{"id":61775,"date":"2025-12-14T05:09:55","date_gmt":"2025-12-14T05:09:55","guid":{"rendered":"http:\/\/zydq.1006ss.com\/?p=61775"},"modified":"2025-12-14T05:09:55","modified_gmt":"2025-12-14T05:09:55","slug":"%e3%80%90%e8%a7%84%e8%8c%83%e4%b8%8e%e6%8c%87%e5%8d%97%e3%80%91%e9%9d%9e%e5%a5%88%e5%88%a9%e9%85%ae%e4%b8%b4%e5%ba%8a%e5%ba%94%e7%94%a8%e5%a4%9a%e5%ad%a6%e7%a7%91%e4%b8%93%e5%ae%b6%e5%85%b1%e8%af%86","status":"publish","type":"post","link":"http:\/\/zydq.1006ss.com\/?p=61775","title":{"rendered":"\u3010\u89c4\u8303\u4e0e\u6307\u5357\u3011\u975e\u5948\u5229\u916e\u4e34\u5e8a\u5e94\u7528\u591a\u5b66\u79d1\u4e13\u5bb6\u5171\u8bc6\uff082025\u7248\uff09"},"content":{"rendered":"

\u6587\u7ae0\u6765\u6e90\uff1a\u4e2d\u534e\u7cd6\u5c3f\u75c5\u6742\u5fd7, 2025, 17(11): 1427-1437.<\/p>\n

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\u6458\u8981<\/p>\n

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\u7cd6\u5c3f\u75c5\u3001\u80be\u810f\u75be\u75c5\u4e0e\u5fc3\u8840\u7ba1\u75be\u75c5\u4e4b\u95f4\u5b58\u5728\u5bc6\u5207\u7684\u76f8\u4e92\u5173\u7cfb\uff0c\u5b83\u4eec\u5f80\u5f80\u5171\u75c5\u3001\u5171\u56e0\u3001\u5171\u8fdb\u5c55\u3002\u76d0\u76ae\u8d28\u6fc0\u7d20\u53d7\u4f53\uff08mineralocorticoid receptor\uff0cMR\uff09\u8fc7\u5ea6\u6fc0\u6d3b\u662f\u7cd6\u5c3f\u75c5\u60a3\u8005\u591a\u5668\u5b98\u635f\u4f24\u7684\u5173\u952e\u56e0\u7d20\u4e4b\u4e00\uff0c\u5176\u901a\u8fc7\u6c27\u5316\u5e94\u6fc0\u3001\u708e\u75c7\u7ea7\u8054\u53cd\u5e94\u3001\u7ea4\u7ef4\u5316\u53ca\u8840\u6d41\u52a8\u529b\u5b66\u7d0a\u4e71\u7b49\u591a\u9014\u5f84\uff0c\u4fc3\u8fdb\u5fc3\u80be\u75be\u75c5\u8fdb\u5c55 \uff3b <\/sup>1 \uff3d <\/sup>\u3002\u9488\u5bf9MR\u8fc7\u5ea6\u6fc0\u6d3b\u7684\u9776\u5411\u5e72\u9884\u53ef\u5ef6\u7f13\u75be\u75c5\u8fdb\u5c55\u3002\u975e\u753e\u4f53\u7c7b\u76d0\u76ae\u8d28\u6fc0\u7d20\u53d7\u4f53\u62ee\u6297\u5242\uff08non\u2011steroidal mineralocorticoid receptor antagonist\uff0cns\u2011MRA\uff09\u975e\u5948\u5229\u916e\uff0c\u901a\u8fc7\u7cbe\u51c6\u6291\u5236MR\u8fc7\u5ea6\u6fc0\u6d3b\u9a71\u52a8\u7684\u708e\u75c7\u2011\u7ea4\u7ef4\u5316\u53cd\u5e94\uff0c\u663e\u8457\u6539\u5584\u5fc3\u80be\u9776\u5668\u5b98\u7ed3\u5c40\u3002\u591a\u9879\u5927\u578b\u2162\u671f\u4e34\u5e8a\u8bd5\u9a8c\u7ed3\u679c\u5df2\u8bc1\u5b9e\uff0c\u5728\u8840\u538b\u548c\u8840\u7cd6\u7ba1\u7406\u7684\u540c\u65f6\uff0c\u8054\u5408\u975e\u5948\u5229\u916e\u53ef\u8fdb\u4e00\u6b65\u6539\u55842\u578b\u7cd6\u5c3f\u75c5\uff08type 2 diabetes mellitus\uff0cT2DM\uff09\u76f8\u5173\u6162\u6027\u80be\u810f\u75c5\uff08chronic kidney disease\uff0cCKD\uff09\u60a3\u8005\u7684\u767d\u86cb\u767d\u5c3f\u6c34\u5e73\uff0c\u964d\u4f4e\u5fc3\u3001\u80be\u4e0d\u826f\u4e8b\u4ef6\u53d1\u751f\u98ce\u9669\u3002\u57fa\u4e8e\u6b64\uff0c\u76f8\u5173\u4e13\u5bb6\u5236\u8ba2\u53d1\u5e03\u4e86\u300a\u975e\u5948\u5229\u916e\u5728\u7cd6\u5c3f\u75c5\u5408\u5e76\u6162\u6027\u80be\u810f\u75c5\u60a3\u8005\u4e2d\u5e94\u7528\u7684\u4e2d\u56fd\u4e13\u5bb6\u5171\u8bc6\uff082023\u7248\uff09\u300b \uff3b <\/sup>2 \uff3d <\/sup>\uff0c\u4e3a\u4e34\u5e8a\u5b9e\u8df5\u63d0\u4f9b\u4e86\u53c2\u8003\u4f9d\u636e\u3002<\/p>\n

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\u5de5\u4f5c\u7ec4\u6210\u7acb\u4e86\u8bc1\u636e\u68c0\u7d22\u4e0e\u8bc4\u4ef7\u5c0f\u7ec4\uff0c\u56f4\u7ed5\u5171\u8bc6\u5173\u952e\u95ee\u9898\u5f00\u5c55\u6587\u732e\u68c0\u7d22\u3002\u68c0\u7d22\u7684\u6570\u636e\u5e93\u5305\u62ecPubMed\u3001Embase\u3001Web of Science\u3001\u4e2d\u56fd\u77e5\u7f51\u3001\u4e07\u65b9\u77e5\u8bc6\u670d\u52a1\u5e73\u53f0\u3001\u4e2d\u534e\u533b\u5b66\u671f\u520a\u7f51\u53ca\u4e2d\u56fd\u751f\u7269\u533b\u5b66\u6587\u732e\u6570\u636e\u5e93\u7b49\u3002\u7eb3\u5165\u6587\u732e\u9996\u9009\u56fd\u5185\u5916\u516c\u5f00\u53d1\u8868\u7684\u835f\u8403\u5206\u6790\u3001\u7cfb\u7edf\u7efc\u8ff0\u3001RCT\uff0c\u82e5\u65e0\uff0c\u5219\u7eb3\u5165\u961f\u5217\u7814\u7a76\u548c\u75c5\u4f8b\u5bf9\u7167\u7814\u7a76\u7b49\uff0c\u540c\u65f6\u53c2\u8003\u56fd\u5185\u5916\u76f8\u5173\u6307\u5357\u6216\u4e13\u5bb6\u5171\u8bc6\u3002<\/p>\n

\u4e94\u3001\u63a8\u8350\u610f\u89c1\u7684\u5f62\u6210<\/p>\n

\u5de5\u4f5c\u7ec4\u57fa\u4e8e\u8bc1\u636e\u68c0\u7d22\u4e0e\u8bc4\u4ef7\u5c0f\u7ec4\u63d0\u4f9b\u7684\u56fd\u5185\u5916\u8bc1\u636e\uff0c\u5e76\u7ed3\u5408\u6211\u56fd\u5b9e\u9645\u60c5\u51b5\uff0c\u521d\u6b65\u5f62\u6210\u4e86\u9488\u5bf9\u5404\u5173\u952e\u95ee\u9898\u7684\u63a8\u8350\u610f\u89c1\uff0c\u7ecf\u591a\u6b21\u8ba8\u8bba\u3001\u53cd\u9988\u548c\u4fee\u6539\uff0c\u6700\u7ec8\u8fbe\u6210\u5171\u8bc6\uff0c\u5f62\u6210\u4e8619\u6761\u63a8\u8350\u610f\u89c1\uff08\u88681\uff09\u3002<\/p>\n

\u975e\u5948\u5229\u916e\u7684\u4f5c\u7528\u673a\u5236\u548c\u836f\u7406\u5b66\u7279\u70b9<\/p>\n

