uff0c\u5efa\u8bae\u884c\u80be\u6d3b\u68c0\u75c5\u7406\u68c0\u6d4b\u660e\u786e\u8bca\u65ad\u3002\u5982\u679c\u5b58\u5728\u5bfc\u81f4 CKD \u7684\u5176\u4ed6\u5168\u8eab\u6027\u75be\u75c5\uff0c\u6216\u4e0d\u5b58\u5728\u89c6\u7f51\u819c\u75c5\u53d8\uff08\u5c24\u5176\u662f\u5728 T1DM \u60a3\u8005\u4e2d\uff09\u6216\u5177\u6709\u7cd6\u5c3f\u75c5\u4e0d\u5e38\u89c1\u7684 CKD \u4f53\u5f81\uff08\u5982\u80be\u5c0f\u7403\u6e90\u6027\u8840\u5c3f\u3001eGFR \u77ed\u671f\u5185\u5feb\u901f\u4e0b\u964d\u7b49\uff09\u65f6\uff0c\u5e94\u8003\u8651\u7cd6\u5c3f\u75c5\u4ee5\u5916\u7684 CKD\u539f\u56e0\u3002<\/p>\n

2010\u5e74\u7f8e\u56fd\u80be\u810f\u75c5\u7406\u5b66\u4f1a\u6839\u636e\u80be\u810f\u7ec4\u7ec7\u5149\u5b66\u663e\u5fae\u955c\u3001\u7535\u5b50\u663e\u5fae\u955c\u53ca\u514d\u75ab\u8367\u5149\u7684\u6539\u53d8\u5236\u5b9a\u4e86 DKD\u80be\u5c0f\u7403\u75c5\u7406\u5206\u7ea7\u6807\u51c6\uff0c\u5c06\u80be\u5c0f\u7403\u635f\u4f24\u5206\u4e3a4\u7ea7\uff08\u8868 3\uff09 \uff3b <\/sup>32 \uff3d<\/sup> <\/sup>\u3002\u540c\u65f6\uff0c\u5bf9\u80be\u5c0f\u7ba1\u95f4\u8d28\u548c\u8840\u7ba1\u75c5\u53d8\u7a0b\u5ea6\u8fdb\u884c\u4e86\u534a\u5b9a\u91cf\u8bc4\u4f30\uff0c\u80be\u5c0f\u7ba1\u548c\u95f4\u8d28\u75c5\u53d8\u6839\u636e\u80be\u5c0f\u7ba1\u840e\u7f29\u7a0b\u5ea6\u3001\u708e\u75c7\u7ec6\u80de\u6d78\u6da6\u548c\u80be\u95f4\u8d28\u7ea4\u7ef4\u5316\u7684\u8303\u56f4\u8fdb\u884c\u8bc4\u5206\uff1b\u80be\u8840\u7ba1\u7684\u635f\u4f24\u6839\u636e\u5c0f\u8840\u7ba1\u900f\u660e\u53d8\u6027\u548c\u5927\u8840\u7ba1\u52a8\u8109\u7ca5\u6837\u786c\u5316\u8fdb\u884c\u8bc4\u5206\uff08\u8868 4\uff09 \uff3b <\/sup>32 \uff3d<\/sup> <\/sup>\u3002\u4ee5\u4e0a\u5206\u578b\u53ca\u8bc4\u5206\u5728T1DM\u53caT2DM\u540c\u6837\u9002\u7528\u3002<\/p>\n<\/p>\n

DKD\u7684\u65e9\u671f\u7b5b\u67e5\u4e0e\u8bc4\u4f30<\/p>\n

\u8981\u70b9\u63d0\u793a\uff1a<\/p>\n

1. \u75c5\u7a0b\u22655 \u5e74\u7684 1 \u578b\u7cd6\u5c3f\u75c5\uff08T1DM\uff09\u60a3\u8005\u548c\u6240\u6709 2\u578b\u7cd6\u5c3f\u75c5\uff08T2DM\uff09\u60a3\u8005\u5728\u786e\u8bca\u65f6\u5c31\u5efa\u8bae\u5f00\u59cb\u8fdb\u884c\u7cd6\u5c3f\u75c5\u80be\u810f\u75c5\uff08DKD\uff09\u7684\u65e9\u671f\u7b5b\u67e5\uff08A\uff09 <\/p>\n

2.\u4f30\u7b97\u80be\u5c0f\u7403\u6ee4\u8fc7\u7387\uff08eGFR\uff09\u662f\u8bc4\u4f30\u80be\u5c0f\u7403\u6ee4\u8fc7\u529f\u80fd\u7684\u91cd\u8981\u6307\u6807\uff0c\u63a8\u8350\u91c7\u7528 2021 \u5e74\u6162\u6027\u80be\u810f\u75c5\u6d41\u884c\u75c5\u5b66\u534f\u4f5c\uff08CKD\u2011EPI\uff09\u516c\u5f0f\uff0c\u6839\u636e\u8840\u808c\u9150\u3001\u5e74\u9f84\u548c\u6027\u522b\u4f30\u7b97\u80be\u5c0f\u7403\u6ee4\u8fc7\u7387\uff08A\uff09 <\/p>\n

3. \u5c3f\u767d\u86cb\u767d\u662f\u8bc4\u4f30\u80be\u5c0f\u7403\u635f\u4f24\u7684\u91cd\u8981\u6307\u6807\uff0c\u63a8\u8350\u91c7\u7528\u968f\u673a\u5c3f\u6db2\u6837\u672c\u6d4b\u5b9a\u5c3f\u767d\u86cb\u767d\uff0c\u540c\u65f6\u68c0\u6d4b\u5c3f\u808c\u9150\u5bf9\u767d\u86cb\u767d\u8fdb\u884c\u6821\u6b63\uff0c\u5373\u5c3f\u767d\u86cb\u767d\/\u808c\u9150\u6bd4\u503c\uff08UACR\uff09\uff08A\uff09 <\/p>\n

4. \u7cd6\u5c3f\u75c5\u89c6\u7f51\u819c\u75c5\u53d8\uff08DR\uff09\u662f DKD \u8bca\u65ad\u7684\u91cd\u8981\u4f9d\u636e\uff0c\u4f46DR\u5e76\u975e\u8bca\u65adT2DM\u5bfc\u81f4\u7684DKD\u7684\u5fc5\u5907\u6761\u4ef6\uff08B\uff09<\/p>\n

DKD \u65e9\u671f\u7b5b\u67e5\u662f\u6307\u5bf9\u7cd6\u5c3f\u75c5\u60a3\u8005\u8fdb\u884c\u591a\u9879\u4e34\u5e8a\u6307\u6807\u68c0\u6d4b\uff0c\u4f9d\u636e\u68c0\u6d4b\u7ed3\u679c\u5236\u5b9a\u4e2a\u6027\u5316\u7684\u76d1\u6d4b\u8ba1\u5212\uff0c\u5e76\u5c3d\u65e9\u8bc6\u522b DKD \u4ee5\u8fdb\u884c\u6709\u6548\u7ba1\u7406\u3002\u901a\u8fc7\u5728\u65e9\u671f\u9636\u6bb5\u53ca\u65f6\u5e72\u9884\uff0c\u4e0d\u4ec5\u80fd\u591f\u5ef6\u7f13\u751a\u81f3\u9006\u8f6c\u75be\u75c5\u7684\u53d1\u751f\u4e0e\u8fdb\u5c55\uff0c\u8fd8\u80fd\u663e\u8457\u964d\u4f4e ESKD \u7684\u53d1\u751f\u7387\u3002\u56e0\u6b64\uff0c\u65e9\u671f\u7b5b\u67e5\u662f\u51cf\u5c11DKD\u53d1\u751f\u53ca\u6539\u5584\u60a3\u8005\u9884\u540e\u7684\u6838\u5fc3\u624b\u6bb5\u3002<\/p>\n

\u4e00\u3001\u65e9\u671f\u7b5b\u67e5\u76ee\u6807\u4eba\u7fa4\u53ca\u65f6\u673a <\/p>\n

T1DM\u60a3\u8005\u901a\u5e38\u5728\u8bca\u65ad5\u5e74\u540e\u53ef\u80fd\u51fa\u73b0\u5c3f\u767d\u86cb\u767d\u6c34\u5e73\u7684\u5347\u9ad8\uff0c\u800cT2DM\u60a3\u8005\u7684\u53d1\u75c5\u65f6\u95f4\u901a\u5e38\u96be\u4ee5\u786e\u5b9a\uff0c\u5728\u8bca\u65ad\u7cd6\u5c3f\u75c5\u65f6\u5373\u53ef\u80fd\u6709\u5c3f\u767d\u86cb\u767d\u5347\u9ad8 \uff3b <\/sup>33-34 \uff3d<\/sup> <\/sup>\u3002\u56e0\u6b64\uff0c\u5efa\u8bae\u75c5\u7a0b\u22655 \u5e74\u7684 T1DM \u60a3\u8005\u548c\u6240\u6709 T2DM\u60a3\u8005\u5728\u786e\u8bca\u65f6\u5f00\u59cb\u8fdb\u884cDKD\u7684\u7b5b\u67e5 \uff3b <\/sup>26 \uff3d<\/sup> <\/sup>\u3002<\/p>\n

\u4e8c\u3001\u76ee\u524d\u7684\u7b5b\u67e5\u8bc4\u4f30\u6307\u6807<\/p>\n

\uff08\u4e00\uff09eGFR<\/p>\n

1.\u4e34\u5e8a\u4ef7\u503c\uff1aeGFR\u662f\u8bc4\u4f30\u80be\u529f\u80fd\uff08\u5c24\u5176\u662f\u80be\u5c0f\u7403\u6ee4\u8fc7\u529f\u80fd\uff09\u7684\u91cd\u8981\u6307\u6807\uff0c\u5728CKD\u53caDKD\u7684\u8bca\u65ad\u548c\u76d1\u6d4b\u4e2d\u5177\u6709\u91cd\u8981\u4f5c\u7528\u3002\u63a8\u8350\u6210\u4eba\u60a3\u8005\uff08\u226518 \u5c81\uff09\u4f7f\u7528\u9176\u6cd5\u68c0\u6d4b\u8840\u808c\u9150\u6c34\u5e73\uff0c\u91c7\u7528 2021 \u5e74\u6162\u6027\u80be\u810f\u75c5\u6d41\u884c\u75c5\u5b66\u534f\u4f5c\uff08CKD\u2011EPI\uff09\u516c\u5f0f\uff0c\u6839\u636e\u8840\u808c\u9150\u3001\u5e74\u9f84\u548c\u6027\u522b\u4f30\u7b97\u80be\u5c0f\u7403\u6ee4\u8fc7\u7387 \uff3b <\/sup>35 \uff3d<\/sup> <\/sup>\u3002\u4f7f\u7528\u8be5\u516c\u5f0f\u5f53 eGFR<60 ml\u00b7min\u207b\u00b9\u00b7\uff081.73 m\u00b2\uff09\u207b\u00b9 <\/sup>\u65f6\uff0c\u89c6\u4e3a eGFR \u4e0b\u964d\uff0c\u5373\u8868\u660e\u80be\u529f\u80fd\u53d7\u635f\u3002\u8fd1\u5e74\u6765\uff0c\u57fa\u4e8e\u8840\u808c\u9150\u53ca\u80f1\u6291\u7d20 C \u7684 CKD\u2011EPI \u808c\u9150\u2011\u80f1\u6291\u7d20 C \u516c\u5f0f\uff08CKD\u2011EPIscr_cys\u2011c\uff09\u88ab\u63a8\u8350\u7528\u4e8e CKD \u60a3\u8005\u7684\u80be\u529f\u80fd\u8bc4\u4f30 \uff3b 36-37<\/sup> \uff3d<\/sup> <\/sup>\uff0c\u5e76\u5df2\u5728\u4e2d\u56fd\u7cd6\u5c3f\u75c5\u60a3\u8005\u4e2d\u663e\u793a\u51fa\u8f83\u9ad8\u7684\u51c6\u786e\u6027 \uff3b <\/sup>38 \uff3d<\/sup> <\/sup>\u3002<\/p>\n

2. \u5c40\u9650\u6027\uff1a\u9996\u5148\uff0ceGFR \u8ba1\u7b97\u4f9d\u8d56\u4e8e\u8840\u808c\u9150\u6c34\u5e73\uff0c\u800c\u808c\u9150\u7684\u6d53\u5ea6\u6613\u53d7\u591a\u79cd\u56e0\u7d20\u7684\u5f71\u54cd\uff0c\u5982\u60a3\u8005\u7684\u808c\u8089\u91cf\u3001\u996e\u98df\u3001\u6025\u6027\u75c5\u72b6\u6001\u3001\u836f\u7269\u4f7f\u7528\u7b49\uff0c\u56e0\u6b64\u53ef\u80fd\u5bfc\u81f4 eGFR\u7684\u4f30\u7b97\u4e0d\u51c6\u786e\u3002\u6b64\u5916\uff0cDKD\u65e9\u671f\u9636\u6bb5\u901a\u5e38\u4e0d\u4f1a\u4f34\u968f\u660e\u663e\u7684\u8840\u808c\u9150\u5347\u9ad8\uff0c\u63d0\u793a\u5728 DKD \u65e9\u671f eGFR\u53ef\u80fd\u65e0\u6cd5\u53ca\u65f6\u53cd\u6620\u80be\u810f\u529f\u80fd\u7684\u5fae\u5c0f\u53d8\u5316\u3002\u56e0\u6b64\uff0ceGFR\u5728\u65e9\u671f\u7b5b\u67e5\u4e2d\u53ef\u80fd\u4f4e\u4f30\u80be\u810f\u635f\u4f24\u7684\u7a0b\u5ea6\uff0c\u7279\u522b\u662f\u5728 DKD \u521d\u671f\uff0c\u53ef\u80fd\u672a\u80fd\u5145\u5206\u53cd\u6620\u80be\u810f\u7684\u65e9\u671f\u635f\u5bb3\u3002<\/p>\n

\uff08\u4e8c\uff09UACR<\/p>\n

1.\u4e34\u5e8a\u4ef7\u503c\uff1a\u5c3f\u767d\u86cb\u767d\u662f\u8bc4\u4f30\u80be\u5c0f\u7403\u635f\u4f24\u7684\u91cd\u8981\u6307\u6807\uff0c\u88ab\u5e7f\u6cdb\u7528\u4e8e DKD \u7684\u65e9\u671f\u7b5b\u67e5\u3002\u63a8\u8350\u91c7\u7528\u968f\u673a\u5c3f\u6db2\u6837\u672c\u6d4b\u5b9a\u5c3f\u767d\u86cb\u767d\uff0c\u540c\u65f6\u68c0\u6d4b\u5c3f\u808c\u9150\u5bf9\u767d\u86cb\u767d\u8fdb\u884c\u6821\u6b63\uff08\u5373 UACR\uff09\uff0c\u4ee5\u4fbf\u80fd\u591f\u5feb\u901f\u53cd\u6620\u5c3f\u767d\u86cb\u767d\u7684\u6392\u6cc4\u60c5\u51b5\uff0c\u6709\u52a9\u4e8e\u65e9\u671f\u8bc6\u522b\u548c\u8bca\u65ad DKD\u3002\u6839\u636e UACR \u7684\u6d4b\u5b9a\u7ed3\u679c\uff0c\u901a\u5e38\u5c06\u5176\u5206\u4e3a 3 \u4e2a\u9636\u6bb5\uff1a UACR<30 mg\/g\u4e3a\u6b63\u5e38\uff08A1\u671f\uff09\uff0c30~299 mg\/g\u4e3a\u5fae\u91cf\u767d\u86cb\u767d\u5c3f\uff08A2 \u671f\uff09\uff0c\u2265300 mg\/g \u4e3a\u5927\u91cf\u767d\u86cb\u767d\u5c3f\uff08A3\u671f\uff09\u3002 <\/p>\n

2. \u5c40\u9650\u6027\uff1a\u5c3d\u7ba1\u5b83\u662f\u5e38\u7528\u7684\u68c0\u6d4b\u65b9\u6cd5\uff0c\u4f46\u5176\u5728\u7075\u654f\u5ea6\u3001\u7279\u5f02\u5ea6\u4ee5\u53ca\u68c0\u6d4b\u7a97\u53e3\u7b49\u65b9\u9762\u4ecd\u5b58\u5728\u4e0d\u8db3 \uff3b <\/sup>39-41 \uff3d<\/sup> <\/sup>\u3002\u4f8b\u5982\uff0c\u90e8\u5206DKD\u60a3\u8005\u5728\u75c5\u7a0b\u65e9\u671f\u751a\u81f3\u53d1\u5c55\u8fc7\u7a0b\u4e2d\u53ef\u80fd\u5e76\u672a\u51fa\u73b0\u86cb\u767d\u5c3f\uff0c\u5bfc\u81f4\u5047\u9634\u6027\u7ed3\u679c\uff0c\u4ece\u800c\u6f0f\u8bca \uff3b <\/sup>42-43 \uff3d <\/sup>\u3002\u540c\u65f6\uff0c\u5c3f\u767d\u86cb\u767d\u7684\u6392\u6cc4\u53d7\u591a\u79cd\u56e0\u7d20\u7684\u5f71\u54cd\uff0c\u5982\u8fd0\u52a8\u3001\u611f\u67d3\u3001\u53d1\u70ed\u3001\u8840\u7cd6\u6216\u8840\u538b\u8fc7\u9ad8\u3001\u6708\u7ecf\u671f\u3001\u916e\u75c7\u9178\u4e2d\u6bd2\u7b49\uff0c\u8fd9\u4e9b\u56e0\u7d20\u53ef\u80fd\u5bfc\u81f4\u5047\u9633\u6027\u7ed3\u679c\u3002\u6b64\u5916\uff0cUACR \u7684\u53d8\u5f02\u6027\u8f83\u5927\uff0c\u8d85\u8fc7 20% \u7684\u53d8\u5f02\u7387\u4f7f\u5f97\u5355\u6b21\u68c0\u6d4b\u7ed3\u679c\u7684\u53ef\u9760\u6027\u53d7\u5230\u5f71\u54cd\uff0c\u56e0\u6b64\uff0c\u901a\u5e38\u9700\u8981\u5728 3~6 \u4e2a\u6708\u5185\u91cd\u590d\u68c0\u6d4b\u3002\u53ea\u6709\u5728\u6392\u9664\u5e72\u6270\u56e0\u7d20\u540e\uff0c\u4e143\u6b21\u68c0\u6d4b\u4e2d\u81f3\u5c112\u6b21UACR\u5f02\u5e38\uff0c\u624d\u53ef\u4ee5\u786e\u8ba4\u5c3f\u767d\u86cb\u767d\u6392\u6cc4\u589e\u52a0\u3002\u867d\u7136 24 h \u5c3f\u767d\u86cb\u767d\u6392\u6cc4\u7387\u5728 DKD\u8bca\u65ad\u4e2d\u7684\u6548\u80fd\u4e0eUACR\u76f8\u5f53\uff0c\u4f46\u7531\u4e8e\u5176\u64cd\u4f5c\u590d\u6742\uff0c\u901a\u5e38\u5728 UACR \u53d8\u5f02\u8f83\u5927\u65f6\uff0c\u5c3f\u767d\u86cb\u767d\u6392\u6cc4\u7387\u624d\u4f5c\u4e3a\u8865\u5145\u68c0\u6d4b\u65b9\u6cd5\u3002\u56e0\u6b64\uff0cUACR\u5728DKD\u7b5b\u67e5\u4e2d\u7684\u4e34\u5e8a\u5e94\u7528\u5177\u6709\u4e00\u5b9a\u7684\u5c40\u9650\u6027\uff0c\u9700\u8981\u7ed3\u5408\u5176\u4ed6\u56e0\u7d20\u8fdb\u884c\u7efc\u5408\u8bc4\u4f30\uff0c\u4ee5\u63d0\u9ad8\u8bca\u65ad\u7684\u51c6\u786e\u6027\u3002<\/p>\n

\uff08\u4e09\uff09\u7cd6\u5c3f\u75c5\u89c6\u7f51\u819c\u75c5\u53d8\uff08diabetic retinopathy\uff0c DR\uff09 <\/p>\n

1.\u4e34\u5e8a\u4ef7\u503c\uff1aDR \u4e0e DKD \u540c\u4e3a\u7cd6\u5c3f\u75c5\u7684\u4e3b\u8981\u5fae\u8840\u7ba1\u5e76\u53d1\u75c7\uff0c\u4e24\u8005\u5728\u53d1\u75c5\u673a\u5236\u4e0a\u5177\u6709\u9ad8\u5ea6\u76f8\u4f3c\u6027\uff0c\u4e14\u5e38\u4f34\u968f\u53d1\u751f\u3002\u5927\u91cf\u4e34\u5e8a\u7814\u7a76\u7ed3\u679c\u8bc1\u5b9e\uff0cDR \u53ef\u4f5c\u4e3aDKD\u7b5b\u67e5\u7684\u91cd\u8981\u8bc4\u4f30\u6307\u6807\u3002\u4e00\u9879\u57fa\u4e8e20\u4e2a\u961f\u5217\u7814\u7a76\u7684\u7cfb\u7edf\u8bc4\u4ef7\u548cMeta\u5206\u6790\u7ed3\u679c\u663e\u793a\uff0c\u5b58\u5728DR\u662f T2DM \u60a3\u8005\u53d1\u751f DKD \u7684\u72ec\u7acb\u5371\u9669\u56e0\u7d20 \uff3b <\/sup>44 \uff3d<\/sup> <\/sup>\u3002\u53e6\u4e00\u9879\u835f\u8403\u5206\u6790\u7ed3\u679c\u4e5f\u663e\u793a\uff0cDR\uff08\u5c24\u5176\u662f\u589e\u6b96\u671f\u89c6\u7f51\u819c\u75c5\u53d8\uff09\u662f\u9884\u6d4b T2DM \u60a3\u8005\u53d1\u751f DKD \u7684\u9ad8\u5ea6\u7279\u5f02\u6027\u6307\u6807 \uff3b <\/sup>45 \uff3d<\/sup> <\/sup>\u3002\u6b64\u5916\uff0cDR \u7684\u4e25\u91cd\u7a0b\u5ea6\u4e0e\u5c3f\u5fae\u91cf\u767d\u86cb\u767d\u6c34\u5e73\u548ceGFR\u5177\u6709\u663e\u8457\u76f8\u5173\u6027\u3002\u56fd\u5185\u4e00\u9879\u9488\u5bf9T2DM\u60a3\u8005\u80be\u6d3b\u68c0\u7684\u7814\u7a76\u7ed3\u679c\u663e\u793a\uff0cDKD\u60a3\u8005\u4e2d DR\u60a3\u75c5\u7387\u9ad8\u8fbe 86.4%\uff0c\u4e14 DR \u5bf9 DKD \u7684\u8bca\u65ad\u5177\u6709\u8f83\u9ad8\u7075\u654f\u5ea6\uff0886.4%\uff09\u548c\u7279\u5f02\u5ea6\uff0878.8%\uff09\uff1b\u968f\u7740 DR \u4e25\u91cd\u7a0b\u5ea6\u7684\u589e\u52a0\uff0c\u80be\u5c0f\u7403\u75c5\u53d8\u7684\u4e25\u91cd\u7a0b\u5ea6\u53ca Kimmelstiel\u2011Wilson \u7ed3\u8282\uff08\u7b80\u79f0 K\u2011W \u7ed3\u8282\uff09\u51fa\u73b0\u7387\u663e\u8457\u5347\u9ad8\uff0c\u8fdb\u4e00\u6b65\u63d0\u793aDR\u662fDKD\u53ef\u9760\u7684\u9884\u6d4b\u56e0\u5b50 \uff3b <\/sup>46 \uff3d<\/sup> <\/sup>\u3002\u4ee5\u4e0a\u7ed3\u679c\u63d0\u793a\uff0c DR \u4e0e DKD \u5728\u75c5\u7406\u751f\u7406\u8fc7\u7a0b\u53ca\u4e34\u5e8a\u8fdb\u5c55\u4e0a\u5177\u6709\u5bc6\u5207\u7684\u5173\u8054\uff0c\u53ef\u4f5c\u4e3a DKD\u7684\u9884\u8b66\u6307\u6807\u3002DR\u7684\u65e9\u671f\u8bca\u65ad\u6280\u672f\u5982\u773c\u5e95\u7167\u76f8\u548c\u5149\u5b66\u76f8\u5e72\u65ad\u5c42\u626b\u63cf\u6280\u672f\u53ef\u4ee5\u4e0e\u5176\u4ed6\u751f\u7269\u6807\u5fd7\u7269\uff08\u5982\u5c3f\u5fae\u91cf\u767d\u86cb\u767d\u548ceGFR\u7b49\uff09\u8054\u5408\u5e94\u7528\uff0c\u4ece\u800c\u63d0\u5347DKD\u7b5b\u67e5\u7684\u51c6\u786e\u6027\u548c\u53ef\u9760\u6027\u3002 <\/p>\n

2.\u5c40\u9650\u6027\uff1a\u5e76\u975e\u6240\u6709\u7684DKD\u60a3\u8005\u90fd\u4f34\u6709DR\uff0c\u90e8\u5206 T2DM \u60a3\u8005\u65e9\u671f\u53ef\u65e0 DR \u8868\u73b0\uff0c\u63d0\u793a DR \u53ef\u4f5c\u4e3a T2DM\u60a3\u8005DKD\u7684\u91cd\u8981\u8bca\u65ad\u4f9d\u636e\uff0c\u4f46\u5e76\u975e\u8bca\u65ad\u7684\u5fc5\u5907\u6761\u4ef6\u3002\u5355\u72ec\u4f9d\u8d56 DR \u8fdb\u884c DKD \u7b5b\u67e5\u53ef\u80fd\u4f1a\u5bfc\u81f4\u6f0f\u8bca\u6216\u8bef\u8bca\u3002\u6b64\u5916\uff0cDR \u7684\u8fdb\u5c55\u53ef\u80fd\u53d7\u5230\u591a\u79cd\u56e0\u7d20\u7684\u5f71\u54cd\uff0c\u5982\u8840\u7cd6\u63a7\u5236\u3001\u8840\u538b\u6c34\u5e73\u548c\u9057\u4f20\u56e0\u7d20\u7b49\uff0c\u56e0\u6b64\uff0c\u9700\u8981\u7efc\u5408\u8003\u8651\u591a\u79cd\u56e0\u7d20\u8fdb\u884c DKD \u7684\u7b5b\u67e5\u548c\u8bca\u65ad\u3002<\/p>\n

DKD\u65e9\u671f\u7b5b\u67e5\u751f\u7269\u6807\u5fd7\u7269<\/p>\n

\u8981\u70b9\u63d0\u793a\uff1a<\/p>\n

1.\u5c3f\u6db2\u7ed3\u5408\u73e0\u86cb\u767d\u6c34\u5e73\u80fd\u591f\u9884\u6d4b\u65e9\u671f\u80be\u529f\u80fd\u4e0b\u964d\uff0c\u4e0e\u5c3f\u767d\u86cb\u767d\/\u808c\u9150\u6bd4\u503c\uff08UACR\uff09\u8054\u5408\u68c0\u6d4b\u53ef\u663e\u8457\u63d0\u9ad8\u80be\u529f\u80fd\u635f\u4f24\u7684\u9884\u6d4b\u80fd\u529b\uff08C\uff09 <\/p>\n

2.\u5c3f\u6db2\u80f1\u6291\u7d20C\u3001\u5c3f\u6db2\u89c6\u9ec4\u9187\u7ed3\u5408\u86cb\u767d\u7b49\u65b0\u578b\u6807\u5fd7\u7269\u7684\u6c34\u5e73\u80fd\u591f\u53cd\u6620\u80be\u5c0f\u7ba1\u548c\u80be\u5c0f\u7403\u635f\u4f24\uff0c\u9884\u6d4b\u7cd6\u5c3f\u75c5\u80be\u810f\u75c5\uff08DKD\uff09\u53d1\u751f\u53d1\u5c55\uff0c\u662f DKD \u65e9\u671f\u8bca\u65ad\u7684\u6f5c\u5728\u751f\u7269\u6807\u5fd7\u7269\uff08C\uff09<\/p>\n

\u8fd1\u5e74\u6765\uff0c\u968f\u7740\u5206\u5b50\u751f\u7269\u5b66\u548c\u7ec4\u5b66\u6280\u672f\u7684\u53d1\u5c55\uff0c\u8d8a\u6765\u8d8a\u591a\u7684\u6f5c\u5728\u751f\u7269\u6807\u5fd7\u7269\u88ab\u53d1\u73b0\u53ef\u80fd\u7528\u4e8e DKD \u7684\u65e9\u671f\u7b5b\u67e5\u3002\u8fd9\u4e9b\u6807\u5fd7\u7269\u6d89\u53ca\u80be\u5c0f\u7403\u635f\u4f24\u3001\u80be\u5c0f\u7ba1\u635f\u4f24\u3001\u708e\u75c7\u3001\u6c27\u5316\u5e94\u6fc0\u3001\u7ea4\u7ef4\u5316\u7b49\u591a\u79cd\u75c5\u7406\u751f\u7406\u8fc7\u7a0b \uff3b <\/sup>47-48 \uff3d<\/sup> <\/sup>\u3002\uff0c\u57fa\u4e8e\u53d1\u75c5\u673a\u5236\u5f00\u53d1\u7684\u65b0\u578b\u6807\u5fd7\u7269\u5177\u6709\u4e00\u5b9a\u7684\u4e34\u5e8a\u8f6c\u5316\u524d\u666f\u3002\u7136\u800c\uff0c\u76ee\u524d\u5bf9\u4e8e\u8fd9\u4e9b\u751f\u7269\u6807\u5fd7\u7269\u7684\u4e34\u5e8a\u5e94\u7528\u4ecd\u7f3a\u4e4f\u7edf\u4e00\u7684\u8ba4\u8bc6\u548c\u89c4\u8303\u3002\u672c\u5171\u8bc6\u7f16\u5199\u7ec4\u7cfb\u7edf\u68b3\u7406\u4e86\u5f53\u524d\u53ef\u89c4\u6a21\u5316\u68c0\u6d4b\u7684\u86cb\u767d\u6807\u5fd7\u7269\uff0c\u57fa\u4e8e\u5faa\u8bc1\u533b\u5b66\u8bc1\u636e\u7b49\u7ea7\u3001\u4e34\u5e8a\u610f\u4e49\u3001\u68c0\u6d4b\u53ef\u53ca\u6027\u53ca\u6210\u672c\u6548\u76ca\u5206\u6790\u7b49\u591a\u7ef4\u5ea6\u8bc4\u4f30\uff0c\u9074\u9009\u51fa\u5177\u6709\u4e00\u5b9a\u4e34\u5e8a\u5e94\u7528\u4ef7\u503c\u7684\u751f\u7269\u6807\u5fd7\u7269\uff0c\u5e76\u5efa\u8bae\u5c3f\u6db2\u6807\u5fd7\u7269\u4f7f\u7528\u5c3f\u808c\u9150\u8fdb\u884c\u6821\u6b63\u540e\u4f5c\u4e3a DKD \u65e9\u671f\u7b5b\u67e5\u7684\u68c0\u6d4b\u6307\u6807\u3002\u7531\u4e8e\u5404\u9879\u6807\u5fd7\u7269\u7684\u53c2\u8003\u503c\u8303\u56f4\u5c1a\u672a\u6807\u51c6\u5316\uff0c\u5404\u533b\u7597\u673a\u6784\u5e94\u4f9d\u636e\u672c\u5355\u4f4d\u68c0\u6d4b\u65b9\u6cd5\u786e\u5b9a\u6b63\u5e38\u53c2\u8003\u503c\u8303\u56f4\u3002\u540c\u65f6\uff0c\u9488\u5bf9\u76ee\u524d\u5c1a\u5904\u4e8e\u79d1\u7814\u9636\u6bb5\u3001\u672a\u5b9e\u73b0\u4e34\u5e8a\u5e38\u89c4\u68c0\u6d4b\u7684\u6f5c\u5728\u6807\u5fd7\u7269\uff0c\u672c\u5171\u8bc6\u4e2d\u4e5f\u4e88\u4ee5\u7b80\u8981\u6982\u8ff0\uff0c\u65e8\u5728\u4e3a\u5177\u5907\u76f8\u5e94\u68c0\u6d4b\u6761\u4ef6\u7684\u533b\u7597\u673a\u6784\u63d0\u4f9b\u53c2\u8003\u3002<\/p>\n

\u4e00\u3001\u53ef\u7528\u4e8e\u4e34\u5e8a\u68c0\u6d4b\u7684\u65e9\u671f\u7b5b\u67e5\u5c3f\u6db2\u6807\u5fd7\u7269<\/p>\n