\u5fc3\u80be\u7ec4\u7ec7\u4e2d MR \u7684\u8fc7\u5ea6\u6fc0\u6d3b\u53ef\u4fc3\u8fdb\u6d3b\u6027\u6c27\u751f\u6210\u3001\u4ecb\u5bfc\u7ec4\u7ec7\u708e\u75c7\u53cd\u5e94\u53ca\u7ea4\u7ef4\u5316\u8fdb\u7a0b\uff0c\u8fdb\u800c\u5f15\u53d1\u5fc3\u808c\u80a5\u5927\u3001\u5fc3\u5ba4\u91cd\u6784\u3001\u80be\u5c0f\u7403\u80a5\u5927\u3001\u80be\u5c0f\u7403\u786c\u5316\u7b49\u75c5\u7406\u751f\u7406\u6539\u53d8\uff0c\u6700\u7ec8\u5bfc\u81f4\u5fc3\u80be\u4e0d\u826f\u7ed3\u5c40 \uff3b <\/sup>4 \uff3d <\/sup>\u3002\u975e\u5948\u5229\u916e\u901a\u8fc7\u9ad8\u9009\u62e9\u6027\u62ee\u6297 MR \u6838\u8f6c\u4f4d\u53ca DNA \u7ed3\u5408\u6d3b\u6027\uff0c\u963b\u65ad\u4e0a\u76ae\uff08\u5982\u80be\u810f\uff09\u548c\u975e\u4e0a\u76ae\uff08\u5982\u5fc3\u810f\u548c\u8840\u7ba1\uff09\u7ec4\u7ec7\u4e2dMR\u4ecb\u5bfc\u7684\u94a0\u91cd\u5438\u6536\u548c MR \u8fc7\u5ea6\u6fc0\u6d3b\uff0c\u6291\u5236\u4e0b\u6e38\u708e\u75c7\u53ca\u7ea4\u7ef4\u5316\u76f8\u5173\u57fa\u56e0\u7684\u8f6c\u5f55\u6fc0\u6d3b\uff0c\u4ece\u800c\u6291\u5236\u80be\u95f4\u8d28\u6210\u7ea4\u7ef4\u7ec6\u80de\u6d3b\u5316\u3001\u5fc3\u808c\u80f6\u539f\u6c89\u79ef\u53ca\u8840\u7ba1\u5185\u76ae\u529f\u80fd\u7d0a\u4e71\uff0c\u53d1\u6325\u6297\u708e\u548c\u6297\u7ea4\u7ef4\u5316\u4f5c\u7528 \uff3b <\/sup>5 \uff3d <\/sup>\u3002<\/p>\n

\u76f8\u8f83\u4e8e\u4f20\u7edf\u753e\u4f53\u7c7b\u76d0\u76ae\u8d28\u6fc0\u7d20\u53d7\u4f53\u62ee\u6297\u5242\uff08mineralocorticoid receptor antagonist\uff0c MRA\uff09 \uff0cns\u2011MRA \u975e\u5948\u5229\u916e\u5177\u6709\u72ec\u7279\u7684\u975e\u753e\u4f53\u5927\u5757\u72b6\u7ed3\u6784\uff0c\u53ef\u4e0e MR \u7acb\u4f53\u7ed3\u5408\uff0c\u7ed3\u5408\u4f4d\u70b9\u66f4\u591a\uff0c\u53ef\u4e0e MR \u7279\u6709\u7684Ala\u2011773\u548c Ser\u2011810\u6b8b\u57fa\u7ed3\u5408\uff0c\u7279\u5f02\u6027\u66f4\u9ad8 \uff3b <\/sup>6 \uff3d <\/sup>\u3002\u4e0e MR\u7ed3\u5408\u540e\uff0c\u975e\u5948\u5229\u916e\u4f7f C \u7aef\u914d\u4f53\u4f9d\u8d56\u6d3b\u5316\u7ed3\u6784\u57dfAF2 \u7684\u87ba\u65cb\u6bb5 helix12 \u5411\u7ed3\u6784\u57df\u5916\u7a81\u51fa\uff0c\u5f62\u6210\u201c\u975e\u6d3b\u6027\u6784\u50cf\u201d\uff0c\u5145\u5206\u6291\u5236\u5171\u8c03\u8282\u56e0\u5b50\u52df\u96c6\u3002\u6b64\u5916\uff0c\u975e\u5948\u5229\u916e\u4e0d\u4e0e\u7cd6\u76ae\u8d28\u6fc0\u7d20\u53d7\u4f53\u3001\u96c4\u6fc0\u7d20\u53d7\u4f53\u53ca\u5b55\u6fc0\u7d20\u53d7\u4f53\u7ed3\u5408\uff0c\u9009\u62e9\u6027\u66f4\u9ad8\uff0c\u4e14\u56e0\u4e0d\u6291\u5236\u76d0\u76ae\u8d28\u6fc0\u7d20\u5408\u6210\uff0c\u4ee3\u8c22\u901a\u8def\u4e0e\u8840\u94be\u8c03\u8282\u5173\u8054\u5ea6\u4f4e\uff0c\u5176\u9ad8\u94be\u8840\u75c7\u53d1\u751f\u7387\u663e\u8457\u4f4e\u4e8e\u753e\u4f53\u7c7b\u836f\u7269\uff08\u5206\u522b\u4e3a3.3%\u548c7.2%\uff09 \uff3b <\/sup>7 \uff3d <\/sup>\u3002<\/p>\n

\u975e\u5948\u5229\u916e\u53e3\u670d\u540e\uff0c\u4e8e 0.50~1.25 h \u8fbe\u5230\u8840\u6db2\u5cf0\u503c\u6d53\u5ea6\uff0c\u8840\u6d46\u86cb\u767d\u7ed3\u5408\u7387\u4e3a 92%\uff0c\u5728\u5fc3\u548c\u80be\u7ec4\u7ec7\u5206\u5e03\u5747\u8861\uff08\u6bd4\u4f8b 1\u22361\uff09\uff0c\u534a\u8870\u671f\u4e3a 1.7~2.8 h\u3002\u5176\u4e3b\u8981\u901a\u8fc7\u809d\u810f CYP3A4\uff0890%\uff09\u548c CYP2C8\uff0810%\uff09\u4ee3\u8c22\uff0c\u65e0\u6d3b\u6027\u4ee3\u8c22\u4ea7\u7269 \uff3b <\/sup>8 \uff3d <\/sup>\u3002<\/p>\n

\u4e34\u5e8a\u5e94\u7528\u63a8\u8350<\/p>\n

\u56fd\u5185\u5916\u76f8\u5173\u5171\u8bc6\u4e0e\u6307\u5357\u5747\u5f3a\u8c03\uff0c\u5e94\u91cd\u89c6\u7cd6\u5c3f\u75c5\u60a3\u8005CKD\u548c\u5fc3\u8840\u7ba1\u75be\u75c5\uff08cardiovascular diseases\uff0cCVD\uff09\u7684\u7b5b\u67e5\uff0c\u4ee5\u5b9e\u73b0\u65e9\u8bca\u65ad\u3001\u65e9\u6cbb\u7597\u8fdb\u800c\u5ef6\u7f13CKD\u8fdb\u5c55\uff0c\u5e76\u51cf\u5c11\u5fc3\u8840\u7ba1\u4e8b\u4ef6\u7684\u53d1\u751f\u98ce\u9669 \uff3b <\/sup>9-11 \uff3d <\/sup>\u3002\u8be5\u7c7b\u75be\u75c5\u5728\u9009\u62e9\u6cbb\u7597\u65b9\u6848\u65f6\uff0c\u5e94\u4fa7\u91cd\u7efc\u5408\u7ba1\u7406\u548c\u5fc3\u80be\u7ed3\u5c40\u83b7\u76ca\u3002<\/p>\n

\u4e00\u3001\u975e\u5948\u5229\u916e\u5728\u4f34\u767d\u86cb\u767d\u5c3f\u7684 T2DM \u76f8\u5173 CKD\u60a3\u8005\u4e2d\u7684\u5e94\u7528<\/p>\n

\u591a\u9879\u5927\u578b RCT \u53ca RWE \u5df2\u8bc1\u5b9e\uff0c\u5728\u6807\u51c6\u6cbb\u7597\u57fa\u7840\u4e0a\uff0c\u975e\u5948\u5229\u916e\u53ef\u4e3a\u4f34\u767d\u86cb\u767d\u5c3f\uff3b\u5c3f\u767d\u86cb\u767d\/\u808c\u9150\u6bd4\u503c\uff08urinary albumin\u2011to\u2011creatinine ratio\uff0cUACR\uff09\u226530 mg\/g\uff3d\u7684 T2DM \u76f8\u5173 CKD \u60a3\u8005\u5e26\u6765\u660e\u786e\u7684\u5fc3\u80be\u83b7\u76ca\u3002<\/p>\n