1. \u5c3f\u6db2\u7ed3\u5408\u73e0\u86cb\u767d\uff08haptoglobin\uff0cHp\uff09\uff1a\u7ed3\u5408\u73e0\u86cb\u767d\u53c8\u540d\u89e6\u73e0\u86cb\u767d\uff0c\u662f\u4e00\u79cd\u4e3b\u8981\u7531\u809d\u810f\u5408\u6210\u7684\u6025\u6027\u65f6\u76f8\u53cd\u5e94\u86cb\u767d\uff0c\u5176\u7ecf\u5178\u7684\u751f\u7269\u5b66\u529f\u80fd\u662f\u4e0e\u6e38\u79bb\u8840\u7ea2\u86cb\u767d\u7ed3\u5408\u5f62\u6210\u7ed3\u5408\u73e0\u86cb\u767d\u2011\u8840\u7ea2\u86cb\u767d\u590d\u5408\u7269\uff0c\u9632\u6b62\u94c1\u4e22\u5931\u5e76\u51cf\u5c11\u8840\u7ea2\u86cb\u767d\u4ecb\u5bfc\u7684\u80be\u810f\u6c27\u5316\u635f\u4f24 \uff3b <\/sup>49 \uff3d<\/sup> <\/sup>\u3002\u8fd1\u5e74\u6765\uff0c\u591a\u9879\u7814\u7a76\u53d1\u73b0Hp\u5728DKD\u7684\u8bca\u65ad\u548c\u9884\u540e\u8bc4\u4f30\u4e2d\u5177\u6709\u91cd\u8981\u7684\u4e34\u5e8a\u610f\u4e49\uff0c\u5c3f\u6db2Hp\u5728DKD\u60a3\u8005\u4e2d\u663e\u8457\u5347\u9ad8\uff0c\u4e14\u4e0e\u80be\u529f\u80fd\u4e0b\u964d\u5bc6\u5207\u76f8\u5173\uff0c\u4f7f\u5176\u6210\u4e3aDKD\u65e9\u671f\u8bca\u65ad\u548c\u9884\u540e\u8bc4\u4f30\u7684\u6f5c\u5728\u751f\u7269\u6807\u5fd7\u7269\u3002\u6709\u7814\u7a76\u8005\u901a\u8fc7\u6db2\u76f8\u8272\u8c31\u2011\u8d28\u8c31\u8054\u7528\u6280\u672f\u7b5b\u9009\u51fa\u591a\u4e2a\u5019\u9009\u6807\u5fd7\u7269\uff0c\u5176\u4e2d\u5c3f\u6db2Hp\u5728\u9884\u6d4b\u65e9\u671f\u80be\u529f\u80fd\u4e0b\u964d\u65b9\u9762\u8868\u73b0\u6700\u4f73\uff1b\u53e6\u5916\uff0c\u5728\u80be\u529f\u80fd\u6b63\u5e38\uff0c\u5373 eGFR\u226560 ml\u00b7min\u207b\u00b9\u00b7\uff081.73 m\u00b2\uff09\u207b\u00b9 <\/sup>\u4e14 UACR<300 mg\/g \u7684 T2DM \u60a3\u8005\u4e2d\uff0c\u5c3f\u6db2 Hp\/\u5c3f\u808c\u9150\u6bd4\u503c\u6700\u9ad8\u4e09\u5206\u4f4d\u6570\u60a3\u8005\u80be\u529f\u80fd\u4e0b\u964d\u98ce\u9669\u8f83\u6700\u4f4e\u4e09\u5206\u4f4d\u60a3\u8005\u589e\u52a02.7\u500d\uff0c\u63d0\u793a\u5c3f\u6db2Hp\u53ef\u4f5c\u4e3a\u9884\u6d4b\u60a3\u8005\u65e9\u671f\u80be\u529f\u80fd\u4e0b\u964d\u7684\u6709\u6548\u6307\u6807 \uff3b <\/sup>50 \uff3d<\/sup> <\/sup>\u3002\u5728\u4e9a\u6d32 T2DM \u60a3\u8005\u4e2d\u4e5f\u53d1\u73b0\uff0c\u80be\u529f\u80fd\u5feb\u901f\u8fdb\u5c55\u7ec4\uff3b\u5373 eGFR \u5e74\u4e0b\u964d\u2265 5 ml\u00b7min\u207b\u00b9\u00b7\uff081.73 m\u00b2\uff09\u207b\u00b9 <\/sup>\uff3d\u60a3\u8005\u7684\u57fa\u7ebf\u5c3f\u6db2 Hp\u6c34\u5e73\u8f83\u975e\u8fdb\u5c55\u7ec4\u589e\u52a011\u500d\uff0c\u4e14\u5728CKD 3\u671f\u60a3\u8005\u4e2d\uff0c\u5c3f\u6db2Hp \u9884\u6d4b\u80fd\u529b\u4f18\u4e8e\u4f20\u7edf\u7684\u5c3f\u767d\u86cb\u767d\u68c0\u6d4b \uff3b 5<\/sup>1 \uff3d<\/sup> <\/sup>\u3002<\/p>\n

\u5c3f\u6db2 Hp \u68c0\u6d4b\u548c\u4f20\u7edf\u6807\u5fd7\u7269\u7ed3\u5408\u5728 DKD \u4e2d\u8fd8\u5177\u6709\u534f\u540c\u4f5c\u7528 \uff3b <\/sup>52 \uff3d<\/sup> <\/sup>\u3002\u4e00\u9879\u5c3f\u6db2\u86cb\u767d\u8d28\u7ec4\u5b66\u7814\u7a76\u7ed3\u679c\u663e\u793a\uff0c\u57fa\u7ebf\u5c3f\u6db2Hp\u226520 ng\/min\u7684\u60a3\u8005\u53d1\u751f\u6162\u6027\u80be\u529f\u80fd\u4e0d\u5168\u7684\u98ce\u9669\u589e\u52a03.27\u500d \uff3b <\/sup>53 \uff3d<\/sup> <\/sup>\u3002\u503c\u5f97\u6ce8\u610f\u7684\u662f\uff0c\u5c3f\u6db2 Hp\u4e0e\u5fae\u91cf\u767d\u86cb\u767d\u5c3f\u8054\u5408\u68c0\u6d4b\u53ef\u8fdb\u4e00\u6b65\u63d0\u9ad8\u6162\u6027\u80be\u529f\u80fd\u4e0d\u5168\u7684\u9884\u6d4b\u6548\u80fd\u3002\u7814\u7a76\u8bc1\u5b9e\uff0c\u5c3f\u6db2 Hp\/\u5c3f\u808c\u9150\u6bd4\u503c\u7684\u9884\u6d4b\u80fd\u529b\u663e\u8457\u4f18\u4e8e\u5c3f\u767d\u86cb\u767d\u6d4b\u5b9a\uff0c\u540c\u65f6\u5c3f\u6db2 Hp\u4e0e UACR \u8054\u5408\u68c0\u6d4b\u53ef\u8fdb\u4e00\u6b65\u63d0\u9ad8\u80be\u529f\u80fd\u635f\u4f24\u7684\u9884\u6d4b\u51c6\u786e\u6027\uff0c\u4f7f\u5176\u6210\u4e3a\u4f20\u7edf\u5c3f\u767d\u86cb\u767d\u68c0\u6d4b\u7684\u91cd\u8981\u8865\u5145 \uff3b <\/sup>54 \uff3d<\/sup> <\/sup>\u3002\u57fa\u4e8e\u4ee5\u4e0a\u7814\u7a76\u8bc1\u636e\uff0c\u5c3f\u6db2 Hp \u5df2\u88ab\u89c6\u4e3a DKD \u65e9\u671f\u7b5b\u67e5\u7684\u654f\u611f\u6307\u6807\uff0c\u751a\u81f3\u53ef\u4f5c\u4e3a\u5c3f\u767d\u86cb\u767d\u7684\u8865\u5145\uff0c\u63d0\u4f9b\u989d\u5916\u8bca\u65ad\u4ef7\u503c\u3002\u5c3f\u6db2 Hp \u68c0\u6d4b\u8bd5\u5242\u76d2\u5df2\u83b7\u6279\u4e34\u5e8a\u5e94\u7528 \uff3b <\/sup>55 \uff3d<\/sup> <\/sup>\uff0c\u4e3aDKD\u7684\u65e9\u671f\u5e72\u9884\u63d0\u4f9b\u4e86\u65b0\u5de5\u5177\u3002<\/p>\n

\u7136\u800c\uff0c\u5c3f\u6db2Hp\u7684\u7279\u5f02\u6027\u4ecd\u53d7\u9650\u4e8e\u6025\u6027\u80be\u635f\u4f24\u3001\u975e\u7cd6\u5c3f\u75c5\u6027\u80be\u75c5\u53ca\u5168\u8eab\u6027\u708e\u75c7\u7b49\u56e0\u7d20\u7684\u5e72\u6270 \uff3b <\/sup>56-58 \uff3d<\/sup> <\/sup>\uff0c\u9700\u901a\u8fc7\u591a\u4e2d\u5fc3\u5927\u6837\u672c\u7814\u7a76\u8fdb\u4e00\u6b65\u9a8c\u8bc1\u5176\u4e34\u5e8a\u9002\u7528\u6027\u3002\u672a\u6765\u63a8\u5e7f\u5c3f\u6db2 Hp \u6807\u51c6\u5316\u68c0\u6d4b\u65b9\u6cd5\uff0c\u5e76\u8054\u5408\u5176\u4ed6\u80be\u5c0f\u7403\u53ca\u80be\u5c0f\u7ba1\u635f\u4f24\u6807\u5fd7\u7269\uff0c\u6709\u671b\u63d0\u9ad8 DKD \u8bca\u65ad\u7684\u51c6\u786e\u6027\uff0c\u4e3a\u7cd6\u5c3f\u75c5\u60a3\u8005\u7684\u80be\u810f\u5065\u5eb7\u7ba1\u7406\u63d0\u4f9b\u66f4\u7cbe\u51c6\u7684\u8bc4\u4f30\u7b56\u7565\u3002<\/p>\n

2.\u5c3f\u6db2\u80f1\u6291\u7d20C\uff08Cystatin C\uff0cCys C\uff09\uff1aCys C\u662f\u4e00\u79cd\u4f4e\u5206\u5b50\u91cf\u7684\u534a\u80f1\u6c28\u9178\u86cb\u767d\u9176\u6291\u5236\u5242\uff0c\u4e3b\u8981\u901a\u8fc7\u80be\u5c0f\u7403\u6ee4\u8fc7\uff0c\u5e76\u5728\u8fd1\u7aef\u5c0f\u7ba1\u5185\u88ab\u91cd\u5438\u6536\u548c\u5206\u89e3\uff3b <\/sup>59 \uff3d<\/sup> <\/sup>\u3002\u7531\u4e8e Cys C \u751f\u6210\u901f\u7387\u6052\u5b9a\uff0c\u4e0d\u53d7\u708e\u75c7\u3001\u6027\u522b\u3001\u5e74\u9f84\u7b49\u56e0\u7d20\u7684\u663e\u8457\u5f71\u54cd\uff0c\u8fd1\u5e74\u6765\u5728 DKD \u65e9\u671f\u8bca\u65ad\u4e2d\u5c55\u73b0\u51fa\u5177\u6709\u91cd\u8981\u4ef7\u503c\u3002\u5c3f\u6db2 Cys C \u6c34\u5e73\u5728 DKD \u60a3\u8005\u4e2d\u663e\u8457\u5347\u9ad8 \uff3b <\/sup>60 \uff3d<\/sup> <\/sup>\uff0c\u5e76\u4e0e\u80be\u5c0f\u7ba1\u635f\u4f24\u5bc6\u5207\u76f8\u5173 \uff3b 6<\/sup>1 \uff3d<\/sup> <\/sup>\uff0c\u53ef\u4f5c\u4e3a\u8bc4\u4f30\u80be\u5c0f\u7ba1\u635f\u4f24\u7684\u91cd\u8981\u6307\u6807\u3002\u5728 DKD \u65e9\u671f\u9636\u6bb5\uff0c\u7279\u522b\u662f\u5f53\u60a3\u8005\u5c1a\u5904\u4e8e\u6b63\u5e38\u767d\u86cb\u767d\u5c3f\u65f6\u671f\uff0c\u5c3f\u6db2 Cys C \u6c34\u5e73\u5373\u53ef\u51fa\u73b0\u663e\u8457\u5347\u9ad8 \uff3b 6<\/sup>1 \uff3d<\/sup> <\/sup>\uff0c\u63d0\u793a\u4e0e\u4f20\u7edf\u7684\u5c3f\u767d\u86cb\u767d\u68c0\u6d4b\u76f8\u6bd4\uff0c\u5c3f\u6db2Cys C\u5177\u6709\u66f4\u9ad8\u7684\u7075\u654f\u5ea6\u548c\u7279\u5f02\u5ea6\uff0c\u80fd\u66f4\u65e9\u8bc6\u522b\u60a3\u8005\u7684\u80be\u635f\u4f24\uff0c\u662f DKD \u65e9\u671f\u8bca\u65ad\u7684\u654f\u611f\u6807\u5fd7\u7269 \uff3b <\/sup>62 \uff3d<\/sup> <\/sup>\u3002\u6b64\u5916\uff0c\u5c3f\u6db2 Cys C \u6c34\u5e73\u5347\u9ad8\u8fd8\u4e0e DKD \u60a3\u8005\u80be\u529f\u80fd\u8fdb\u5c55\u7b49\u4e0d\u826f\u9884\u540e\u76f8\u5173 \uff3b <\/sup>63-64 \uff3d<\/sup> <\/sup>\uff0c\u8fd9\u4f7f\u5176\u4e0d\u4ec5\u5177\u6709\u8bca\u65ad\u4ef7\u503c\uff0c\u8fd8\u5177\u5907\u4e00\u5b9a\u7684\u9884\u540e\u8bc4\u4f30\u6f5c\u529b\u3002 <\/p>\n

3. \u5c3f\u6db2\u89c6\u9ec4\u9187\u7ed3\u5408\u86cb\u767d\uff08retinol\u2011binding protein\uff0cRBP\uff09\uff1aRBP\u662f\u4e00\u79cd\u4f4e\u5206\u5b50\u86cb\u767d\uff0c\u80fd\u81ea\u7531\u901a\u8fc7\u80be\u5c0f\u7403\u6ee4\u8fc7\u819c\uff0c\u5176\u4e2d\u7edd\u5927\u90e8\u5206\uff0899.97%\uff09\u88ab\u8fd1\u7aef\u80be\u5c0f\u7ba1\u4e0a\u76ae\u7ec6\u80de\u91cd\u5438\u6536\u5e76\u5206\u89e3\uff0c\u4ec5\u6709\u5c11\u91cf\u4ece\u5c3f\u6db2\u4e2d\u6392\u51fa\u3002\u56e0\u6b64\uff0c\u5c3f\u6db2\u4e2dRBP\u6c34\u5e73\u76f4\u63a5\u53cd\u6620\u4e86\u8fd1\u7aef\u80be\u5c0f\u7ba1\u7684\u91cd\u5438\u6536\u529f\u80fd\u3002\u7814\u7a76\u8868\u660e\uff0c\u5c3f\u6db2RBP\u7684\u6392\u6cc4\u91cf\u4e0e\u80be\u5c0f\u7ba1\u95f4\u8d28\u75c5\u53d8\u7684\u4e25\u91cd\u7a0b\u5ea6\u5448\u6b63\u76f8\u5173\uff0c\u4e14\u4e0e\u80be\u95f4\u8d28\u7ea4\u7ef4\u5316\u663e\u8457\u76f8\u5173\uff0c\u662f\u8bc4\u4f30\u80be\u5c0f\u7ba1\u635f\u4f24\u548c\u9884\u6d4b\u80be\u95f4\u8d28\u7ea4\u7ef4\u5316\u7684\u7406\u60f3\u6307\u6807 \uff3b <\/sup>65 \uff3d<\/sup> <\/sup>\u3002\u5728\u7cd6\u5c3f\u75c5\u60a3\u8005\u4e2d\uff0c\u4e0e\u65e0\u7cd6\u5c3f\u75c5\u5fae\u8840\u7ba1\u5e76\u53d1\u75c7\u7684\u60a3\u9ad8\u7684\u7075\u654f\u5ea6\uff080.76\uff0c95%CI 0.71~0.80\uff09\u548c\u7279\u5f02\u5ea6\uff080.81\uff0c95%CI 0.76~0.85\uff09 \uff3b <\/sup>69 \uff3d<\/sup> <\/sup>\u3002 <\/p>\n