1.\u4e3b\u8981\u5fc3\u80be\u7ed3\u5c40\u83b7\u76ca\uff1a\uff081\uff09RCT\u8bc1\u636e\uff1a\u5173\u952e\u2162\u671f\u7814\u7a76\uff08FIDELIO\u2011DKD \uff3b <\/sup>1 2\uff3d <\/sup>\u3001FIGARO\u2011DKD \uff3b <\/sup>13 \uff3d <\/sup>\uff09\u53ca\u5176\u9884\u8bbe\u7684\u6c47\u603b\u5206\u6790\uff08FIDELITY \uff3b <\/sup>14 \uff3d <\/sup>\uff09\u8868\u660e\uff0c\u975e\u5948\u5229\u916e\u53ef\u663e\u8457\u964d\u4f4e\u4e3b\u8981\u5fc3\u80be\u590d\u5408\u7ec8\u70b9\u98ce\u9669\uff1b\uff082\uff09FOUNTAIN \uff3b <\/sup>15 \uff3d <\/sup>\u7cfb\u5217\u7814\u7a76\u7b49\u5927\u578bRWE\u8fdb\u4e00\u6b65\u9a8c\u8bc1\u4e86\u5176\u5728\u5e7f\u6cdbT2DM\u76f8\u5173CKD\u60a3\u8005\u7fa4\u4f53\u7684\u9002\u7528\u6027\uff0c\u663e\u793a\u5176\u53ef\u4f7f\u8be5\u7fa4\u4f53UACR\u6301\u7eed\u964d\u4f4e\uff0c\u4e14\u9ad8\u94be\u8840\u75c7\u76f8\u5173\u4f4f\u9662\u7387\u4f4e\uff08\u7ea61.2%\uff09\u3002<\/p>\n

2.\u9884\u9632\u65b0\u53d1HF\u4e0e\u5fc3\u623f\u98a4\u52a8\uff1a\u9274\u4e8eMR\u8fc7\u5ea6\u6fc0\u6d3b\u4e0e\u4fc3\u5fc3\u808c\u7ea4\u7ef4\u5316\u548c\u5fc3\u5f8b\u5931\u5e38\u5bc6\u5207\u76f8\u5173\uff0c\u975e\u5948\u5229\u916e\u5728\u964d\u4f4e\u65b0\u53d1 HF \u548c\u5fc3\u623f\u98a4\u52a8\u98ce\u9669\u65b9\u9762\u5c55\u73b0\u51fa\u4f18\u52bf\uff0c\u56e0\u6b64\uff0c\u5bf9\u4e8e\u5177\u6709\u9ad8\u5371\u56e0\u7d20\u7684 T2DM \u76f8\u5173 CKD \u60a3\u8005\uff0c\u65e9\u671f\u5e94\u7528\u975e\u5948\u5229\u916e\u6709\u52a9\u4e8e\u9884\u9632\u8fd9\u4e9b\u5fc3\u8840\u7ba1\u5e76\u53d1\u75c7 \uff3b <\/sup>16 \uff3d <\/sup>\u3002<\/p>\n

3.\u5728\u5408\u5e76CVD\u60a3\u8005\u4e2d\u7684\u83b7\u76ca\uff1a\u5bf9\u4e8e\u57fa\u7ebf\u5df2\u5408\u5e76CVD \u7684\u60a3\u8005\uff0c\u975e\u5948\u5229\u916e\u6cbb\u7597\u83b7\u76ca\u660e\u786e\u6216\u8d8b\u52bf\u66f4\u4f73 \uff3b <\/sup>16-25 \uff3d <\/sup>\u3002\uff081\uff09\u5bf9\u4e8e\u5408\u5e76 HF \u7684\u60a3\u8005\uff0c\u975e\u5948\u5229\u916e\u53ef\u964d\u4f4eHF\u4f4f\u9662\u98ce\u9669\uff1b\uff082\uff09\u5bf9\u4e8e\u5408\u5e76\u52a8\u8109\u7ca5\u6837\u786c\u5316\u6027\u5fc3\u8840\u7ba1\u75be\u75c5\uff08atherosclerotic cardiovascular disease\uff0cASCVD\uff09\u6216\u5de6\u5fc3\u5ba4\u80a5\u539a\uff08left ventricular hypertrophy\uff0cLVH\uff09\u7684\u60a3\u8005\uff0c\u53ef\u663e\u8457\u964d\u4f4e\u5fc3\u8840\u7ba1\u4e8b\u4ef6\u98ce\u9669\uff0c\u65e9\u671f\u5e94\u7528\u53ef\u4e3a\u60a3\u8005\u5e26\u6765\u8fdc\u671f\u5fc3\u80be\u83b7\u76ca\u3002<\/p>\n

4. \u5728\u4e2d\u56fd T2DM \u76f8\u5173 CKD \u60a3\u8005\u4e2d\u7684\u83b7\u76ca\uff1aFIDELITY \u7814\u7a76\u4e2d\u56fd\u4e9a\u7ec4\u6570\u636e \uff3b <\/sup>26 \uff3d <\/sup>\u663e\u793a\uff0c\u975e\u5948\u5229\u916e\u663e\u8457\u964d\u4f4e\u4e3b\u8981\u80be\u810f\u590d\u5408\u7ec8\u70b9\u98ce\u9669 43%\uff0c\u964d\u4f4e\u6b21\u8981\u80be\u810f\u590d\u5408\u7ec8\u70b9\u98ce\u9669 46%\uff0c\u5176\u4e2d\u80be\u8870\u7aed\u98ce\u9669\u964d\u4f4e 47%\u3002\u5fc3\u8840\u7ba1\u590d\u5408\u7ec8\u70b9\u98ce\u9669\u8d8b\u52bf\u4e0e\u5168\u7403\u4eba\u7fa4\u4e00\u81f4\uff08HR=0.82\uff0c95%CI \u4e3a 0.52~1.29\uff09\u3002\u5c3d\u7ba1\u4e2d\u56fd\u60a3\u8005\u57fa\u7ebfUACR \u663e\u8457\u9ad8\u4e8e\u5168\u7403\u4eba\u7fa4\uff0c\u975e\u5948\u5229\u916e\u4ecd\u53ef\u663e\u8457\u964d\u4f4e\u4e2d\u56fd\u60a3\u8005UACR\u8fbe32.7%\u3002<\/p>\n

\u4ece\u6570\u503c\u4e0a\u770b\uff0c\u4e2d\u56fd\u4eba\u7fa4\u4e3b\u8981\u80be\u810f\u590d\u5408\u7ec8\u70b9\u83b7\u76ca\u9ad8\u4e8e\u5168\u7403\u5e73\u5747\u6c34\u5e73\uff0c\u673a\u5236\u5c1a\u672a\u660e\u786e\uff0c\u6216\u5f52\u56e0\u4e8e\u9ad8\u76d0\u66b4\u9732\u3001\u80be\u810f\u635f\u4f24\u76f8\u5bf9\u66f4\u4e3a\u4e25\u91cd\uff08\u8868\u73b0\u4e3a\u57fa\u7ebf\u4e2d\u4f4dUACR\u503c\u66f4\u9ad8\uff09\u7b49\u56e0\u7d20\u3002<\/p>\n

\u4e8c\u3001\u975e\u5948\u5229\u916e\u5728HFmrEF\/HFpEF\u60a3\u8005\u4e2d\u7684\u5e94\u7528<\/p>\n

\u5728 HF \u60a3\u8005\u4e2d\u5f00\u5c55\u7684\u968f\u673a\u3001\u53cc\u76f2\u3001\u5b89\u6170\u5242\u5bf9\u7167\u3001\u5168\u7403\u591a\u4e2d\u5fc3 FINEARTS\u2011HF \u2162\u671f\u4e34\u5e8a\u7814\u7a76\uff0c\u7eb3\u51656 001 \u4f8b\u5de6\u5fc3\u5ba4\u5c04\u8840\u5206\u6570\uff08left ventricular ejection fraction\uff0cLVEF\uff09\u226540% \u7684\u75c7\u72b6\u6027 HF \u60a3\u8005\uff3b\u7f8e\u56fd\u7ebd\u7ea6\u5fc3\u810f\u75c5\u5b66\u4f1a\uff08New York Heart Association\uff0cNYHA\uff09\u5fc3\u529f\u80fd\u5206\u7ea7\u2161~\u2163\u7ea7\uff3d\uff0c\u7814\u7a76\u7ed3\u679c\u663e\u793a\uff0c\u975e\u5948\u5229\u916e\u964d\u4f4e\u4e3b\u8981\u590d\u5408\u7ec8\u70b9\uff08\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u548c\u603b\u4f53 HF \u4e8b\u4ef6\uff09\u98ce\u9669\u8fbe 16% \uff3b <\/sup>24 \uff3d <\/sup>\u30021 \u9879\u7eb3\u5165 FINEARTS\u2011HF\u3001FIDELIO\u2011DKD \u548c FIGARO\u2011DKD \u8fd9 3 \u9879 RCT \u7814\u7a76\u7684HF \u60a3\u8005\u6570\u636e\u7684\u835f\u8403\u5206\u6790\u7ed3\u679c\u663e\u793a\uff0c\u975e\u5948\u5229\u916e\u53ef\u4f7fHF \u60a3\u8005\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u98ce\u9669\u964d\u4f4e 25%\u3001HF \u4f4f\u9662\u548c HF\u6b7b\u4ea1\u98ce\u9669\u964d\u4f4e 19% \uff3b <\/sup>27 \uff3d <\/sup>\u3002\u53e6 1 \u9879\u65e8\u5728\u8bc4\u4f30\u975e\u5948\u5229\u916e\u5bf9 HF\u60a3\u8005 HF\u7ed3\u5c40\u5f71\u54cd\u7684\u835f\u8403\u5206\u6790\u7ed3\u679c\u663e\u793a\uff0c\u975e\u5948\u5229\u916e\u53ef\u4f7f HF \u60a3\u8005\u9996\u6b21\u56e0 HF \u4f4f\u9662\u6cbb\u7597\u7684\u98ce\u9669\u964d\u4f4e18% \uff3b <\/sup>28 \uff3d <\/sup>\u3002\u7f8e\u56fd\u4e1c\u90e8\u65f6\u95f42025\u5e747\u670811\u65e5\uff0c\u7f8e\u56fd\u98df\u54c1\u836f\u54c1\u76d1\u7763\u7ba1\u7406\u5c40\u6b63\u5f0f\u6279\u51c6\u975e\u5948\u5229\u916e\u7528\u4e8e LVEF\u226540% \u7684\u6210\u4eba HF \u60a3\u8005\uff0c\u7528\u4e8e\u964d\u4f4e\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u3001HF \u4f4f\u9662\u548cHF\u6025\u8bca\u5c31\u8bca\u98ce\u9669\u3002<\/p>\n

HF \u60a3\u8005\u53d1\u751f\u7cd6\u5c3f\u75c5\u3001\u5fc3\u623f\u98a4\u52a8\u53ca CKD \u7684\u98ce\u9669\u8f83\u9ad8\u3002FINEARTS\u2011HF \u7814\u7a76\u7684\u591a\u9879\u9884\u8bbe\u4e9a\u7ec4\u5206\u6790\u4e2d\u5747\u89c2\u5bdf\u5230\u975e\u5948\u5229\u916e\u5728\u8fd9\u4e9b\u65b9\u9762\u7684\u79ef\u6781\u8d8b\u52bf\u3002\u65b0\u53d1\u7cd6\u5c3f\u75c5\u4e9a\u7ec4\u5206\u6790\u7ed3\u679c\u663e\u793a\uff0c\u975e\u5948\u5229\u916e\u663e\u8457\u964d\u4f4e\u4e86\u65b0\u53d1\u7cd6\u5c3f\u75c5\uff08\u8fde\u7eed 2 \u6b21\u6d4b\u91cf\u7cd6\u5316\u8840\u7ea2\u86cb\u767d\u22656.5% \u6216\u9996\u6b21\u4f7f\u7528\u964d\u7cd6\u836f\u7269\uff09\u7684\u53d1\u751f\u98ce\u9669\u8fbe 25% \u4ee5\u4e0a\uff3b\u5728\u94a0\u2011\u8461\u8404\u7cd6\u5171\u8f6c\u8fd0\u86cb\u767d 2 \u6291\u5236\u5242\uff08sodium\u2011glucose co\u2011transporter 2 inhibitor\uff0cSGLT2i\uff09\u57fa\u7840\u4e0a\u4f7f\u7528\u975e\u5948\u5229\u916e\u663e\u8457\u964d\u4f4e\u65b0\u53d1\u7cd6\u5c3f\u75c5\u7684\u98ce\u9669\u8fbe 27%\uff0c\u672a\u4f7f\u7528SGLT2i \u4ea6\u53ef\u663e\u8457\u964d\u4f4e\u65b0\u53d1\u7cd6\u5c3f\u75c5\u8fbe 25%\uff3d \uff3b <\/sup>29 \uff3d <\/sup>\u3002\u80be\u529f\u80fd\u4e9a\u7ec4\u5206\u6790\u7ed3\u679c\u663e\u793a\uff0c\u975e\u5948\u5229\u916e\u53ef\u4f7f\u65b0\u53d1\u5fae\u91cf\u767d\u86cb\u767d\u5c3f\u98ce\u9669\u964d\u4f4e 24%\uff0c\u65b0\u53d1\u5927\u91cf\u767d\u86cb\u767d\u5c3f\u7684\u98ce\u9669\u964d\u4f4e 38% \uff3b <\/sup>30 \uff3d <\/sup>\u3002\u5fc3\u623f\u98a4\u52a8\u4e9a\u7ec4\u5206\u6790\u7ed3\u679c\u663e\u793a\uff0c\u63a5\u53d7\u975e\u5948\u5229\u916e\u6cbb\u7597\u7684\u60a3\u8005\u65b0\u53d1\u5fc3\u623f\u98a4\u52a8\/\u5fc3\u623f\u6251\u52a8\u7684\u98ce\u9669\u4f3c\u4e4e\u66f4\u4f4e \uff3b 3<\/sup>1 \uff3d <\/sup>\u3002<\/p>\n

\u4e09\u3001\u975e\u5948\u5229\u916e\u5728nd\u2011CKD\u60a3\u8005\u4e2d\u7684\u5e94\u7528<\/p>\n

\u57fa\u4e8e\u975e\u5948\u5229\u916e\u7684\u4f5c\u7528\u673a\u5236\uff0c\u5176\u5728 nd\u2011CKD \u6cbb\u7597\u9886\u57df\u53ef\u80fd\u5b58\u5728\u83b7\u76ca\u30022023 \u5e74 M\u00e5rup \u7b49 \uff3b <\/sup>32 \uff3d <\/sup>\u7684\u4e00\u9879\u7814\u7a76\u53d1\u73b0\uff0c\u975e\u5948\u5229\u916e\u6cbb\u7597 nd\u2011CKD \u60a3\u8005 4 \u5468\u53ef\u663e\u8457\u964d\u4f4e\u60a3\u8005 UACR \u8fbe 24%\uff0c\u4e14\u8010\u53d7\u6027\u826f\u597d\u30022025 \u5e74 Li\u7b49 \uff3b <\/sup>33 \uff3d <\/sup>\u7684\u4e00\u9879\u8bc4\u4f30\u975e\u5948\u5229\u916e\u6cbb\u7597 nd\u2011CKD\u60a3\u8005\u7684\u56de\u987e\u6027\u7814\u7a76\u663e\u793a\uff0c\u968f\u8bbf\u671f\u95f4 UACR \u964d\u4f4e\u4e2d\u4f4d\u6570\u4e3a664.95 mg\/g\uff08P=0.002\uff09\uff0c\u4e14\u5b89\u5168\u6027\u826f\u597d\u3002<\/p>\n

\u5728 IgA \u80be\u75c5\uff08IgA nephropathy\uff0cIgAN\uff09\u9886\u57df\u7684\u591a\u9879\u63a2\u7d22\u6027\u7814\u7a76\u4e2d\uff0c\u5747\u89c2\u5bdf\u5230\u975e\u5948\u5229\u916e\u6cbb\u7597\u7684\u6f5c\u5728\u83b7\u76ca\u30022025 \u5e74 Wang \u7b49 \uff3b <\/sup>34 \uff3d <\/sup>\u7684\u4e00\u9879\u591a\u4e2d\u5fc3\u89c2\u5bdf\u6027\u7814\u7a76\u7eb3\u5165 178 \u4f8b\u7ecf\u80be\u6d3b\u68c0\u786e\u8bca\u3001\u5c3f\u86cb\u767d\u808c\u9150\u6bd4\u503c\uff08protein\u2011to\u2011creatinine ratio\uff0cPCR\uff09>0.3 g\/g \u7684 IgAN \u60a3\u8005\uff0c\u7ed3\u679c\u663e\u793a\uff0c\u975e\u5948\u5229\u916e\u6cbb\u7597 IgAN 6 \u4e2a\u6708\u65f6\uff0c\u4e2d\u4f4dPCR \u964d\u5e45\u8fbe 45.1%\uff0c\u540c\u65f6 eGFR \u5728\u6574\u4e2a\u7814\u7a76\u671f\u95f4\u4fdd\u6301\u7a33\u5b9a\uff0c\u4e14\u5b89\u5168\u6027\u826f\u597d\u30022025 \u5e74 Tang \u7b49 \uff3b <\/sup>35 \uff3d <\/sup>\u7684\u4e00\u9879\u771f\u5b9e\u4e16\u754c\u56de\u987e\u6027\u7814\u7a76\u663e\u793a\uff0cIgAN \u60a3\u8005\u5728\u4f20\u7edf\u6cbb\u7597\u57fa\u7840\u4e0a\u4f7f\u7528\u975e\u5948\u5229\u916e\u6cbb\u7597\uff0c\u86cb\u767d\u5c3f\u6c34\u5e73\u5728 3 \u4e2a\u6708\u65f6\u4ece\u4e2d\u4f4d\u6570 1.07 g\/d \u964d\u81f3 0.49 g\/d\uff08P=0.015\uff09\uff0c\u5728\u6574\u4e2a\u7814\u7a76\u671f\u95f4\uff0c\u60a3\u8005\u7684 eGFR \u548c\u8840\u94be\u6c34\u5e73\u4fdd\u6301\u7a33\u5b9a\u30022025 \u5e74 Gao \u7b49 \uff3b <\/sup>36 \uff3d <\/sup>\u7684\u4e00\u9879\u771f\u5b9e\u4e16\u754c\u7814\u7a76\u7ed3\u679c\u663e\u793a\uff0cIgAN \u60a3\u8005\u4f7f\u7528\u975e\u5948\u5229\u916e\u6cbb\u7597 3 \u4e2a\u6708\uff0c\u4e2d\u4f4d UACR \u964d\u5e45\u9ad8\u8fbe 42.29%\uff0c\u6cbb\u7597\u671f\u95f4\u65e0 eGFR \u548c\u8840\u94be\u6c34\u5e73\u6ce2\u52a8\uff0c\u5b89\u5168\u6027\u826f\u597d\u3002<\/p>\n