4.\u5c3f\u6db2N\u2011\u4e59\u9170\u2011\u03b2\u2011D\u2011\u6c28\u57fa\u8461\u8404\u7cd6\u82f7\u9176\uff08N\u2011acetyl\u2011\u03b2\u2011d\u2011glucosaminidase\uff0cNAG\uff09\uff1aNAG \u4e3b\u8981\u5b58\u5728\u4e8e\u7ec6\u80de\u7684\u6eb6\u9176\u4f53\u4e2d\uff0cNAG \u6d3b\u6027\u7684\u6d4b\u5b9a\u662f\u80be\u5c0f\u7ba1\u635f\u4f24\u7684\u654f\u611f\u6307\u6807\u3002\u5f53\u80be\u5c0f\u7ba1\u53d7\u635f\u65f6\uff0cNAG \u4f1a\u4ece\u80be\u5c0f\u7ba1\u4e0a\u76ae\u7ec6\u80de\u7684\u6eb6\u9176\u4f53\u4e2d\u91ca\u653e\u51fa\u6765\uff0c\u4f7f\u5f97\u5c3f\u6db2\u4e2d NAG\u6d53\u5ea6\u5347\u9ad8\u3002\u7814\u7a76\u8868\u660e\uff0c\u5728DKD\u65e9\u671f\uff0c\u5c3f\u6db2NAG \u7684\u6c34\u5e73\u5373\u53ef\u5347\u9ad8\uff0c\u4e14\u5176\u5347\u9ad8\u5f80\u5f80\u65e9\u4e8e eGFR \u7684\u4e0b\u964d\u548c\u5c3f\u767d\u86cb\u767d\u7684\u5347\u9ad8 \uff3b <\/sup>70-71 \uff3d<\/sup> <\/sup>\u3002\u56e0\u6b64\uff0c\u5c3f\u6db2NAG\u88ab\u8ba4\u4e3a\u662f DKD\u65e9\u671f\u80be\u5c0f\u7ba1\u635f\u4f24\u7684\u654f\u611f\u9884\u6d4b\u56e0\u5b50\u3002 <\/p>\n

5. \u5c3f\u6db2 \u03b22\u2011\u5fae\u7403\u86cb\u767d\uff08\u03b22\u2011microglobulin\uff0c \u03b22\u2011MG\uff09\uff1a\u03b22\u2011MG \u662f\u4e00\u79cd\u7531\u6dcb\u5df4\u7ec6\u80de\u4ea7\u751f\u7684\u4f4e\u5206\u5b50\u91cf\u86cb\u767d\uff0c\u4e3b\u8981\u901a\u8fc7\u80be\u810f\u6392\u6cc4\u3002\u751f\u7406\u72b6\u6001\u4e0b\uff0c\u8840\u6db2\u4e2d \u03b22\u2011MG\u53ef\u7ecf\u80be\u5c0f\u7403\u81ea\u7531\u6ee4\u8fc7\uff0c\u901a\u5e38\u51e0\u4e4e\u5168\u90e8\u88ab\u8fd1\u66f2\u5c0f\u7ba1\u91cd\u5438\u6536\uff0c\u7136\u540e\u5728\u4f53\u5185\u5206\u89e3\uff0c\u56e0\u6b64\u6b63\u5e38\u4eba\u5c3f\u6db2\u4e2d \u03b22\u2011MG\u542b\u91cf\u5f88\u4f4e\u3002\u5f53\u80be\u5c0f\u7ba1\u91cd\u5438\u6536\u529f\u80fd\u53d7\u635f\u65f6\uff0c\u5c3f \u03b22\u2011MG \u7684\u6c34\u5e73\u663e\u8457\u5347\u9ad8 \uff3b <\/sup>72 \uff3d<\/sup> <\/sup>\u3002\u5728 DKD \u65e9\u671f\uff0c\u5373\u4f7f\u5c3f\u767d\u86cb\u767d\u5c1a\u672a\u660e\u663e\u5347\u9ad8\uff0c\u5c3f\u6db2 \u03b22\u2011MG \u6c34\u5e73\u5df2\u53ef\u663e\u8457\u589e\u52a0\uff0c\u56e0\u6b64\u5176\u88ab\u8ba4\u4e3a\u662f DKD \u80be\u5c0f\u7ba1\u635f\u4f24\u7684\u654f\u611f\u6307\u6807 \uff3b <\/sup>73 \uff3d<\/sup> <\/sup>\u3002<\/p>\n

6. \u5c3f\u6db2 \u03b1\u20111 \u5fae\u7403\u86cb\u767d\uff08\u03b11\u2011microglobulin\uff0c \u03b11\u2011MG\uff09\uff1a\u03b11\u2011MG\u662f\u4e00\u79cd\u7ecf\u6dcb\u5df4\u7ec4\u7ec7\u3001\u809d\u810f\u5206\u6ccc\u7684\u5c0f\u5206\u5b50\u7cd6\u86cb\u767d\uff0c\u53ef\u7ecf\u7531\u80be\u5c0f\u7403\u6ee4\u8fc7\u5e76\u88ab\u80be\u5c0f\u7ba1\u91cd\u5438\u6536\u3002\u5728\u7cd6\u5c3f\u75c5\u7ec4\u60a3\u8005\u4e2d\uff0c\u5c3f \u03b11\u2011MG \u6c34\u5e73\u663e\u8457\u9ad8\u4e8e\u975e\u7cd6\u5c3f\u75c5\u7ec4\uff0c\u4e14\u6bd4\u767d\u86cb\u767d\u66f4\u65e9\u51fa\u73b0\u5728\u5c3f\u6db2\u4e2d \uff3b <\/sup>73-74 \uff3d<\/sup> <\/sup>\u3002\u6b64\u5916\uff0c\u5c3f \u03b11\u2011MG\/\u5c3f\u808c\u9150\u6bd4\u503c\u5347\u9ad8\u53ef\u51fa\u73b0\u5728\u5c3f\u767d\u86cb\u767d\u9634\u6027\u7684 T2DM \u60a3\u8005\u4e2d\uff0c\u4e14\u4e0e eGFR \u5448\u663e\u8457\u8d1f\u76f8\u5173\uff08r=-0.37\uff0cP<0.05\uff09\uff3b <\/sup>75 \uff3d<\/sup> <\/sup>\u3002\u56e0\u6b64\uff0c\u03b11\u2011MG \u88ab\u8ba4\u4e3a\u662f\u80be\u5c0f\u7ba1\u635f\u4f24\u7684\u7279\u5f02\u6027\u6807\u5fd7\u86cb\u767d\uff0c\u5bf9\u4e34\u5e8a\u65e9\u671f\u8bca\u65ad DKD \u5177\u6709\u91cd\u8981\u610f\u4e49\u3002<\/p>\n

7.\u5c3f\u6db2\u8f6c\u94c1\u86cb\u767d\uff08transferrin\uff0cTF\uff09\uff1aTF\u662f\u4e00\u79cd\u94c1\u7ed3\u5408\u86cb\u767d\uff0c\u4e3b\u8981\u5b58\u5728\u4e8e\u8840\u6d46\u4e2d\uff0c\u8d1f\u8d23\u94c1\u79bb\u5b50\u7684\u8f6c\u8fd0\u3002\u5728\u751f\u7406\u72b6\u6001\u4e0b\uff0c\u7531\u4e8e\u80be\u5c0f\u7403\u6ee4\u8fc7\u5c4f\u969c\u7684\u7535\u8377\u9009\u62e9\u6027\u548c\u5b54\u5f84\u9009\u62e9\u6027\uff0cTF\u6781\u5c11\u51fa\u73b0\u5728\u5c3f\u6db2\u4e2d\u3002\u7136\u800c\uff0c\u5f53\u80be\u5c0f\u7403\u6ee4\u8fc7\u5c4f\u969c\u53d7\u635f\u65f6\uff0c\u6ee4\u8fc7\u819c\u5b54\u5f84\u589e\u5927\u548c\u8d1f\u7535\u8377\u51cf\u5c11\uff0c\u5bfc\u81f4 TF \u6ee4\u51fa\u589e\u591a\uff0c\u4e14\u7531\u4e8e\u5176\u5206\u5b50\u91cf\u8f83\u5927\uff0c\u5f88\u96be\u88ab\u80be\u5c0f\u7ba1\u91cd\u5438\u6536\uff0c\u4ece\u800c\u4f7f\u5c3f\u6db2 TF \u6392\u6cc4\u589e\u52a0\u3002\u7814\u7a76\u8868\u660e\uff0c\u7531\u4e8eTF\u5e26\u6709\u8f83\u5c11\u7684\u8d1f\u7535\u8377\uff0c\u53d7\u5230\u7684\u7535\u8377\u6392\u65a5\u529b\u8f83\u767d\u86cb\u767d\u5c0f\uff0c\u66f4\u5bb9\u6613\u6f0f\u51fa\uff0c\u56e0\u6b64\uff0c\u5728 T2DM \u60a3\u8005\u4e2d\uff0c\u5c3f\u6db2TF\u7684\u5347\u9ad8\u5f80\u5f80\u65e9\u4e8e\u767d\u86cb\u767d\u5c3f\u7684\u51fa\u73b0\uff0c\u6210\u4e3a\u53cd\u6620\u65e9\u671f\u80be\u5c0f\u7403\u7535\u8377\u5c4f\u969c\u635f\u4f24\u7684\u654f\u611f\u6807\u5fd7\u7269 \uff3b <\/sup>76-78 \uff3d<\/sup> <\/sup>\u3002\u6b64\u5916\uff0c\u5c3f\u6db2 TF \u6392\u6cc4\u589e\u52a0\u5bf9\u4e8e\u9884\u6d4b\u6b63\u5e38\u767d\u86cb\u767d\u5c3f\u7684 T2DM \u60a3\u8005\u53d1\u751f\u5fae\u91cf\u767d\u86cb\u767d\u5c3f\u5177\u6709\u4e00\u5b9a\u7684\u4e34\u5e8a\u4ef7\u503c \uff3b <\/sup>78-80 \uff3d<\/sup> <\/sup>\u3002\u4e0eUACR\u76f8\u6bd4\uff0c\u5c3f\u6db2TF\u5347\u9ad8\u53ef\u80fd\u662f\u66f4\u654f\u611f\u7684DKD\u65e9\u671f\u8bca\u65ad\u6307\u6807 \uff3b 8<\/sup>1 \uff3d<\/sup> <\/sup>\u3002<\/p>\n

8.\u5c3f\u6db2\u514d\u75ab\u7403\u86cb\u767dG\uff08immunoglobulin G\uff0cIgG\uff09\uff1a IgG \u662f\u4e00\u79cd 150 kDa\u7684\u5927\u5206\u5b50\u91cf\u514d\u75ab\u86cb\u767d\u3002\u5728\u751f\u7406\u60c5\u51b5\u4e0b\uff0c\u7531\u4e8e\u80be\u5c0f\u7403\u6ee4\u8fc7\u819c\u7684\u5c4f\u969c\u4f5c\u7528\uff0cIgG\u51e0\u4e4e\u4e0d\u901a\u8fc7\u6ee4\u8fc7\u819c\u3002\u7136\u800c\uff0c\u5f53\u80be\u5c0f\u7403\u57fa\u5e95\u819c\u53d7\u635f\u548c\u901a\u900f\u6027\u589e\u52a0\u65f6\uff0cIgG\u4f1a\u6f0f\u51fa\u4e14\u65e0\u6cd5\u88ab\u80be\u5c0f\u7ba1\u91cd\u5438\u6536\uff0c\u4f7f\u5176\u5728\u5c3f\u6db2\u4e2d\u7684\u542b\u91cf\u5347\u9ad8\u3002\u7814\u7a76\u8868\u660e\uff0c\u5c3f\u6db2 IgG \u6392\u6cc4\u968f DKD \u7684\u8fdb\u5c55\u800c\u589e\u52a0 \uff3b <\/sup>82 \uff3d<\/sup> <\/sup>\u3002\u4e00\u9879\u524d\u77bb\u6027\u961f\u5217\u7814\u7a76\u663e\u793a\uff0c\u57fa\u7ebf\u5c3f\u6db2 IgG\u6392\u6cc4\u589e\u52a0\u53ef\u4ee5\u9884\u6d4b\u5fae\u91cf\u767d\u86cb\u767d\u5c3f\u7684\u53d1\u751f\u98ce\u9669 \uff3b <\/sup>78 \uff3d<\/sup> <\/sup>\u3002\u5728\u6b63\u5e38\u767d\u86cb\u767d\u5c3f\u7684\u7cd6\u5c3f\u75c5\u60a3\u8005\u4e2d\uff0c\u5c3f\u6db2 IgG \u6392\u6cc4\u4e5f\u53ef\u80fd\u56e0\u80be\u5c0f\u7403\u8840\u6d41\u52a8\u529b\u5b66\u5f02\u5e38\u800c\u5347\u9ad8 \uff3b <\/sup>83 \uff3d<\/sup> <\/sup>\u3002\u8fd9\u4e9b\u7814\u7a76\u53d1\u73b0\u63d0\u793a\uff0c\u5c3f\u6db2 IgG\u53ef\u80fd\u662f\u9884\u6d4b T2DM\u60a3\u8005\u5fae\u91cf\u767d\u86cb\u767d\u5c3f\u53d1\u751f\u7684\u6709\u6548\u6807\u5fd7\u7269\u3002 <\/p>\n

DKD \u65e9\u671f\u7b5b\u67e5\u65b0\u578b\u751f\u7269\u6807\u5fd7\u7269\u53ca\u5176\u4e34\u5e8a\u5e94\u7528\u4ef7\u503c\u89c1\u88685\u3002<\/p>\n<\/p>\n

\u4e8c\u3001\u5176\u4ed6\u65b0\u578b\u6807\u5fd7\u7269 <\/p>\n

1. \u80be\u635f\u4f24\u5206\u5b50\u20111\uff08kidney injury molecule\u20111\uff0c KIM\u20111\uff09\uff1a\u662f\u4e00\u79cd\u2160\u578b\u8de8\u819c\u7cd6\u86cb\u767d\uff0c\u5728\u80be\u810f\u4e3b\u8981\u8868\u8fbe\u4e8e\u80be\u810f\u8fd1\u66f2\u5c0f\u7ba1\u4e0a\u76ae\u7ec6\u80de\u4e2d\u3002\u751f\u7406\u60c5\u51b5\u4e0b\u5176\u8868\u8fbe\u91cf\u8f83\u4f4e\uff0c\u5f53\u80be\u810f\u53d7\u635f\u65f6\u5176\u8868\u8fbe\u53ef\u660e\u663e\u589e\u52a0\u3002\u8840\u6d46\u548c\u5c3f\u6db2 KIM\u20111 \u6c34\u5e73\u5747\u4e0e DKD \u53d1\u751f\u53d1\u5c55\u76f8\u5173 \u3002ACCORD \u7814\u7a76\u548c NEPHRON\u2011D \u961f\u5217\u7814\u7a76\u7ed3\u679c\u663e\u793a\uff0c\u57fa\u7ebf\u8840\u6d46 KIM\u20111 \u6c34\u5e73\u5347\u9ad8\u4e0e\u80be\u529f\u80fd\u8fdb\u884c\u6027\u4e0b\u964d\uff08eGFRcr\u2011cys \u5e74\u964d\u5e45\u22653.3%\uff09\uff0c\u8fdb\u5c55\u81f3 CKD 3 \u671f\u53ca\u53d1\u751f ESRD\u7684\u98ce\u9669\u663e\u8457\u76f8\u5173\uff0c\u4e14\u8fd9\u79cd\u5173\u8054\u72ec\u7acb\u4e8e\u80be\u5c0f\u7403\u635f\u4f24\u6807\u5fd7\u7269\uff08\u5982\u5c3f\u767d\u86cb\u767d\u3001IgG2\uff09\u53ca\u5176\u4ed6\u4e34\u5e8a\u56e0\u7d20\uff0c\u63d0\u793a\u5176\u53ef\u4f5c\u4e3aDKD\u8fdb\u5c55\u7684\u9884\u6d4b\u6307\u6807 \uff3b <\/sup>84 \uff3d<\/sup> <\/sup>\u3002\u540c\u65f6\uff0c\u8840\u6d46 KIM\u20111 \u4e0e T2DM \u60a3\u8005\u65e9\u671f\u80be\u529f\u80fd\u4e0b\u964d\u98ce\u9669\u589e\u52a0\u72ec\u7acb\u76f8\u5173\uff08OR \u503c\u4e3a 1.41\uff0c95%CI 1.13~1.75\uff09 \uff3b <\/sup>85 \uff3d<\/sup> <\/sup>\u3002\u6b64\u5916\uff0c\u5c3f\u6db2 KIM\u20111 \u4e5f\u5177\u6709\u9884\u6d4b DKD \u8fdb\u5c55\u7684\u4ef7\u503c\u3002\u5728 T2DM \u60a3\u8005\u4e2d\uff0c\u5c3f\u6db2 KIM\u20111 \u6c34\u5e73\u5347\u9ad8\u4e0e eGFR \u964d\u4f4e\u5448\u8d1f\u76f8\u5173\uff0c\u6709\u52a9\u4e8e\u65e9\u671f\u8bc4\u4f30T2DM\u60a3\u8005\u7684\u80be\u810f\u75be\u75c5 \uff3b <\/sup>76,85-87 \uff3d<\/sup> <\/sup>\u3002\u5728 DKD \u65e9\u671f\uff0c\u5c3f\u6db2 KIM\u20111 \u53ef\u80fd\u662f\u4e0e\u767d\u86cb\u767d\u5c3f\u76f8\u5173\u7684\u72ec\u7acb\u56e0\u7d20 \uff3b <\/sup>88 \uff3d<\/sup> <\/sup>\u3002 <\/p>\n

2.\u80bf\u7624\u574f\u6b7b\u56e0\u5b50\u53d7\u4f53 1 \u548c 2\uff08tumor necrosis factor receptor\uff0cTNFR\u20111\/2\uff09\uff1aTNFR\u20111\/2\u662f\u80bf\u7624\u574f\u6b7b\u56e0\u5b50\u2011\u03b1 \u7684\u5faa\u73af\u53d7\u4f53\uff0c\u901a\u8fc7\u53c2\u4e0e\u708e\u75c7\u53cd\u5e94\u5728 DKD \u53d1\u751f\u53d1\u5c55\u4e2d\u53d1\u6325\u91cd\u8981\u4f5c\u7528\u3002\u7814\u7a76\u663e\u793a\uff0c\u8840\u6d46 TNFR\u20111\/2\u4e0e\u7cd6\u5c3f\u75c5\u60a3\u8005\u65e9\u671f\u80be\u529f\u80fd\u4e0b\u964d\u7684\u98ce\u9669\u5bc6\u5207\u76f8\u5173 \uff3b <\/sup>85 , 89 \uff3d<\/sup> <\/sup>\u3002\u5bf9 2 553 \u4f8b\u6b63\u5e38\u767d\u86cb\u767d\u5c3f\u7684 T2DM \u60a3\u8005\u968f\u8bbf\u4e86 6.1 \u5e74\uff08\u4e2d\u4f4d\u968f\u8bbf\u65f6\u95f4\uff09\u540e\u53d1\u73b0\uff0c\u57fa\u7ebf\u8840\u6d46 TNFR\u20111 \uff08HR \u503c\u4e3a 4.2\uff0c 95%CI 1.8~9.6\uff09 \u548c TNFR\u20112\uff08HR \u503c\u4e3a 2.3\uff0c95%CI 1.5~3.6\uff09\u6c34\u5e73\u500d\u589e\u4e0e\u80be\u810f\u7ed3\u5c40\u98ce\u9669\u663e\u8457\u5347\u9ad8\u72ec\u7acb\u76f8\u5173 \uff3b <\/sup>90 \uff3d<\/sup> <\/sup>\u3002\u7814\u7a76\u663e\u793a\uff0c TNFR\u20112 \u6700\u9ad8\u56db\u5206\u4f4d\u6570\u7684 T1DM \u60a3\u8005\u968f\u8bbf 12 \u5e74\u540e\uff0c eGFR<60 ml\u00b7min\u207b\u00b9\u00b7\uff081.73 m\u00b2\uff09\u207b\u00b9<\/sup> <\/sup>\u7684\u7d2f\u79ef\u53d1\u751f\u7387\u4e3a 60%\uff0c\u800c\u5176\u4f59 TNFR\u20112 \u56db\u5206\u4f4d\u6570\u7684 T1DM \u60a3\u8005\u7d2f\u79ef\u53d1\u751f\u7387\u4e3a5%~19%\uff0c\u6700\u9ad8TNFR\u20112\u56db\u5206\u4f4d\u6570\u7684T1DM \u60a3\u8005\u7ecf\u5386\u80be\u529f\u80fd\u4e0b\u964d\u7684\u53ef\u80fd\u6027\u662f\u5176\u4ed6\u56db\u5206\u4f4d\u6570\u60a3\u8005\u76843\u500d\uff08HR\u503c\u4e3a3.0\uff0c95%CI 1.7~5.5\uff09 \uff3b 9<\/sup>1 \uff3d<\/sup> <\/sup>\u3002<\/p>\n

3. \u809d\u578b\u8102\u80aa\u9178\u7ed3\u5408\u86cb\u767d\uff08liver type fatty acid binding protein\uff0cL\u2011FABP\uff09\uff1aL\u2011FABP \u662f\u4e00\u79cd\u4e3b\u8981\u5728\u8fd1\u7aef\u5c0f\u7ba1\u7ec6\u80de\u8d28\u4e2d\u4ea7\u751f\u7684\u86cb\u767d\u8d28\uff0c\u53c2\u4e0e\u957f\u94fe\u8102\u80aa\u9178\u7684\u4ee3\u8c22\u3002\u5f53\u80be\u5c0f\u7ba1\u53d7\u635f\u65f6\uff0c\u5c3f\u6db2\u4e2dL\u2011FABP\u6c34\u5e73\u5347\u9ad8\uff0c\u5e76\u5728 DKD \u7684\u65e9\u671f\u9636\u6bb5\u5c31\u53ef\u4ee5\u51fa\u73b0\u5f02\u5e38\u3002\u7814\u7a76\u663e\u793a\uff0c\u7cd6\u5c3f\u75c5\u60a3\u8005\u5c3f\u6db2 L\u2011FABP \u6c34\u5e73\u7684\u5347\u9ad8\u65e9\u4e8e\u5c3f\u86cb\u767d\u7684\u5347\u9ad8\uff0c\u53ef\u63d0\u793a\u65e9\u671fDKD\u7684\u53d1\u751f \uff3b <\/sup>92-93 \uff3d<\/sup> <\/sup>\u3002\u4e00\u9879\u524d\u77bb\u6027\u7814\u7a76\u7ed3\u679c\u663e\u793a\uff0c\u5728\u6b63\u5e38\u767d\u86cb\u767d\u5c3f\u53ca\u5fae\u91cf\u767d\u86cb\u767d\u5c3f\u7684 T2DM \u60a3\u8005\u4e2d\uff0c\u6700\u9ad8\u4e09\u5206\u4f4d\u6570\u5c3f L\u2011FABP \u4e0e eGFR \u4e0b\u964d\u548c\u4e0d\u826f\u5fc3\u8840\u7ba1\u4e8b\u4ef6\u7684\u53d1\u751f\u76f8\u5173\uff0c\u6821\u6b63 HR\u503c\u4e3a 1.93\uff0895%CI 1.13~3.29\uff09 \uff3b <\/sup>94 \uff3d<\/sup> <\/sup>\u3002 <\/p>\n

4. \u7ec4\u5b66\u6280\u672f\uff1a\u76ee\u524d\uff0c\u4ee5\u9ad8\u901a\u91cf\u7ec4\u5b66\u6280\u672f\u4e3a\u652f\u6491\u7684\u751f\u7269\u6807\u5fd7\u7269\u5f00\u53d1\u8303\u5f0f\u4e3aDKD\u65e9\u671f\u8bca\u65ad\u6807\u5fd7\u7269\u7684\u7814\u7a76\u63d0\u4f9b\u4e86\u65b0\u7684\u601d\u8def\u3002\u4e00\u9879\u591a\u4e2d\u5fc3\u3001\u524d\u77bb\u3001\u89c2\u5bdf\u6027\u7814\u7a76\u548c\u5d4c\u5165\u5f0f\u968f\u673a\u5bf9\u7167\u8bd5\u9a8c\uff08PRIORITY\u7814\u7a76\uff09\u7684\u7ed3\u679c\u663e\u793a\uff0c\u5728\u6b63\u5e38\u767d\u86cb\u767d\u5c3f\u7684 T2DM \u60a3\u8005\u4e2d\uff0c\u5c3f\u86cb\u767d\u7ec4\u5b66\u5206\u7c7b\u5668 CKD 273 \u7684\u9ad8\u98ce\u9669\u8bc4\u5206\u4e0e\u4e2d\u4f4d\u65f6\u95f4 2.5 \u5e74\u5185\u8fdb\u5c55\u4e3a\u5fae\u91cf\u767d\u86cb\u767d\u5c3f\u7684\u98ce\u9669\u589e\u52a0\u76f8\u5173 \uff3b <\/sup>95 \uff3d<\/sup> <\/sup>\u3002\u5728\u65e0\u86cb\u767d\u5c3f\u7684\u7cd6\u5c3f\u75c5\u60a3\u8005\u4e2d\uff0cCKD 273\u80fd\u591f\u6709\u6548\u9884\u6d4b DKD \u7684\u53d1\u751f\uff08HR \u503c\u4e3a 1.9\uff0c95%CI 1.3~2.7\uff09 \uff3b <\/sup>96 \uff3d<\/sup> <\/sup>\u3002\u57fa\u56e0\u7ec4\u5b66\u3001\u86cb\u767d\u8d28\u7ec4\u5b66\u3001\u8f6c\u5f55\u7ec4\u5b66\u548c\u4ee3\u8c22\u7ec4\u5b66\u7b49\u591a\u7ec4\u5b66\u6280\u672f\u7684\u6574\u5408\u5e94\u7528\uff0c\u4e0d\u4ec5\u80fd\u591f\u7cfb\u7edf\u63ed\u793a DKD \u53d1\u751f\u53d1\u5c55\u7684\u5206\u5b50\u673a\u5236\uff0c\u8fd8\u80fd\u7b5b\u9009\u51fa\u5177\u6709\u9ad8\u7075\u654f\u5ea6\u548c\u7279\u5f02\u5ea6\u7684\u65b0\u578b\u751f\u7269\u6807\u5fd7\u7269\u7ec4\u5408\u3002\u7279\u522b\u503c\u5f97\u5173\u6ce8\u7684\u662f\uff0c\u5355\u7ec6\u80de\u6d4b\u5e8f\u6280\u672f\u548c\u7a7a\u95f4\u8f6c\u5f55\u7ec4\u5b66\u7b49\u65b0\u5174\u6280\u672f\u7684\u5e94\u7528\uff0c\u4f7f\u7814\u7a76\u8005\u80fd\u591f\u5728\u5355\u7ec6\u80de\u5206\u8fa8\u7387\u6c34\u5e73\u4e0a\u89e3\u6790 DKD \u80be\u810f\u5fae\u73af\u5883\u4e2d\u4e0d\u540c\u7c7b\u578b\u7ec6\u80de\u7684\u5206\u5b50\u7279\u5f81\u53ca\u5176\u4e92\u4f5c\u7f51\u7edc\uff0c\u4e3a\u53d1\u73b0\u66f4\u7cbe\u786e\u7684\u65e9\u671f\u8bca\u65ad\u6807\u5fd7\u7269\u63d0\u4f9b\u4e86\u65b0\u7684\u6280\u672f\u8def\u5f84\u3002\u6b64\u5916\uff0c\u4eba\u5de5\u667a\u80fd\u8f85\u52a9\u7684\u591a\u7ec4\u5b66\u6570\u636e\u6574\u5408\u5206\u6790\u6709\u671b\u5efa\u7acb DKD \u65e9\u671f\u8bca\u65ad\u7684\u9884\u6d4b\u6a21\u578b\uff0c\u8fdb\u4e00\u6b65\u63d0\u9ad8\u8bca\u65ad\u7684\u51c6\u786e\u6027\u548c\u4e34\u5e8a\u5b9e\u7528\u6027\u3002<\/p>\n

\u4e0a\u8ff0\u6807\u5fd7\u7269\u5728 DKD\u7684\u65e9\u671f\u8bca\u65ad\u4e2d\u663e\u793a\u51fa\u826f\u597d\u7684\u5e94\u7528\u524d\u666f\uff0c\u4f46\u76ee\u524d\u53d7\u9650\u4e8e\u68c0\u6d4b\u9700\u8981\u4f9d\u8d56\u7279\u6b8a\u8bbe\u5907\u4e14\u8d39\u7528\u6602\u8d35\uff0c\u5e76\u4e14\u9700\u8981\u66f4\u591a\u7684\u3001\u66f4\u9ad8\u7ea7\u522b\u7684\u4e34\u5e8a\u5faa\u8bc1\u533b\u5b66\u8bc1\u636e\uff0c\u672a\u6765\u9700\u8981\u7ee7\u7eed\u5f00\u53d1\u65b0\u7684\u53ef\u4e34\u5e8a\u666e\u53ca\u7684\u68c0\u6d4b\u65b9\u6cd5\u3002<\/p>\n

DKD\u65e9\u671f\u7b5b\u67e5\u6d41\u7a0b<\/p>\n

\u8981\u70b9\u63d0\u793a\uff1a<\/p>\n

1. \u63a8\u8350\u75c5\u7a0b\u22655 \u5e74\u7684 1 \u578b\u7cd6\u5c3f\u75c5\uff08T1DM\uff09\u60a3\u8005\u548c\u6240\u6709 2 \u578b\u7cd6\u5c3f\u75c5\uff08T2DM\uff09\u60a3\u8005\u5728\u786e\u8bca\u65f6\u8fdb\u884c\u7cd6\u5c3f\u75c5\u80be\u810f\u75c5\uff08DKD\uff09\u7b5b\u67e5\uff0c\u5305\u62ec\u5c3f\u767d\u86cb\u767d\/\u808c\u9150\u6bd4\u503c\uff08UACR\uff09\u68c0\u6d4b\u548c\u4f30\u7b97\u80be\u5c0f\u7403\u6ee4\u8fc7\u7387\uff08eGFR\uff09\u8bc4\u4f30\uff0c\u4ee5\u540e\u6bcf\u5e74\u81f3\u5c11\u7b5b\u67e51\u6b21\uff08B\uff09 <\/p>\n

2.\u63a8\u8350\u5728DKD\u65e9\u671f\u7b5b\u67e5\u7684\u540c\u65f6\u8fdb\u884c\u7cd6\u5c3f\u75c5\u89c6\u7f51\u819c\u75c5\u53d8\uff08DR\uff09\u7b5b\u67e5\uff0c\u5e76\u5efa\u8bae\u6b64\u540e\u6bcf\u5e74\u81f3\u5c11\u8fdb\u884c 1 \u6b21 DR \u8bc4\u4f30\uff0c\u5982\u8bca\u65ad\u4e3a DR\uff0c\u5efa\u8bae\u6bcf\u5e74\u589e\u52a0 eGFR\u548cUACR\u7684\u68c0\u6d4b\u9891\u73871~2\u6b21\uff08B\uff09 <\/p>\n

3. \u5bf9\u4e8e UACR \u548c eGFR \u5c1a\u672a\u8fbe\u5230 DKD \u8bca\u65ad\u6807\u51c6\u7684\u60a3\u8005\uff0c\u63a8\u8350\u68c0\u6d4b\u5c3f\u6db2\u7ed3\u5408\u73e0\u86cb\u767d\u53ca\u5176\u4ed6\u80be\u5c0f\u7ba1\u548c\u80be\u5c0f\u7403\u635f\u4f24\u751f\u7269\u6807\u5fd7\u7269\uff0c\u4ee5\u65e9\u671f\u8bca\u65ad DKD\uff08C\uff09 <\/p>\n

4. \u5bf9\u4e8e DKD \u65e9\u671f\u7b5b\u67e5\u6307\u6807\u9634\u6027\u7684\u60a3\u8005\uff0c\u63a8\u8350\u6b64\u540e\u6bcf\u5e74\u81f3\u5c11\u8fdb\u884c1\u6b21DKD\u76f8\u5173\u751f\u7269\u6807\u5fd7\u7269\u7684\u68c0\u6d4b\uff08B\uff09 <\/p>\n

5.\u5bf9\u4e8e\u22651\u9879 DKD \u76f8\u5173\u751f\u7269\u6807\u5fd7\u7269\u9633\u6027\u7684\u60a3\u8005\uff0c\u5efa\u8bae\u5728 3~6 \u4e2a\u6708\u5185\u5bf9\u5f02\u5e38\u6307\u6807\u8fdb\u884c\u91cd\u590d\u68c0\u6d4b\u3002\u5728\u6392\u9664\u5e72\u6270\u56e0\u7d20\u7684\u6761\u4ef6\u4e0b\uff0c3\u6b21\u68c0\u6d4b\u4e2d\u6709 2\u6b21\u7ed3\u679c\u5f02\u5e38\uff0c\u5219\u8003\u8651 DKD\u53ef\u80fd\u6027\u5927\uff0c\u9700\u52a8\u6001\u76d1\u6d4bUACR\u548ceGFR\uff08C\uff09 <\/p>\n