\u819c\u6027\u80be\u75c5\u662f\u4e00\u79cd\u5e38\u89c1\u7684\u80be\u5c0f\u7403\u75be\u75c5\uff0c\u5360\u6240\u6709\u80be\u7ec4\u7ec7\u7a7f\u523a\u6d3b\u68c0\u60a3\u8005\u768423.4%\uff0c\u4ec5\u6b21\u4e8eIgAN\uff0828.1%\uff09\uff0c\u5176\u4e34\u5e8a\u7279\u5f81\u4e3a\u5927\u91cf\u86cb\u767d\u5c3f\u548c\u6c34\u80bf \uff3b <\/sup>37-38 \uff3d <\/sup>\u3002\u6709\u7814\u7a76\u8868\u660e\uff0c\u51cf\u5c11\u86cb\u767d\u5c3f\u662f\u6cbb\u7597\u819c\u6027\u80be\u75c5\u7684\u5173\u952e\u8981\u7d20\u4e4b\u4e00 \uff3b <\/sup>38 \uff3d <\/sup>\u30022025\u5e74Lin\u7b49\uff3b38\uff3d\u7684\u4e00\u9879\u56de\u987e\u6027\u3001\u771f\u5b9e\u4e16\u754c\u7814\u7a76\u7eb3\u516520\u4f8b\u63a5\u53d7\u975e\u5948\u5229\u916e\u6cbb\u7597\u7684\u819c\u6027\u80be\u75c5\u60a3\u8005\uff0c\u7ed3\u679c\u663e\u793a\uff0c\u975e\u5948\u5229\u916e\u6cbb\u75976\u4e2a\u6708\u540e\uff0cPCR\u548cUACR\u7684\u4e2d\u4f4d\u4e0b\u964d\u767e\u5206\u6bd4\u5206\u522b\u4e3a42.03%\u548c43.66%\uff1b\u6cbb\u7597\u671f\u95f4\uff0ceGFR\u4fdd\u6301\u7a33\u5b9a\uff0c\u8840\u94be\u548c\u8840\u808c\u9150\u6c34\u5e73\u65e0\u660e\u663e\u53d8\u5316\u3002<\/p>\n

2025 \u5e74\uff0cQiu \u7b49 \uff3b <\/sup>39 \uff3d <\/sup>\u7684\u4e00\u9879\u961f\u5217\u7814\u7a76\u9996\u6b21\u5bf9\u975e\u5948\u5229\u916e\u5728\u80a5\u80d6\u76f8\u5173\u6027\u80be\u75c5\u60a3\u8005\u4e2d\u7684\u77ed\u671f\u7597\u6548\u4e0e\u5b89\u5168\u6027\u8fdb\u884c\u8bc4\u4f30\uff0c\u7ed3\u679c\u663e\u793a\uff0c\u5728 1 \u5e74\u968f\u8bbf\u4e2d\uff0c\u4e0e\u5bf9\u7167\u7ec4\u76f8\u6bd4\uff0c\u975e\u5948\u5229\u916e\u7ec4\u7684 24 h \u86cb\u767d\u5c3f\uff08\u5206\u522b\u4e3a-35.03% \u548c-11.20%\uff0cP=0.01\uff09\u548c\u6536\u7f29\u538b\uff3b\u5206\u522b\u4e3a -10.07 \u548c-4.44 mmHg\uff081 mmHg=0.133 kPa\uff09\uff0cP=0.045\uff3d\u663e\u8457\u964d\u4f4e\uff0ceGFR \u66f4\u7a33\u5b9a\uff08\u5206\u522b\u4e3a 2.85% \u548c -8.20%\uff0cP=0.009\uff09\uff0c\u4e24\u7ec4\u4e4b\u95f4\u7684\u4e0d\u826f\u4e8b\u4ef6\u5dee\u5f02\u65e0\u7edf\u8ba1\u5b66\u610f\u4e49\u3002<\/p>\n

\u7279\u6b8a\u4eba\u7fa4\u7528\u836f<\/p>\n

\u4e00\u3001\u8001\u5e74\u60a3\u8005<\/p>\n

FIDELIO\u2011DKD \u7814\u7a76\u4e2d\uff0c\u975e\u5948\u5229\u916e\u7ec4\u60a3\u8005\u5e74\u9f84\u4e3a\uff0865.4\u00b18.9\uff09\u5c81\uff0c\u57fa\u4e8e\u5e74\u9f84\u5206\u5c42\u7684\u4e9a\u7ec4\u5206\u6790\u53d1\u73b0\uff0c\u5e74\u9f84\u226565\u5c81\u7684\u60a3\u8005\u4e0e\u5e74\u8f7b\u60a3\u8005\u95f4\u5b89\u5168\u6027\u4e0e\u6709\u6548\u6027\u672a\u89c1\u603b\u4f53\u5dee\u5f02 \uff3b <\/sup>12 \uff3d <\/sup>\uff0c\u5728\u7528\u836f\u65f6\u65e0\u987b\u8fdb\u884c\u5242\u91cf\u8c03\u6574 \uff3b <\/sup>40 \uff3d <\/sup>\u3002FIDELITY\u4e8b\u540e\u5206\u6790\u7ed3\u679c\u63d0\u793a\uff0c\u5728<65 \u5c81\u548c 65~74 \u5c81\u4e9a\u7ec4\u4e2d\uff0c\u975e\u5948\u5229\u916e\u5747\u53ef\u4ee5\u5b9e\u73b0\u4e00\u81f4\u7684\u80be\u810f\u4e0e\u5fc3\u8840\u7ba1\u83b7\u76ca\uff0c\u6709\u6548\u964d\u4f4e\u86cb\u767d\u5c3f\u6c34\u5e73\uff0c\u5ef6\u7f13 eGFR \u4e0b\u964d \uff3b 4<\/sup>1 \uff3d <\/sup>\u3002<\/p>\n

\u4e8c\u3001\u5b55\u5987\u3001\u54fa\u4e73\u671f\u5987\u5973\u3001\u513f\u7ae5\u53ca\u9752\u5c11\u5e74<\/p>\n

1. \u5b55\u5987\uff1a\u57fa\u4e8e\u52a8\u7269\u7814\u7a76\u4e2d\u89c2\u5bdf\u5230\u7684\u751f\u6b96\u6bd2\u6027\uff0c\u975e\u5948\u5229\u916e\u7981\u7528\u4e8e\u5b55\u5987\u3002<\/p>\n

2. \u80b2\u9f84\u671f\u5973\u6027\uff1a\u5bf9\u4e8e\u6709\u751f\u80b2\u6f5c\u529b\u7684\u5973\u6027\uff0c\u5728\u5f00\u59cb\u975e\u5948\u5229\u916e\u6cbb\u7597\u524d\u5e94\u786e\u8ba4\u672a\u598a\u5a20\uff0c\u5e76\u5728\u6cbb\u7597\u671f\u95f4\u53ca\u505c\u836f\u540e\u81f3\u5c11 1 \u5468\u5185\u91c7\u53d6\u6709\u6548\u7684\u907f\u5b55\u63aa\u65bd\u3002\u82e5\u8ba1\u5212\u598a\u5a20\uff0c\u5efa\u8bae\u81f3\u5c11\u63d0\u524d1\u5468\u505c\u836f\u3002<\/p>\n