6. \u5bf9\u4e8e\u22651 \u9879\u751f\u7269\u6807\u5fd7\u7269\u9633\u6027\u7684\u60a3\u8005\uff0c\u5efa\u8bae\u589e\u52a0 eGFR \u548c UACR \u7684\u68c0\u6d4b\u9891\u7387\uff08\u6bcf\u5e74 1~2 \u6b21\uff09\uff0c\u53ef\u8054\u5408\u80be\u810f\u8d85\u58f0\u8bc4\u4f30\u80be\u635f\u4f24\u60c5\u51b5\uff1b\u5fc5\u8981\u65f6\u53ef\u884c\u80be\u810f\u75c5\u7406\u5b66\u68c0\u67e5\uff0c\u4ee5\u5b9e\u73b0 DKD \u7684\u65e9\u671f\u8bca\u65ad\uff08C\uff09<\/p>\n

\u75c5\u7a0b\u22655\u5e74\u7684 T1DM \u60a3\u8005\u3001\u6240\u6709 T2DM \u60a3\u8005\u5728\u786e\u8bca\u65f6\u5f00\u59cb DKD \u65e9\u671f\u7b5b\u67e5\uff0cDKD \u521d\u6b21\u7b5b\u67e5\u5e94\u68c0\u67e5 UACR\u3001\u8840\u6e05\u808c\u9150\u5e76\u8ba1\u7b97 eGFR\uff0c\u5bf9\u65e2\u5f80\u672a\u8bca\u65ad DR \u7684\u60a3\u8005\u5efa\u8bae\u8fdb\u884cDR\u7b5b\u67e5\u3002\u63a8\u8350\u8fdb\u884c\u5c3f\u6db2\u7ed3\u5408\u73e0\u86cb\u767d\u3001\u5c3f\u6db2\u80f1\u6291\u7d20 C\u3001\u5c3f\u6db2\u8f6c\u94c1\u86cb\u767d\u7b49\u80be\u5c0f\u7ba1\u548c\u80be\u5c0f\u7403\u635f\u4f24\u751f\u7269\u6807\u5fd7\u7269\u68c0\u6d4b\uff0c\u5e76\u8054\u5408UACR\u548ceGFR\uff0c\u4ee5\u65e9\u671f\u8bca\u65adDKD\u3002<\/p>\n

\u5bf9\u4e8e\u4e0a\u8ff0 DKD \u65e9\u671f\u7b5b\u67e5\u6307\u6807\u9634\u6027\u7684\u60a3\u8005\uff0c\u63a8\u8350\u4ee5\u540e\u6bcf\u5e74\u81f3\u5c11\u7b5b\u67e51\u6b21\u4e0a\u8ff0\u6307\u6807\u3002<\/p>\n

\u5bf9\u4e8eeGFR\u548cUACR\u68c0\u6d4b\u672a\u8fbe\u5230\u73b0\u6709DKD\u4e34\u5e8a\u8bca\u65ad\u6807\u51c6\uff0c\u4f46\u51fa\u73b0\u22651\u9879DKD\u76f8\u5173\u751f\u7269\u6807\u5fd7\u7269\u9633\u6027\u7684\u60a3\u8005\uff0c\u5efa\u8bae\u5bf9\u5f02\u5e38\u6307\u6807\u57283~6\u4e2a\u6708\u5185\u91cd\u590d\u68c0\u6d4b\uff0c\u5728\u6392\u9664\u5e72\u6270\u56e0\u7d20\u7684\u6761\u4ef6\u4e0b\uff0c3\u6b21\u68c0\u6d4b\u4e2d\u67092\u6b21\u5f02\u5e38\u8005\uff0c\u8003\u8651 DKD\u53ef\u80fd\u6027\u5927\uff0c\u5efa\u8bae\u589e\u52a0eGFR\u548cUACR\u7684\u68c0\u6d4b\u9891\u7387\uff0c\u6bcf\u5e741~2\u6b21\uff0c\u53ef\u8054\u5408\u80be\u810f\u8d85\u58f0\u8bc4\u4f30\u80be\u635f\u4f24\u60c5\u51b5\uff0c\u5fc5\u8981\u65f6\u8fdb\u884c\u80be\u810f\u75c5\u7406\u5b66\u68c0\u67e5\uff0c\u4ee5\u4fbf\u65e9\u671f\u8bca\u65adDKD\u3002<\/p>\n

\u5bf9\u4e8e\u6839\u636e UACR \u548c eGFR \u68c0\u6d4b\u786e\u8bca\u4e3a DKD \u7684\u60a3\u8005\uff0c\u63a8\u8350\u6839\u636e eGFR \u548c UACR \u6c34\u5e73\u8fdb\u884c DKD \u5206\u671f\uff0c\u8bc4\u4f30CKD\u5e76\u53d1\u75c7\u3001\u5fc3\u8840\u7ba1\u75be\u75c5\u3001ESKD\u53ca\u6b7b\u4ea1\u98ce\u9669\uff0c\u6839\u636e\u98ce\u9669\u5206\u5c42\u51b3\u5b9a\u7b5b\u67e5\u9891\u7387\uff08\u88682\uff09\u3002<\/p>\n

DKD\u65e9\u671f\u7b5b\u67e5\u8bc4\u4f30\u6d41\u7a0b\u89c1\u56fe1\u3002<\/p>\n<\/p>\n

\u56fe1 DKD\u65e9\u671f\u7b5b\u67e5\u8bc4\u4f30\u6d41\u7a0b\u56fe<\/p>\n

\u5c3f\u6db2\u751f\u7269\u6807\u5fd7\u7269\u5b9e\u9a8c\u5ba4\u68c0\u6d4b\u65b9\u6cd5<\/p>\n

\u60a3\u8005\u81ea\u884c\u6536\u96c6\u5c3f\u6db2\u6807\u672c\uff0c\u5e76\u8bb0\u5f55\u6536\u96c6\u5c3f\u6db2\u7684\u65f6\u95f4\u3002\u907f\u514d\u5728\u611f\u67d3\u671f\uff08\u5c24\u5176\u662f\u6ccc\u5c3f\u7cfb\u7edf\u611f\u67d3\uff09\u3001\u53d1\u70ed\u3001\u8fd0\u52a8\u3001\u624b\u672f\u3001\u9ad8\u86cb\u767d\u996e\u98df\u540e\u7b49\u53ef\u80fd\u5f71\u54cd\u68c0\u6d4b\u7ed3\u679c\u7684\u65f6\u671f\u6536\u96c6\u6807\u672c\uff0c\u5973\u6027\u5e94\u540c\u65f6\u6ce8\u610f\u907f\u514d\u5728\u6708\u7ecf\u671f\u7559\u5c3f\u3002\u63a8\u8350\u7559\u53d6\u6e05\u6668\u7a7a\u8179\u4e14\u8fd0\u52a8\u524d\u7684\u6668\u5c3f\uff0c\u7559\u6837\u5bb9\u5668\u5fc5\u987b\u786e\u4fdd\u6d01\u51c0\u3001\u65e0\u6e17\u6f0f\u3001\u4e0d\u542b\u9632\u8150\u5242\u4e14\u4fbf\u4e8e\u8fd0\u8f93\u3002<\/p>\n

\u6807\u672c\u9001\u81f3\u5b9e\u9a8c\u5ba4\u540e\u5efa\u8bae\u5c06\u5c3f\u6db2\u6837\u672c\u79bb\u5fc3\uff083 000 r\/min\uff0c10 min\uff09\u540e\u518d\u8fdb\u884c\u68c0\u6d4b\u3002\u9001\u68c0\u6837\u672c\u5e94\u5c3d\u91cf\u5728 2 h\u5185\u5b8c\u6210\u68c0\u6d4b\uff0c\u5982\u65e0\u6cd5\u5728 2 h\u5185\u5b8c\u6210\u68c0\u6d4b\uff0c\u5efa\u8bae\u7f6e\u4e8e2~8 \u2103\u51b0\u7bb1\u4fdd\u5b58\uff0c\u4f46\u5404\u86cb\u767d\u5177\u4f53\u4fdd\u5b58\u65f6\u95f4\u9700\u63d0\u524d\u8fdb\u884c\u7a33\u5b9a\u6027\u8bc4\u4f30\u3002<\/p>\n

\u6307\u6807\u68c0\u6d4b\u63a8\u8350\u4f7f\u7528\u81ea\u52a8\u5316\u8bbe\u5907\u5728\u5b9e\u9a8c\u5ba4\u5b8c\u6210\uff0c\u5e76\u6309\u7167\u68c0\u6d4b\u8bf4\u660e\u4e66\u64cd\u4f5c\uff0c\u4e25\u683c\u8fdb\u884c\u8d28\u91cf\u63a7\u5236\uff0c\u4ee5\u786e\u4fdd\u7ed3\u679c\u7684\u53ef\u9760\u6027\u3002\u5bf9\u4e8e\u5c3f\u6db2\u4e2d\u68c0\u6d4b\u86cb\u767d\u6d53\u5ea6\u8fc7\u9ad8\u8d85\u51fa\u68c0\u6d4b\u8303\u56f4\u65f6\uff0c\u5e94\u5bf9\u6837\u672c\u8fdb\u884c\u7a00\u91ca\u540e\u518d\u68c0\u6d4b\uff0c\u5fc5\u8981\u65f6\u5bf9\u53ef\u7591\u6837\u672c\u8fdb\u884c\u91cd\u590d\u68c0\u6d4b\u3002\u5efa\u8bae\u5c3f\u6db2\u6807\u5fd7\u7269\u68c0\u6d4b\u91c7\u7528\u5c3f\u808c\u9150\u8fdb\u884c\u6821\u51c6\u3002<\/p>\n

DKD\u7b5b\u67e5\u540e\u7ba1\u7406<\/p>\n

\u8981\u70b9\u63d0\u793a\uff1a<\/p>\n

1. \u5bf9\u4e8e\u5df2\u786e\u8bca\u7cd6\u5c3f\u75c5\u80be\u810f\u75c5\uff08DKD\uff09\u7684\u60a3\u8005\uff0c\u5e94\u7acb\u5373\u8fdb\u884c\u4f30\u7b97\u80be\u5c0f\u7403\u6ee4\u8fc7\u7387\uff08eGFR\uff09\u5206\u671f\u53ca\u5c3f\u767d\u86cb\u767d\u5206\u7ea7\uff08C\uff09\uff0c\u5e76\u6839\u636e\u98ce\u9669\u5206\u5c42\u51b3\u5b9a\u76d1\u6d4b\u9891\u7387\uff08B\uff09 <\/p>\n

2. \u5f53 eGFR<60 ml\u00b7min\u207b\u00b9\u00b7\uff081.73 m\u00b2\uff09\u207b\u00b9\u65f6\uff0c\u5bf9\u786e\u8bca DKD\u7684\u60a3\u8005\u5e94\u53ca\u65f6\u8fdb\u884c\u80be\u5fc3\u4e0d\u826f\u9884\u540e\u98ce\u9669\u4ee5\u53ca\u6b7b\u4ea1\u98ce\u9669\u7684\u7efc\u5408\u8bc4\u4f30\uff08A\uff09 <\/p>\n

3.2\u578b\u7cd6\u5c3f\u75c5\uff08T2DM\uff09\u4f34DKD\u60a3\u8005\u7684\u8840\u7cd6\u836f\u7269\u7ba1\u7406\u63a8\u8350\u9996\u9009\u5177\u6709\u5fc3\u80be\u83b7\u76ca\u8bc1\u636e\u7684\u964d\u7cd6\u836f\uff0c\u5982\u94a0\u2011\u8461\u8404\u7cd6\u5171\u8f6c\u8fd0\u86cb\u767d 2 \u6291\u5236\u5242\uff08SGLT2i\uff09\u3001\u80f0\u9ad8\u7cd6\u7d20\u6837\u80bd\u20111 \u53d7\u4f53\u6fc0\u52a8\u5242\uff08GLP\u20111RA\uff09\uff0c\u4ee5\u51cf\u5c11\u80be\u810f\u75be\u75c5\u8fdb\u5c55\u548c\u5fc3\u8840\u7ba1\u4e8b\u4ef6\uff08A\uff09 <\/p>\n

4.\u5f53\u7cd6\u5c3f\u75c5\u60a3\u8005\u5c3f\u767d\u86cb\u767d\/\u808c\u9150\u6bd4\u503c\uff08UACR\uff09\u6c34\u5e73\u6301\u7eed\u5347\u9ad8\u548c\uff08\u6216\uff09eGFR\u6301\u7eed\u4e0b\u964d\uff0c\u6216\u8003\u8651\u5b58\u5728\u5176\u4ed6\u539f\u56e0\u7684\u80be\u75c5\u65f6\uff0c\u5efa\u8bae\u8f6c\u8bca\u81f3\u80be\u5185\u79d1\uff0c\u5fc5\u8981\u65f6\u8fdb\u884c\u80be\u6d3b\u68c0\u660e\u786e\u8bca\u65ad\uff08B\uff09<\/p>\n

\u7ed3\u5408\u56fd\u5185\u5916\u6307\u5357\u548c\u5171\u8bc6\u5efa\u8bae \uff3b <\/sup>26-31 \uff3d <\/sup>\uff0c\u63a8\u8350\u4ece\u4ee5\u4e0b\u65b9\u9762\u8fdb\u884cDKD\u7b5b\u67e5\u540e\u7ba1\u7406\u3002\u5bf9\u4e8e DKD \u65e9\u671f\u7b5b\u67e5\u6307\u6807\u9634\u6027\u7684\u60a3\u8005\uff0c\u5173\u952e\u5728\u4e8e\u9884\u9632\u548c\u65e9\u671f\u7684\u7efc\u5408\u7ba1\u7406\u3002<\/p>\n

\u5bc6\u5207\u76d1\u63a7\u5371\u9669\u56e0\u7d20\uff0c\u901a\u8fc7\u5b9a\u671f\u5c3f\u6db2\u3001\u80be\u529f\u80fd\u3001\u773c\u5e95\u7b49\u68c0\u67e5\uff0c\u53ca\u65e9\u53d1\u73b0\u5f02\u5e38\uff0c\u6bcf\u5e74\u81f3\u5c11\u7b5b\u67e5 1 \u6b21\u3002\u533b\u7597\u56e2\u961f\u5e94\u91cd\u70b9\u6307\u5bfc\u60a3\u8005\u8fdb\u884c\u7cd6\u5c3f\u75c5\u7efc\u5408\u7ba1\u7406\uff0c\u5305\u62ec\u533b\u5b66\u8425\u517b\u6cbb\u7597\uff0c\u8c03\u6574\u751f\u6d3b\u65b9\u5f0f\uff08\u5982\u996e\u98df\u63a7\u5236\u3001\u89c4\u5f8b\u8fd0\u52a8\u3001\u6212\u70df\u7b49\uff09\uff0c\u63a7\u5236\u4f53\u91cd\uff0c\u63a7\u5236\u8840\u7cd6\u3001\u8840\u538b\u3001\u8840\u8102\u3002<\/p>\n

\u5bf9\u4e8e DKD \u65e9\u671f\u7b5b\u67e5\u6307\u6807\u4e2d eGFR \u6216 UACR \u9634\u6027\uff0c\u4f46\u51fa\u73b0\u22651\u9879\u751f\u7269\u6807\u5fd7\u7269\u9633\u6027\uff0c\u4e14\u5f02\u5e38\u6307\u6807\u57283~ 6\u4e2a\u6708\u5185\u590d\u67e5\uff0c3\u6b21\u68c0\u6d4b\u4e2d\u51fa\u73b0 2\u6b21\u9633\u6027\u7684\u60a3\u8005\uff0c\u63a8\u8350\u7eb3\u5165 DKD \u60a3\u8005\u7ba1\u7406\uff0c\u4f8b\u5982\u4f18\u5148\u4f7f\u7528\u5177\u6709\u5fc3\u80be\u4fdd\u62a4\u4f5c\u7528\u7684\u836f\u7269\uff0c\u5e76\u52a8\u6001\u76d1\u6d4beGFR\u3001UACR\u3001\u8840\u6db2\u548c\u5c3f\u6db2\u65b0\u578b\u751f\u7269\u6807\u5fd7\u7269\u3002<\/p>\n