3. \u54fa\u4e73\u671f\u5987\u5973\u3001\u513f\u7ae5\u53ca\u9752\u5c11\u5e74\uff1a\u76ee\u524d\u5c1a\u7f3a\u4e4f\u4e34\u5e8a\u7814\u7a76\u6570\u636e\uff0c\u6682\u4e0d\u63a8\u8350\u4f7f\u7528\u975e\u5948\u5229\u916e\u3002<\/p>\n

\u4e09\u3001\u809d\u635f\u4f24\u60a3\u8005<\/p>\n

1. \u8f7b\u5ea6\u809d\u635f\u4f24\uff08Child\u2011Pugh A \u7ea7\uff09\u60a3\u8005\uff1a\u65e0\u987b\u8c03\u6574\u5242\u91cf\u3002<\/p>\n

2. \u4e2d\u5ea6\u809d\u635f\u4f24\uff08Child\u2011Pugh B \u7ea7\uff09\u60a3\u8005\uff1a\u63a8\u8350\u8d77\u59cb\u5242\u91cf\u4e3a10 mg\uff0c\u6bcf\u65e51\u6b21\uff0c\u4e14\u4e0d\u5efa\u8bae\u4e0a\u8c03\u81f320 mg\u3002<\/p>\n

3. \u91cd\u5ea6\u809d\u635f\u4f24\uff08Child\u2011Pugh C \u7ea7\uff09\u60a3\u8005\uff1a\u7981\u6b62\u4f7f\u7528\u975e\u5948\u5229\u916e\uff0c\u56e0\u5176\u53ef\u80fd\u4f1a\u663e\u8457\u589e\u52a0\u975e\u5948\u5229\u916e\u7684\u5168\u8eab\u66b4\u9732\u91cf\uff0c\u4ece\u800c\u5347\u9ad8\u4e0d\u826f\u53cd\u5e94\u98ce\u9669 \uff3b <\/sup>42 \uff3d <\/sup>\u3002<\/p>\n

\u56db\u3001\u7981\u7528\u4eba\u7fa4<\/p>\n

\u5bf9\u975e\u5948\u5229\u916e\u6d3b\u6027\u6210\u5206\u6216\u4efb\u4f55\u8f85\u6599\u8fc7\u654f\u7684\u60a3\u8005\u3001\u539f\u53d1\u6027\u80be\u4e0a\u817a\u76ae\u8d28\u529f\u80fd\u51cf\u9000\u75c7\u60a3\u8005\uff0c\u7981\u7528\u975e\u5948\u5229\u916e\u3002<\/p>\n

\u4f7f\u7528\u5242\u91cf\u53ca\u76d1\u6d4b\u6307\u6807<\/p>\n

\u4e00\u3001\u8d77\u59cb\u5242\u91cf<\/p>\n

\u975e\u5948\u5229\u916e\u7684\u8d77\u59cb\u5242\u91cf\u9700\u7efc\u5408 eGFR \u548c\u8840\u94be\u6c34\u5e73\u5224\u5b9a\u3002\u5f53\u8840\u94be >5.0 mmol\/L \u6216 eGFR<25 ml\u00b7min –<\/sup>1 <\/sup>\u00b7\uff081.73 m2<\/sup>\uff09–<\/sup>1 <\/sup>\uff0c\u4e0d\u63a8\u8350\u542f\u7528\u975e\u5948\u5229\u916e \u3002\u5bf9\u4e8e\u8840\u94be \u22645.0 mmol\/L \u7684\u60a3\u8005\uff0c\u5f53 eGFR\u226560 ml \u00b7 min–<\/sup>1 <\/sup>\u00b7\uff081.73 m2<\/sup>\uff09–<\/sup>1<\/sup> \u65f6\uff0c\u63a8\u8350\u8d77\u59cb\u5242\u91cf20 mg\/d\uff1b\u5f5325 ml \u00b7 min–<\/sup>1 <\/sup>\u00b7\uff081.73 m2<\/sup>\uff09–<\/sup>1 <\/sup>\u2264eGFR<60 ml \u00b7 min–<\/sup>1 <\/sup>\u00b7\uff081.73 m2 <\/sup>\uff09–<\/sup>1 <\/sup>\u65f6\uff0c\u63a8\u8350\u8d77\u59cb\u5242\u91cf10 mg\/d\u3002<\/p>\n

\u4e8c\u3001\u76d1\u6d4b\u4e0e\u5242\u91cf\u8c03\u6574<\/p>\n

\u9488\u5bf9T2DM\u76f8\u5173CKD\u60a3\u8005\uff0c\u975e\u5948\u5229\u916e\u7684\u76ee\u6807\u5242\u91cf\u4e3a20 mg\uff0c\u6bcf\u65e51\u6b21\u3002\u60a3\u8005\u5728\u63a5\u53d7\u975e\u5948\u5229\u916e\u8d77\u59cb\u6cbb\u75974\u5468\u5185\uff0c\u5e94\u53ca\u65f6\u76d1\u6d4b\u8840\u94be\u4e0eeGFR\u6c34\u5e73\u3002\u82e5\u5f53\u524d\u5242\u91cf\u4e3a10 mg\/d\uff0c\u5f53\u8840\u94be\u22644.8 mmol\/L\u4e14eGFR\u4e0e\u4e0a\u6b21\u68c0\u6d4b\u76f8\u6bd4\u964d\u4f4e\u226430%\uff0c\u53ef\u4e0a\u8c03\u5242\u91cf\u81f320 mg\/d\uff0c\u5f53\u8840\u94be\u4e3a4.9~5.5 mmol\/L\uff0c\u53ef\u7ef4\u630110 mg\/d\u3002\u82e5\u5f53\u524d\u5242\u91cf\u4e3a20 mg\/d\uff0c\u5f53\u8840\u94be\u22645.5 mmol\/L\u5219\u7ef4\u6301\u8be5\u5242\u91cf\uff1b\u82e5\u8840\u94be>5.5 mmol\/L\uff0c\u5e94\u6682\u505c\u975e\u5948\u5229\u916e\u6cbb\u7597\uff0c\u5f85\u8840\u94be\u964d\u81f3\u22645.0 mmol\/L\uff0c\u518d\u884c\u8003\u8651\u91cd\u65b0\u5f00\u59cb\u6cbb\u7597\uff0c\u5242\u91cf\u4e3a10 mg\/d\uff08\u88682\uff09\u3002\u5242\u91cf\u8c03\u6574\u540e\u76844\u5468\u5185\uff0c\u4e5f\u5e94\u8fdb\u884c\u8840\u94be\u4e0eeGFR\u6c34\u5e73\u76d1\u6d4b\u3002\u6574\u4e2a\u6cbb\u7597\u671f\u95f4\u9700\u6301\u7eed\u89c4\u5f8b\u6027\u76d1\u6d4b\u8840\u94be\u4ee5\u6307\u5bfc\u5242\u91cf\u8c03\u6574\uff0c\u82e5\u60a3\u8005\u8840\u94be\u6c34\u5e73\u672a\u8d85\u8fc75.5 mmol\/L\uff0c\u4e3a\u4fdd\u8bc1\u60a3\u8005\u8fdc\u671f\u5fc3\u80be\u83b7\u76ca\uff0c\u5efa\u8bae\u7ef4\u6301\u975e\u5948\u5229\u916e\u6cbb\u7597\uff0c\u4e0d\u5efa\u8bae\u76f4\u63a5\u505c\u836f\uff1b\u82e5\u8fdb\u5c55\u81f3\u7ec8\u672b\u671f\u80be\u75c5\uff0c\u5373eGFR<15 ml\u00b7min–<\/sup>1<\/sup>\u00b7\uff081.73 m2<\/sup>\uff09–<\/sup>1<\/sup>\uff0c\u5e94\u505c\u7528\u975e\u5948\u5229\u916e\u3002<\/p>\n

\u8054\u5408\u7528\u836f<\/p>\n

T2DM\u3001CKD\u3001CVD \u591a\u5171\u5b58\uff0c\u4e14\u60a3\u8005\u7684\u5fc3\u8840\u7ba1\u548c\u80be\u810f\u98ce\u9669\u8f83\u9ad8\uff0c\u5355\u4e00\u836f\u7269\u6cbb\u7597\u53ef\u80fd\u65e0\u6cd5\u5b8c\u5168\u6ee1\u8db3\u8fd9\u7c7b\u60a3\u8005\u7684\u590d\u6742\u9700\u6c42\uff0c\u901a\u5e38\u9700\u8981\u591a\u79cd\u673a\u5236\u7684\u836f\u7269\u8054\u5408\u4f7f\u7528\u3002\u975e\u5948\u5229\u916e\u76f4\u63a5\u6291\u5236 MR \u8fc7\u5ea6\u6fc0\u6d3b\u76f8\u5173\u7684\u708e\u75c7\u548c\u7ea4\u7ef4\u5316\uff0c\u4e0e\u73b0\u6709\u6cbb\u7597\u7b56\u7565\u4e2d\u7684\u964d\u7cd6\u3001\u964d\u538b\u836f\u7269\u673a\u5236\u4e92\u8865\uff0c\u5c3d\u65e9\u8054\u5408\u4f7f\u7528\u4ee5\u6700\u5927\u5316\u5730\u5ef6\u7f13\u60a3\u8005\u5fc3\u80be\u75be\u75c5\u8fdb\u5c55\u3002<\/p>\n

\u4e00\u3001\u4e0e\u964d\u7cd6\u836f\u7269\u8054\u7528<\/p>\n

1. \u4e0e SGLT2i \u8054\u7528\uff1aFIDELITY \u7814\u7a76\u4e9a\u7ec4\u5206\u6790\u7ed3\u679c\u663e\u793a\uff0c\u5728\u57fa\u7ebf\u4f7f\u7528 SGLT2i\u7684\u57fa\u7840\u4e0a\uff0c\u975e\u5948\u5229\u916e\u6709\u8fdb\u4e00\u6b65\u964d\u4f4e\u80be\u810f\u590d\u5408\u7ec8\u70b9\u4e8b\u4ef6\u4e0e\u5fc3\u8840\u7ba1\u4e0d\u826f\u4e8b\u4ef6\u53d1\u751f\u98ce\u9669\u7684\u8d8b\u52bf\uff0c\u4e24\u836f\u8054\u5408\u4f7f\u7528\u53ef\u964d\u4f4e UACR \u8fbe37%\uff0c\u9ad8\u94be\u8840\u75c7\u53d1\u751f\u7387\u8f83\u65e0 SGLT2i \u7ec4\u4f3c\u4e4e\u66f4\u4f4e \uff3b <\/sup>43 \uff3d <\/sup>\u3002\u4e00\u9879\u57fa\u4e8e\u771f\u5b9e\u4e16\u754c\u6570\u636e\u7684\u56de\u987e\u6027\u961f\u5217\u7814\u7a76\u7ed3\u679c\u663e\u793a\uff0c\u975e\u5948\u5229\u916e\u4e0e SGLT2i \u8054\u7528\u53ef\u8fdb\u4e00\u6b65\u964d\u4f4e CKD \u60a3\u8005\u7684\u4e3b\u8981\u80be\u810f\u4e0d\u826f\u4e8b\u4ef6\u3001\u7ec8\u672b\u671f\u80be\u75c5\u548c\u5168\u56e0\u6b7b\u4ea1\u7387\uff0c\u76f8\u8f83\u4e8e\u5355\u836f\u6cbb\u7597\u5177\u6709\u66f4\u4f18\u7684\u5fc3\u80be\u4fdd\u62a4\u4f5c\u7528 \uff3b <\/sup>44 \uff3d <\/sup>\u3002<\/p>\n

2025 \u5e74\u968f\u673a\u3001\u53cc\u76f2\u3001\u5b89\u6170\u5242\u5bf9\u7167 CONFIDENCE\u7814\u7a76\u7684\u4e3b\u8981\u7ed3\u679c\u8bc1\u5b9e\u4e86\u975e\u5948\u5229\u916e\u4e0e SGLT2i\u540c\u6b65\u8d77\u59cb\u8054\u5408\u7528\u4e8e T2DM \u76f8\u5173 CKD \u60a3\u8005\u7684\u7597\u6548\u548c\u5b89\u5168\u6027 \uff3b <\/sup>45 \uff3d <\/sup>\u3002\u7814\u7a76\u5171\u7eb3\u5165 800 \u4f8b\u60a3\u8005\uff0c\u6309 1\u22361\u22361 \u968f\u673a\u5206\u4e3a\u975e\u5948\u5229\u916e\u8054\u5408\u6069\u683c\u5217\u51c0\u7ec4\u3001\u975e\u5948\u5229\u916e\u8054\u5408\u5b89\u6170\u5242\u7ec4\u3001\u6069\u683c\u5217\u51c0\u8054\u5408\u5b89\u6170\u5242\u7ec4\u3002\u7814\u7a76\u7ed3\u679c\u663e\u793a\uff0c\u7b2c180 \u5929\u65f6\uff0c\u8054\u5408\u6cbb\u7597\u7ec4\u60a3\u8005 UACR \u8f83\u57fa\u7ebf\u663e\u8457\u964d\u4f4e52%\uff0c\u4e14\u4f18\u4e8e\u5355\u836f\u6cbb\u7597\u3002\u4e0e\u975e\u5948\u5229\u916e\u53ca\u6069\u683c\u5217\u51c0\u5355\u836f\u7ec4\u76f8\u6bd4\uff0c\u8054\u5408\u6cbb\u7597\u7ec4 UACR \u5206\u522b\u989d\u5916\u964d\u4f4e 29% \u548c32%\u3002\u4e14\u5728\u6cbb\u7597\u7b2c 2 \u5468\uff0c\u8054\u5408\u6cbb\u7597\u7ec4 UACR \u5373\u53ef\u8fbe\u5230 30% \u7684\u964d\u5e45\u3002\u8054\u5408\u6cbb\u7597\u7ec4\u7684\u603b\u4f53\u4e0d\u826f\u4e8b\u4ef6\u7279\u5f81\u4e0e\u5355\u836f\u7ec4\u76f8\u4f3c\uff0c\u56e0\u4e0d\u826f\u4e8b\u4ef6\u548c\u4e25\u91cd\u4e0d\u826f\u4e8b\u4ef6\u5bfc\u81f4\u7684\u505c\u836f\u6bd4\u4f8b\u8f83\u4f4e\uff08<5%\uff09\u3002eGFR \u53d8\u5316\u60c5\u51b5\u7b26\u5408\u9884\u671f\uff0c4 \u5468\u65f6\u4e0b\u964d 5.6 ml\u00b7min–<\/sup>1<\/sup>\u00b7\uff081.73 m2<\/sup>\uff09–<\/sup>1<\/sup>\uff0c\u968f\u540e\u8d8b\u4e8e\u7a33\u5b9a\uff0c\u505c\u836f\u540e\u6062\u590d\u81f3\u63a5\u8fd1\u57fa\u7ebf\u6c34\u5e73\uff0c\u63d0\u793aeGFR\u53d8\u5316\u5177\u6709\u8840\u6d41\u52a8\u529b\u5b66\u7279\u5f81\u3002\u8054\u5408\u6cbb\u7597\u7ec4\u9ad8\u94be\u8840\u75c7\u53d1\u751f\u7387\u4e3a 9.3%\uff0c\u975e\u5948\u5229\u916e\u7ec4\u548c\u6069\u683c\u5217\u51c0\u7ec4\u9ad8\u94be\u8840\u75c7\u7684\u53d1\u751f\u7387\u5206\u522b\u4e3a 11.4% \u548c 3.8%\uff0c\u63d0\u793a\u8054\u5408 SGLT2i \u53ef\u80fd\u5728\u4e00\u5b9a\u7a0b\u5ea6\u4e0a\u7f13\u89e3\u4e86\u975e\u5948\u5229\u916e\u76f8\u5173\u7684\u9ad8\u94be\u8840\u75c7\u98ce\u9669\u3002\u5404\u7ec4\u5747\u65e0\u56e0\u9ad8\u94be\u8840\u75c7\u5bfc\u81f4\u4f4f\u9662\u6216\u4e25\u91cd\u4e0d\u826f\u4e8b\u4ef6\u3002<\/p>\n