\u5bf9\u4e8e\u6839\u636e\u73b0\u6709\u8bca\u65ad\u6807\u51c6\u786e\u8bca\u4e3a DKD \u7684\u60a3\u8005\uff0c\u5e94\u91c7\u53d6\u5168\u9762\u7efc\u5408\u7684\u6cbb\u7597\u7b56\u7565\u3002\u4ee5\u60a3\u8005\u7684\u4e3b\u52a8\u81ea\u6211\u7ba1\u7406\u4e3a\u6838\u5fc3\uff0c\u5305\u62ec\u4e2a\u6027\u5316\u751f\u6d3b\u65b9\u5f0f\u5e72\u9884\u53ca\u81ea\u6211\u7ba1\u7406\u6559\u80b2\uff0c\u5185\u5206\u6ccc\u79d1\u76d1\u6d4b\u53ca\u7ba1\u7406\uff08\u8bc4\u4f30\u75be\u75c5\u4e25\u91cd\u7a0b\u5ea6\u53ca\u8fdb\u5c55\u98ce\u9669\u3001\u8bc4\u4f30 CKD\u5e76\u53d1\u75c7\u3001\u8bc4\u4f30\u80be\u5fc3\u4e0d\u826f\u9884\u540e\u53ca\u6b7b\u4ea1\u98ce\u9669\u3001\u836f\u7269\u6cbb\u7597\uff09\uff0c\u5fc5\u8981\u65f6\u8f6c\u8bca\u81f3\u80be\u5185\u79d1\u3002\u901a\u8fc7\u5168\u9762\u3001\u4e2a\u6027\u5316\u7684\u65b9\u6cd5\uff0c\u6539\u5584\u60a3\u8005\u7684\u80be\u810f\u548c\u5fc3\u8840\u7ba1\u9884\u540e\u3002<\/p>\n

\u4e00\u3001\u751f\u6d3b\u65b9\u5f0f\u5e72\u9884\u53ca\u81ea\u6211\u7ba1\u7406\u6559\u80b2 <\/p>\n

1. \u996e\u98df\u7ba1\u7406\uff1a\u5408\u7406\u63a7\u5236\u603b\u70ed\u91cf\uff0c\u8fbe\u5230\u6216\u7ef4\u6301\u7406\u60f3\u4f53\u91cd\uff0c\u4f4e\u76d0\u3001\u4f18\u8d28\u86cb\u767d\u996e\u98df\u3002 <\/p>\n

2. \u8fd0\u52a8\u5e72\u9884\uff1a\u63a8\u8350\u6bcf\u5468\u8fdb\u884c\u81f3\u5c11 150 min \u4e0e\u5fc3\u80ba\u529f\u80fd\u5339\u914d\u7684\u8fd0\u52a8\u3002\u8fd0\u52a8\u7c7b\u578b\u5305\u62ec\u6709\u6c27\u8fd0\u52a8\u3001\u6297\u963b\u8fd0\u52a8\u4ee5\u53ca\u67d4\u97e7\u6027\u8bad\u7ec3\u7b49\u3002\u907f\u514d\u5728\u7cd6\u5c3f\u75c5\u916e\u75c7\u9178\u4e2d\u6bd2\u3001\u7a7a\u8179\u8840\u7cd6>16.7 mmol\/L\u6216<3.9 mmol\/L\u7b49\u6025\u6027\u6216\u4e25\u91cd\u75be\u75c5\u7684\u60c5\u51b5\u4e0b\u8fdb\u884c\u8fd0\u52a8\u3002 <\/p>\n

3. \u6212\u70df\u9650\u9152\uff1a\u7cd6\u5c3f\u75c5\u60a3\u8005\u9700\u8981\u6212\u70df\u9650\u9152\uff0c\u5e76\u4fdd\u6301\u89c4\u5f8b\u4f5c\u606f\uff0c\u79ef\u6781\u914d\u5408\u6cbb\u7597\u3002 <\/p>\n

4.\u4f53\u91cd\u7ba1\u7406\uff1a\u8d85\u91cd\u6216\u80a5\u80d6 T2DM \u60a3\u8005\u5efa\u8bae\u81f3\u5c11\u51cf\u91cd 5%\uff0c\u6240\u6709\u7cd6\u5c3f\u75c5\u60a3\u8005\u5e94\u63a7\u5236\u5e76\u7ef4\u6301\u5728\u7406\u60f3\u4f53\u91cd\u6c34\u5e73\u3002 <\/p>\n

5.\u5efa\u8bae\u5bf9 DKD \u60a3\u8005\u5b9e\u65bd\u7ed3\u6784\u5316\u7684\u81ea\u6211\u7ba1\u7406\u6559\u80b2\u9879\u76ee\u3002<\/p>\n

\u4e8c\u3001\u5185\u5206\u6ccc\u79d1\u76d1\u6d4b\u53ca\u7ba1\u7406 <\/p>\n

1.\u75be\u75c5\u4e25\u91cd\u7a0b\u5ea6\u53ca\u8fdb\u5c55\u98ce\u9669\u8bc4\u4f30\uff1a\u5bf9\u4e8e\u5df2\u786e\u8bca DKD\u7684\u60a3\u8005\uff0c\u5e94\u7acb\u5373\u8fdb\u884c eGFR\u5206\u671f\u53ca\u5c3f\u767d\u86cb\u767d\u5206\u7ea7\u3002\u6839\u636e eGFR \u53ca\u5c3f\u767d\u86cb\u767d\u6c34\u5e73\u786e\u5b9a\u5bf9\u8840\u808c\u9150\u3001 UACR\u3001\u8840\u7535\u89e3\u8d28\u7b49\u7684\u76d1\u6d4b\u9891\u7387\uff0c\u4ee5\u8bc4\u4f30\u75be\u75c5\u8fdb\u5c55\u3001\u6307\u5bfc\u6cbb\u7597\u65b9\u6848\u8c03\u6574\u7b49\u3002\u6839\u636e\u80be\u810f\u75be\u75c5\u7684\u9636\u6bb5\uff0c\u5efa\u8bae\u6bcf\u5e74\u76d1\u6d4b\u5c3f\u767d\u86cb\u767d\uff08\u5982UACR\uff09\u548ceGFR 1~4\u6b21\u3002 <\/p>\n

2. CKD\u5e76\u53d1\u75c7\u8bc4\u4f30\uff1aeGFR<60 ml\u00b7min\u207b\u00b9\u00b7\uff081.73 m\u00b2\uff09\u207b\u00b9 \u65f6\uff08CKD G3~5 \u671f\uff09\uff0c\u60a3\u8005\u66f4\u5bb9\u6613\u51fa\u73b0 CKD \u5e76\u53d1\u75c7\uff0c\u5305\u62ec\u8840\u538b\u5347\u9ad8\u3001\u5bb9\u91cf\u8d1f\u8377\u8fc7\u91cd\u3001\u7535\u89e3\u8d28\u7d0a\u4e71\u3001\u4ee3\u8c22\u6027\u9178\u4e2d\u6bd2\u3001\u8d2b\u8840\u53ca\u4ee3\u8c22\u6027\u9aa8\u75c5\u7b49\uff0c\u5e76\u4e14\u968f\u80be\u75c5\u8fdb\u5c55\u800c\u9010\u6e10\u52a0\u91cd\u3002DKD \u60a3\u8005\u5728\u6bcf\u6b21\u4e34\u5e8a\u8bca\u7597\u4e2d\u5747\u5e94\u8fdb\u884c\u8840\u538b\u548c\u5bb9\u91cf\u8d1f\u8377\u8bc4\u4f30\uff1bDKD G3\u671f\u60a3\u8005\u5e94\u81f3\u5c11\u6bcf 6~ 12\u4e2a\u6708\u8fdb\u884c1\u6b21\u751f\u5316\u68c0\u6d4b\uff0c\u800cCKD G4\u671f\u548cG5\u671f\u60a3\u8005\u5e94\u5206\u522b\u81f3\u5c11\u6bcf 3~5 \u4e2a\u6708\u548c\u6bcf 1~3 \u4e2a\u6708\u62bd\u8840\u68c0\u6d4b 1 \u6b21\uff1b\u5f53\u4e34\u5e8a\u75c7\u72b6\u53d8\u5316\u6216\u6cbb\u7597\u65b9\u6848\u8c03\u6574\u65f6\uff0c\u4e5f\u5e94\u8fdb\u884c\u5e76\u53d1\u75c7\u8bc4\u4f30\u3002 <\/p>\n

3. \u80be\u5fc3\u4e0d\u826f\u9884\u540e\u53ca\u6b7b\u4ea1\u98ce\u9669\u8bc4\u4f30\uff1a\u5f53 eGFR< 60 ml\u00b7min\u207b\u00b9\u00b7\uff081.73 m\u00b2\uff09\u207b\u00b9\u65f6\uff0c\u5bf9\u786e\u8bca DKD \u7684\u60a3\u8005\u5e94\u53ca\u65f6\u8fdb\u884c\u80be\u5fc3\u4e0d\u826f\u9884\u540e\u98ce\u9669\u4ee5\u53ca\u6b7b\u4ea1\u98ce\u9669\u7684\u7efc\u5408\u8bc4\u4f30\u3002eGFR\u4e0b\u964d\u5e45\u5ea6\uff082\u5e74\u4e0b\u964d30%~40%\uff09\u548c\u901f\u5ea6\uff3b\u6bcf\u5e74\u4e0b\u964d>5 ml\u00b7min\u207b\u00b9\u00b7\uff081.73 m\u00b2\uff09\u207b\u00b9\uff3d\u4e0e CKD \u5e76\u53d1\u75c7\u3001ESKD\u8fdb\u5c55\u548c\u6b7b\u4ea1\u98ce\u9669\u5bc6\u5207\u76f8\u5173 \uff3b <\/sup>97-98 \uff3d<\/sup> <\/sup>\u3002UACR\u5f02\u5e38\uff08\u226530 mg\/g\uff09\u53ef\u65e9\u4e8e eGFR \u4e0b\u964d\uff0c\u5bf9\u4e8e\u63d0\u793a\u80be\u5355\u4f4d\u53ca\u8840\u7ba1\u5185\u76ae\u635f\u4f24\u3001\u9884\u6d4b\u65e9\u671f CKD \u8fdb\u5c55\u53ca\u5fc3\u8840\u7ba1\u98ce\u9669\u66f4\u4e3a\u654f\u611f\u3002\u6b64\u5916\uff0c\u5b9a\u671f\u8fdb\u884c\u5fc3\u7535\u56fe\u68c0\u67e5\u548c\u5fc3\u810f\u8d85\u58f0\uff0c\u8bc4\u4f30\u5fc3\u810f\u529f\u80fd\u548c\u5fc3\u8840\u7ba1\u75be\u75c5\u98ce\u9669\u3002\u540c\u65f6\u5e94\u6ce8\u610f\u5176\u4ed6\u5e76\u53d1\u75c7\u7b5b\u67e5\u548c\u7ba1\u7406\uff0c\u6bcf\u5e74\u8fdb\u884c 1 \u6b21\u773c\u5e95\u68c0\u67e5\uff0c\u65e9\u671f\u53d1\u73b0\u548c\u6cbb\u7597 DR\uff1b\u6bcf\u5e74\u8fdb\u884c 1\u6b21\u795e\u7ecf\u529f\u80fd\u68c0\u67e5\uff0c\u8bc4\u4f30\u5468\u56f4\u795e\u7ecf\u75c5\u53d8\u548c\u81ea\u4e3b\u795e\u7ecf\u75c5\u53d8\u7684\u60c5\u51b5\uff1b\u6bcf\u5e74\u8fdb\u884c 1 \u6b21\u751f\u5316\u68c0\u67e5\uff0c\u5305\u62ec\u809d\u529f\u80fd\u3001\u80be\u529f\u80fd\u3001\u7535\u89e3\u8d28\u3001\u5c3f\u9178\u7b49\u3002\u5bf9\u4e8e\u6709\u80be\u529f\u80fd\u635f\u4f24\u7684\u60a3\u8005\uff0c\u5e94\u5b9a\u671f\u76d1\u6d4b\u94be\u3001\u94a0\u3001\u9499\u3001\u78f7\u7b49\u7535\u89e3\u8d28\u6c34\u5e73\u4ee5\u53ca\u9178\u78b1\u5e73\u8861\u72b6\u6001\u3002 <\/p>\n

4.\u836f\u7269\u6cbb\u7597\uff1a\u4ee5\u63a7\u5236\u8840\u7cd6\u3001\u8840\u538b\u3001\u8840\u8102\u8fbe\u6807\u53ca\u51cf\u5c11\u5c3f\u86cb\u767d\u4e3a\u4e3b\u8981\u76ee\u6807\u3002T1DM \u60a3\u8005\u7684\u8840\u7cd6\u63a7\u5236\u4ee5\u80f0\u5c9b\u7d20\u4e3a\u57fa\u7840\uff0cT2DM\u4f34DKD\u60a3\u8005\u7684\u8840\u7cd6\u836f\u7269\u7ba1\u7406\u63a8\u8350\u9996\u9009\u5177\u6709\u5fc3\u80be\u83b7\u76ca\u8bc1\u636e\u7684\u964d\u7cd6\u836f\uff0c\u5982\u94a0\u2011\u8461\u8404\u7cd6\u5171\u8f6c\u8fd0\u86cb\u767d 2 \u6291\u5236\u5242 \uff08sodium\u2011glucose co\u2011transporter 2 inhibitor\uff0cSGLT2i\uff09\u3001\u80f0\u9ad8\u7cd6\u7d20\u6837\u80bd\u20111 \u53d7\u4f53\u6fc0\u52a8\u5242\uff08glucagon\u2011like peptide\u20111 receptor agonist\uff0cGLP\u20111RA\uff09\uff0c\u4ee5\u51cf\u5c11\u80be\u810f\u75be\u75c5\u8fdb\u5c55\u548c\u5fc3\u8840\u7ba1\u4e8b\u4ef6\u3002eGFR\u226520 ml\u00b7min\u207b\u00b9\u00b7\uff081.73 m\u00b2\uff09\u207b\u00b9\u7684\u60a3\u8005\uff0c\u63a8\u8350\u4f7f\u7528\u5177\u6709\u5fc3\u80be\u83b7\u76ca\u8bc1\u636e\u7684 SGLT2\uff08i \u5982\u8fbe\u683c\u5217\u51c0 \uff3b <\/sup>99 \uff3d<\/sup> <\/sup> \u3001\u6069\u683c\u5217\u51c0 \uff3b <\/sup>100 \uff3d<\/sup> <\/sup> \uff09\uff0c\u5e76\u5728\u8010\u53d7\u7684\u60c5\u51b5\u4e0b\u7ee7\u7eed\u6cbb\u7597\uff0c\u76f4\u5230\u5f00\u59cb\u900f\u6790\u6216\u79fb\u690d\u3002eGFR\u226515 ml\u00b7min\u207b\u00b9\u00b7\uff081.73 m\u00b2\uff09\u207b\u00b9 \u7684\u60a3\u8005\uff0c\u63a8\u8350\u4f7f\u7528\u6709\u5fc3\u80be\u83b7\u76ca\u8bc1\u636e\u7684\u957f\u6548GLP\u20111RA \uff08\u5982\u53f8\u7f8e\u683c\u9c81\u80bd\u3001\u5229\u62c9\u9c81\u80bd\u7b49 \uff3b <\/sup>101 \uff3d<\/sup> <\/sup>\u3002 \uff09\u3002FLOW\u7814\u7a76\u7ed3\u679c\u663e\u793a \uff0c\u5728 UACR \u4e3a 100~500 mg\/g \u4e14 eGFR \u4e3a 25~ 75 ml\u00b7min\u207b\u00b9\u00b7\uff081.73 m\u00b2\uff09\u207b\u00b9\u7684\u60a3\u8005\u4e2d\uff0c\u4f7f\u7528\u53f8\u7f8e\u683c\u9c81\u80bd 1.0 mg\u663e\u8457\u964d\u4f4e\u80be\u810f\u590d\u5408\u4e8b\u4ef6\u98ce\u9669\u8fbe24% \uff3b <\/sup>102 \uff3d<\/sup> <\/sup>\u3002<\/p>\n

\u4f18\u5316\u8840\u538b\u63a7\u5236\u6709\u52a9\u4e8e\u964d\u4f4e CKD \u7684\u98ce\u9669\u6216\u5ef6\u7f13\u5176\u8fdb\u5c55\uff0c\u964d\u4f4e\u5fc3\u8840\u7ba1\u98ce\u9669 \uff3b <\/sup>103 \uff3d<\/sup> <\/sup>\u3002\u5efa\u8bae DKD \u60a3\u8005\u63a7\u5236\u8840\u538b\u6c34\u5e73\u4e3a<130\/80 mmHg\uff0c\u5efa\u8bae\u5bf9\u4e8e\u7cd6\u5c3f\u75c5\u3001\u9ad8\u8840\u538b\u548c\u767d\u86cb\u767d\u5c3f\u7684\u60a3\u8005\uff0c\u5f00\u59cb\u4f7f\u7528\u8840\u7ba1\u7d27\u5f20\u7d20\u8f6c\u5316\u9176\u6291\u5236\u5242\u6216\u8840\u7ba1\u7d27\u5f20\u7d20\u2161\u53d7\u4f53\u62ee\u6297\u5242\u6cbb\u7597\uff0c\u5e76\u5c06\u8fd9\u4e9b\u836f\u7269\u7684\u5242\u91cf\u8c03\u6574\u81f3\u6700\u5927\u8010\u53d7\u5242\u91cf\u3002<\/p>\n

\u5efa\u8bae\u5bf9\u4e8eT2DM\u3001eGFR\u226525 ml\u00b7min\u207b\u00b7\u00b9\uff081.73 m\u00b2\uff09\u207b\u00b9\u3001\u8840\u6e05\u94be\u6d53\u5ea6\u6b63\u5e38\u4e14\u5df2\u7ecf\u63a5\u53d7\u6700\u5927\u8010\u53d7\u5242\u91cf\u80be\u7d20\u4e0e\u8840\u7ba1\u7d27\u5f20\u7d20\u919b\u56fa\u916e\u6291\u5236\u5242\u4ecd\u6709\u86cb\u767d\u5c3f\uff08UACR\u2265 30 mg\/g\uff09\u7684\u60a3\u8005\uff0c\u4f7f\u7528\u5df2\u8bc1\u660e\u5bf9\u80be\u810f\u6216\u5fc3\u8840\u7ba1\u6709\u76ca\u7684\u975e\u753e\u4f53\u7c7b\u76d0\u76ae\u8d28\u6fc0\u7d20\u53d7\u4f53\u62ee\u6297\u5242\uff08\u5982\u975e\u5948\u5229\u916e \uff3b <\/sup>104 \uff3d<\/sup> <\/sup>\uff09\u3002<\/p>\n

\u5efa\u8bae\u6240\u6709 DKD \u60a3\u8005\u4f7f\u7528\u4ed6\u6c40\u7c7b\u836f\u7269\uff0c\u63a8\u8350\u5c06 LDL\u2011C \u548c\u975e\u9ad8\u5bc6\u5ea6\u8102\u86cb\u767d\u80c6\u56fa\u9187\uff08high\u2011density lipoprotein\u2011cholesterol\uff0cHDL\u2011C\uff09\u4f5c\u4e3a\u8840\u8102\u63a7\u5236\u76ee\u6807\u3002\u63a8\u8350\u5c06\u4e2d\u7b49\u5f3a\u5ea6\u4ed6\u6c40\u7c7b\u836f\u7269\u4f5c\u4e3a\u57fa\u7840\u964d\u8102\u6cbb\u7597\uff0c\u82e5 LDL\u2011C\u4e0d\u8fbe\u6807\uff0c\u9700\u8054\u7528\u80c6\u56fa\u9187\u5438\u6536\u6291\u5236\u5242\u6216\u524d\u86cb\u767d\u8f6c\u5316\u9176\u67af\u8349\u6eb6\u83cc\u7d20 9\uff08PCSK9\uff09\u6291\u5236\u5242\u3002\u5982\u679c LDL\u2011C \u8fbe\u6807\u540e\u4ecd\u6709 TG \u589e\u9ad8\u6216\u975e HDL\u2011C \u4e0d\u8fbe\u6807\uff0c\u8003\u8651\u8054\u7528 \u03c9\u20113\u8102\u80aa\u9178\u6216\u8d1d\u7279\u7c7b\u836f\u7269\uff0c\u8054\u5408\u7528\u836f\u65f6\u5e94\u4f9d\u636e\u80be\u529f\u80fd\u8c03\u6574\u5242\u91cf \uff3b <\/sup>105 \uff3d<\/sup> <\/sup>\u3002<\/p>\n

\u4e09\u3001\u80be\u5185\u79d1\u8f6c\u8bca<\/p>\n

\u5982\u679c\u7cd6\u5c3f\u75c5\u60a3\u8005\u6301\u7eed UACR \u6c34\u5e73\u5347\u9ad8\u548c\uff08\u6216\uff09 eGFR\u4e0b\u964d\uff0c\u6216eGFR<30 ml\u00b7min\u207b\u00b9\u00b7\uff081.73 m\u00b2\uff09\u207b\u00b9\uff0c\u9700\u8981\u8ba8\u8bba ESKD\u7684\u80be\u810f\u66ff\u4ee3\u7597\u6cd5\uff0c\u6216\u51fa\u73b0\u6d3b\u52a8\u6027\u5c3f\u6c89\u6e23\uff08\u542b\u6709\u7ea2\u7ec6\u80de\u6216\u767d\u7ec6\u80de\u6216\u7ec6\u80de\u7ba1\u578b\uff09\u3001\u5c3f\u767d\u86cb\u767d\u6216\u603b\u86cb\u767d\u5c3f\u8fc5\u901f\u589e\u52a0\u3001\u5b58\u5728\u80be\u75c5\u7efc\u5408\u5f81\u3001eGFR\u8fc5\u901f\u4e0b\u964d\u6216\u65e0\u89c6\u7f51\u819c\u75c5\u53d8\u7b49\u63d0\u793a\u80be\u810f\u75be\u75c5\u7684\u5176\u4ed6\u539f\u56e0\u65f6\uff0c\u5e94\u8003\u8651\u8f6c\u8bca\u81f3\u80be\u75c5\u4e13\u79d1\uff0c\u5fc5\u8981\u65f6\u884c\u80be\u6d3b\u68c0\u3002<\/p>\n

\u5bf9\u4e8e DKD \u7684\u8bca\u7597\u9700\u8981\u5185\u5206\u6ccc\u4ee3\u8c22\u79d1\u4e0e\u80be\u5185\u79d1\u3001\u5fc3\u8840\u7ba1\u79d1\u3001\u795e\u7ecf\u5185\u79d1\u3001\u8425\u517b\u79d1\u3001\u75c5\u7406\u79d1\u7b49\u591a\u4e2a\u79d1\u5ba4\u534f\u4f5c\uff0c\u5e76\u5f00\u5c55\u7cfb\u7edf\u7684 DKD \u60a3\u8005\u81ea\u6211\u7ba1\u7406\u53ca\u5065\u5eb7\u6559\u80b2\u3002\u5bf9\u4e8e\u75c5\u60c5\u590d\u6742\u7684\u60a3\u8005\uff0c\u5982\u51fa\u73b0\u96be\u4ee5\u63a7\u5236\u7684\u80be\u810f\u5e76\u53d1\u75c7\uff08\u987d\u56fa\u6027\u9ad8\u8840\u538b\u3001\u4e25\u91cd\u7535\u89e3\u8d28\u7d0a\u4e71\u6216\u4ee3\u8c22\u6027\u9178\u4e2d\u6bd2\u7b49\uff09\u3001\u8003\u8651\u4e3a\u975e\u7cd6\u5c3f\u75c5\u80be\u810f\u75c5\uff0c\u6216\u5df2\u8fdb\u5165 CKD G4 \u671f\u65f6\uff0c\u591a\u5b66\u79d1\u534f\u4f5c\u8bca\u7597\u6a21\u5f0f\u4e0d\u4ec5\u6709\u52a9\u4e8e\u6709\u6548\u63a7\u5236\u75c5\u60c5\uff0c\u8fd8\u80fd\u663e\u8457\u51cf\u5c11\u533b\u7597\u8d39\u7528\uff0c\u5ef6\u7f13\u60a3\u8005\u8fdb\u5165\u900f\u6790\u9636\u6bb5\u7684\u65f6\u95f4\u3002<\/p>\n

\u603b\u7ed3\u4e0e\u5c55\u671b<\/p>\n

DKD \u7684\u53d1\u75c5\u673a\u5236\u6781\u5176\u590d\u6742\uff0c\u4e34\u5e8a\u79ef\u6781\u6cbb\u7597\u5e72\u9884\u7684\u540c\u65f6\uff0c\u4ecd\u7136\u4e0d\u53ef\u907f\u514d\u5730\u6709\u8fdb\u5c55\u81f3 ESKD \u7684\u98ce\u9669\u3002\u76ee\u524dUACR\u548ceGFR\u4ecd\u662f\u4e34\u5e8a\u5e94\u7528\u6700\u5e7f\u6cdb\u7684\u7b5b\u67e5\u6307\u6807\uff0c\u4f46\u8fd9\u4e9b\u4f20\u7edf\u624b\u6bb5\u5b58\u5728\u4e0d\u5c11\u5c40\u9650\u6027\uff0c\u9700\u8981\u7ed3\u5408\u65b0\u578b\u751f\u7269\u6807\u5fd7\u7269\u4ee5\u63d0\u9ad8\u65e9\u671f\u8bca\u65ad\u7387\u3002\u591a\u6807\u5fd7\u7269\u8054\u5408\u68c0\u6d4b\u53ef\u80fd\u662f\u672a\u6765 DKD \u65e9\u671f\u7b5b\u67e5\u7684\u53d1\u5c55\u65b9\u5411\u3002\u672a\u6765\u7814\u7a76\u5e94\u7740\u91cd\u4e8e\u91c7\u7528\u9ad8\u901a\u91cf\u7ec4\u5b66\u6280\u672f\u7b5b\u9009\u751f\u7269\u6807\u5fd7\u7269\uff0c\u5e76\u9a8c\u8bc1\u65b0\u578b\u751f\u7269\u6807\u5fd7\u7269\u7684\u4e34\u5e8a\u4ef7\u503c\uff0c\u63a2\u7d22\u6700\u4f73\u6807\u5fd7\u7269\u7ec4\u5408\uff0c\u5e76\u5efa\u7acb\u6807\u51c6\u5316\u7684\u68c0\u6d4b\u65b9\u6cd5\u548c\u53c2\u8003\u503c\u8303\u56f4\uff0c\u4ee5\u63a8\u52a8DKD\u65e9\u671f\u7b5b\u67e5\u7684\u4e34\u5e8a\u5e94\u7528\u3002<\/p>\n

\u6267\u7b14\u8005\uff1a <\/p>\n

\u6768\u82b3\u8fdc\u3000\u5317\u4eac\u5e02\u7cd6\u5c3f\u75c5\u7814\u7a76\u6240 \u9996\u90fd\u533b\u79d1\u5927\u5b66\u9644\u5c5e\u5317\u4eac\u540c\u4ec1\u533b\u9662<\/p>\n

\u738b   \u6e90\u3000\u5317\u4eac\u5e02\u7cd6\u5c3f\u75c5\u7814\u7a76\u6240 \u9996\u90fd\u533b\u79d1\u5927\u5b66\u9644\u5c5e\u5317\u4eac\u540c\u4ec1\u533b\u9662<\/p>\n

\u674e\u5c0f\u4e9a\u3000\u5317\u4eac\u5e02\u7cd6\u5c3f\u75c5\u7814\u7a76\u6240 \u9996\u90fd\u533b\u79d1\u5927\u5b66\u9644\u5c5e\u5317\u4eac\u540c\u4ec1\u533b\u9662 <\/p>\n

\u4e13\u5bb6\u7ec4\u7ec4\u957f\uff1a <\/p>\n

\u6768\u91d1\u594e\u3000\u5317\u4eac\u5e02\u7cd6\u5c3f\u75c5\u7814\u7a76\u6240 \u9996\u90fd\u533b\u79d1\u5927\u5b66\u9644\u5c5e\u5317\u4eac\u540c\u4ec1\u533b\u9662 <\/p>\n

\u4e13\u5bb6\u7ec4\u6210\u5458\uff08\u6309\u59d3\u6c0f\u6c49\u8bed\u62fc\u97f3\u6392\u5e8f\uff09\uff1a <\/p>\n

\u9648   \u4e3d\u3000\u5c71\u4e1c\u5927\u5b66\u9f50\u9c81\u533b\u9662<\/p>\n

\u9648\u8389\u660e\u3000\u5929\u6d25\u533b\u79d1\u5927\u5b66\u6731\u5baa\u5f5d\u7eaa\u5ff5\u533b\u9662<\/p>\n

\u9648\u9999\u7f8e\u3000\u89e3\u653e\u519b\u603b\u533b\u9662\u7b2c\u4e00\u533b\u5b66\u4e2d\u5fc3<\/p>\n

\u8463\u54f2\u6bc5\u3000\u89e3\u653e\u519b\u603b\u533b\u9662\u7b2c\u4e00\u533b\u5b66\u4e2d\u5fc3<\/p>\n

\u7aa6\u5bb6\u5e86\u3000\u5b89\u5fbd\u533b\u79d1\u5927\u5b66\u9644\u5c5e\u5de2\u6e56\u533b\u9662<\/p>\n

\u9ad8\u5bb6\u6797\u3000\u7696\u5357\u533b\u5b66\u9662\u7b2c\u4e00\u9644\u5c5e\u533b\u9662<\/p>\n

\u7eaa\u7acb\u519c\u3000\u5317\u4eac\u5927\u5b66\u4eba\u6c11\u533b\u9662<\/p>\n

\u5b63\u5b66\u78ca\u3000\u5b89\u5fbd\u7701\u829c\u6e56\u5e02\u7b2c\u4e8c\u4eba\u6c11\u533b\u9662<\/p>\n

\u6797   \u6ce2\u3000\u6d59\u6c5f\u7701\u4eba\u6c11\u533b\u9662<\/p>\n

\u5218   \u715c\u3000\u5357\u4eac\u533b\u79d1\u5927\u5b66\u9644\u5c5e\u9038\u592b\u533b\u9662<\/p>\n

\u5189\u5174\u65e0\u3000\u56db\u5ddd\u5927\u5b66\u534e\u897f\u533b\u9662<\/p>\n

\u90a2\u660c\u8d62\u3000\u6c5f\u82cf\u7701\u4eba\u6c11\u533b\u9662<\/p>\n

\u859b\u8000\u660e\u3000\u5357\u65b9\u533b\u79d1\u5927\u5b66\u5357\u65b9\u533b\u9662<\/p>\n

\u6768\u91d1\u594e\u3000\u5317\u4eac\u5e02\u7cd6\u5c3f\u75c5\u7814\u7a76\u6240 \u9996\u90fd\u533b\u79d1\u5927\u5b66\u9644\u5c5e\u5317\u4eac\u540c\u4ec1\u533b\u9662<\/p>\n

\u53f6\u5c71\u4e1c\u3000\u5b89\u5fbd\u7701\u7acb\u533b\u9662<\/p>\n

\u6613   \u658c\u3000\u4e2d\u5357\u5927\u5b66\u6e58\u96c5\u4e09\u533b\u9662<\/p>\n

\u4e8e    \u6dfc  \u4e2d\u56fd\u533b\u5b66\u79d1\u5b66\u9662 \u5317\u4eac\u534f\u548c\u533b\u9662<\/p>\n

\u66fe\u5929\u8212\u3000\u534e\u4e2d\u79d1\u6280\u5927\u5b66\u540c\u6d4e\u533b\u5b66\u9662\u9644\u5c5e\u534f\u548c\u533b\u9662<\/p>\n

\u5f20\u671d\u4e91\u3000\u590d\u65e6\u5927\u5b66\u9644\u5c5e\u534e\u5c71\u533b\u9662<\/p>\n

\u5f20   \u7433\u3000\u9996\u90fd\u533b\u79d1\u5927\u5b66\u9644\u5c5e\u5317\u4eac\u540c\u4ec1\u533b\u9662<\/p>\n

\u6731\u6653\u84c9\u3000\u9996\u90fd\u533b\u79d1\u5927\u5b66\u9644\u5c5e\u5317\u4eac\u540c\u4ec1\u533b\u9662<\/p>\n

\u5229\u76ca\u51b2\u7a81    \u6240\u6709\u4f5c\u8005\u58f0\u660e\u65e0\u5229\u76ca\u51b2\u7a81<\/p>\n

\u53c2\u8003\u6587\u732e\u7565<\/p>\n

\u4f5c\u8005\u6295\u7a3f\u53ca\u4e13\u5bb6\u5ba1\u7a3f\u8bf7\u767b\u5f55\u4e2d\u534e\u7cd6\u5c3f\u75c5\u6742\u5fd7\u5b98\u65b9\u7f51\u7ad9\uff1azhtnbzz.yiigle.com<\/p>\n

#artContent h1#artContent p img#artContent table<\/p>\n","protected":false},"excerpt":{"rendered":"

\u6587\u7ae0\u6765\u6e90\uff1a\u4e2d\u534e\u7cd6\u5c3f\u75c5\u6742\u5fd7, 2025, 17(7): 786-800. \u4f5c\u8005\uff1a\u300a … \u7ee7\u7eed\u9605\u8bfb →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[70],"tags":[],"class_list":["post-56510","post","type-post","status-publish","format-standard","hentry","category-70"],"_links":{"self":[{"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/posts\/56510","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=56510"}],"version-history":[{"count":0,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/posts\/56510\/revisions"}],"wp:attachment":[{"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=56510"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=56510"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=56510"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}