\u57fa\u4e8e CONFIDENCE \u7814\u7a76\u7ed3\u679c\uff0cT2DM \u76f8\u5173CKD \u60a3\u8005\u540c\u6b65\u8d77\u59cb\u975e\u5948\u5229\u916e\u4e0e SGLT2i \u8054\u5408\u6cbb\u7597\uff0c\u53ef\u5b9e\u73b0 UACR \u5feb\u901f\u3001\u663e\u8457\u4e0b\u964d\uff0c\u4f18\u4e8e\u5355\u836f\u6cbb\u7597\uff0c\u4e14\u5b89\u5168\u6027\u826f\u597d\uff0c\u8054\u5408 SGLT2i \u6709\u52a9\u4e8e\u964d\u4f4e\u9ad8\u94be\u8840\u75c7\u98ce\u9669\uff0c\u4e24\u8005\u673a\u5236\u4e92\u8865\uff0c\u4e3a\u4f18\u5316\u5fc3\u80be\u4fdd\u62a4\u6cbb\u7597\u7b56\u7565\u63d0\u4f9b\u9ad8\u8d28\u91cf\u8bc1\u636e\u3002\u56e0\u6b64\uff0c\u5bf9\u4e8e eGFR\u226530 ml\u00b7min–<\/sup>1<\/sup>\u00b7\uff081.73m2<\/sup>\uff09–<\/sup>1<\/sup>\u4e14\u8840\u94be\u22645.0 mmol\/L \u7684\u60a3\u8005\uff0c\u4e34\u5e8a\u533b\u5e08\u53ef\u8003\u8651\u540c\u6b65\u8d77\u59cb\u4e24\u836f\u8054\u5408\u3002\u975e\u5948\u5229\u916e\uff08\u6297\u708e\u6297\u7ea4\u7ef4\u5316\u4e3a\u4e3b\uff0c\u8840\u6d41\u52a8\u529b\u5b66\u4e3a\u8f85\uff09\u4e0e SGLT2i\uff08\u6539\u5584\u4ee3\u8c22\uff0c\u6539\u5584\u8840\u6d41\u52a8\u529b\u5b66\uff09\u901a\u8fc7\u4e92\u8865\u673a\u5236\u53d1\u6325\u5fc3\u80be\u4fdd\u62a4\u4f5c\u7528\u3002\u65e2\u5f80\u6709\u5206\u6790\u63d0\u793a\uff0cSGLT2i \u53ef\u964d\u4f4e\u4e25\u91cd\u9ad8\u94be\u8840\u75c7\u7684\u98ce\u9669\uff0c\u8054\u5408 SGLT2i \u53ef\u80fd\u6709\u52a9\u4e8e\u964d\u4f4e\u975e\u5948\u5229\u916e\u76f8\u5173\u7684\u9ad8\u94be\u8840\u75c7\u98ce\u9669\u3002\u8054\u5408\u6cbb\u7597\u521d\u671f\uff0c\u7531\u4e8e\u4e24\u836f\u5747\u53ef\u80fd\u5f15\u8d77 eGFR \u4e00\u8fc7\u6027\u4e0b\u964d\uff0c\u5e76\u9700\u5173\u6ce8\u8840\u94be\u53d8\u5316\uff0c\u5efa\u8bae\u5728\u8d77\u59cb\u8054\u5408\u6cbb\u7597\u540e\u7684\u7b2c 2 \u5468\u548c\u7b2c 4 \u5468\u590d\u67e5 eGFR \u4e0e\u8840\u94be\u6c34\u5e73\uff0c\u5e76\u53c2\u7167\u672c\u5171\u8bc6\u524d\u8ff0\u201c\u8d77\u59cb\u5242\u91cf\u201d\u90e8\u5206\u8fdb\u884c\u5242\u91cf\u8c03\u6574\u3002\u5f85\u8840\u94be\u4e0e eGFR \u7a33\u5b9a\u540e\uff0c\u53ef\u5ef6\u957f\u76d1\u6d4b\u95f4\u9694\u3002<\/p>\n

2. \u4e0e\u80f0\u9ad8\u7cd6\u7d20\u6837\u80bd\u20111 \u53d7\u4f53\u6fc0\u52a8\u5242\uff08glucagon\u2011like peptide\u20111 receptor agonist\uff0cGLP\u20111RA\uff09\u8054\u7528\uff1aFIDELITY\u7814\u7a76\u4e2d\u5305\u542b\u4e86 944 \u4f8b\uff087.2%\uff09\u57fa\u7ebf\u4f7f\u7528 GLP\u20111RA \u6cbb\u7597\u7684\u60a3\u8005 \uff3b <\/sup>46 \uff3d <\/sup>\u3002\u8be5\u4eba\u7fa4\u4e9a\u7ec4\u5206\u6790\u663e\u793a\uff0c\u4e0e\u57fa\u7ebf\u672a\u4f7f\u7528 GLP\u20111RA \u8054\u5408\u6cbb\u7597\u7684\u60a3\u8005\u6bd4\u8f83\uff0c\u975e\u5948\u5229\u916e\u8054\u5408GLP\u20111RA\u6cbb\u7597\u7ec4\u5fc3\u80be\u83b7\u76ca\u4e00\u81f4\u3002\u5728FIDELIO\u2011DKD\u8bd5\u9a8c\u4e2d\uff0c\u8054\u5408\u5e94\u7528GLP\u20111RA\u4e9a\u7ec4\u5206\u6790\u663e\u793a\uff0cUACR\u964d\u4f4e\u66f4\u660e\u663e\uff08\u8054\u7528\u65f6\u964d\u4f4e37%\uff0c\u5355\u7528\u975e\u5948\u5229\u916e\u4e3a31%\uff09 \uff3b <\/sup>47 \uff3d <\/sup>\u3002\u56e0\u6b64\uff0c\u975e\u5948\u5229\u916e\u4e0eGLP\u20111RA\u8054\u7528\uff0c\u5728\u51cf\u5c11\u5fc3\u8840\u7ba1\u548c\u80be\u810f\u4e8b\u4ef6\u53d1\u751f\u98ce\u9669\u65b9\u9762\u53ef\u80fd\u5b58\u5728\u4e92\u8865\u4f5c\u7528\u3002<\/p>\n

3.\u4e0e\u80f0\u5c9b\u7d20\u8054\u7528\uff1aFIDELIO\u2011DKD \u7814\u7a76\u4e2d\u670964.1% \u7684\u60a3\u8005\u57fa\u7ebf\u63a5\u53d7\u4e86\u80f0\u5c9b\u7d20\u6cbb\u7597\uff0c\u4e9a\u7ec4\u5206\u6790\u53d1\u73b0\uff0c\u60a3\u8005\u5e94\u7528\u975e\u5948\u5229\u916e\u5fc3\u80be\u83b7\u76ca\u4e0e\u57fa\u7ebf\u662f\u5426\u63a5\u53d7\u80f0\u5c9b\u7d20\u6cbb\u7597\u65e0\u5173\uff0c\u65e0\u8bba\u57fa\u7ebf\u80f0\u5c9b\u7d20\u4f7f\u7528\u60c5\u51b5\u5982\u4f55\uff0c\u4e24\u7ec4\u95f4\u7684\u4e0d\u826f\u4e8b\u4ef6\u53d1\u751f\u7387\u76f8\u4f3c\uff0c\u63d0\u793a\u975e\u5948\u5229\u916e\u53ef\u4e0e\u80f0\u5c9b\u7d20\u8054\u7528 \uff3b <\/sup>48 \uff3d <\/sup>\u3002<\/p>\n

\u4e8c\u3001\u4e0e\u964d\u538b\u836f\u7269\u8054\u7528<\/p>\n

\u975e\u5948\u5229\u916e\u4e0e\u5176\u4ed6\u964d\u8840\u538b\u836f\u7269\u8054\u5408\u4f7f\u7528\u65f6\u53ef\u80fd\u51fa\u73b0\u8840\u538b\u964d\u4f4e\uff0c\u8054\u5408\u6cbb\u7597\u65f6\u9700\u6ce8\u610f\u76d1\u6d4b\u8840\u538b\uff0c\u9632\u6b62\u6655\u5012\u3001\u6655\u53a5\u7684\u53d1\u751f\u3002\u5728 FIDELITY \u7814\u7a76\u4e2d\uff0c\u63a5\u53d7\u975e\u5948\u5229\u916e\u6cbb\u7597\u7684 T2DM \u76f8\u5173 CKD \u60a3\u8005\uff0c\u7b2c 1 \u4e2a\u6708\u5e73\u5747\u6536\u7f29\u538b\u964d\u4f4e 2~4 mmHg\uff0c\u5e73\u5747\u8212\u5f20\u538b\u964d\u4f4e 1~2 mmHg\uff0c\u6b64\u540e\u4fdd\u6301\u7a33\u5b9a\uff0c\u6709 4.6% \u63a5\u53d7\u975e\u5948\u5229\u916e\u6cbb\u7597\u548c 3.0% \u63a5\u53d7\u5b89\u6170\u5242\u6cbb\u7597\u7684\u60a3\u8005\u62a5\u544a\u4e86\u4f4e\u8840\u538b\u4e8b\u4ef6\uff0c\u5927\u591a\u6570\u4f4e\u8840\u538b\u4e8b\u4ef6\u4e3a\u8f7b\u5ea6\u6216\u4e2d\u5ea6\u4e14\u5df2\u6062\u590d \uff3b <\/sup>44 \uff3d <\/sup>\u3002\u5728 FINEARTS\u2011HF \u7814\u7a76\u4e2d\uff0c\u63a5\u53d7\u975e\u5948\u5229\u916e\u6cbb\u7597\u7684\u75c7\u72b6\u6027 HF\uff08LVEF\u226540%\uff09\u60a3\u8005\uff0c6 \u4e2a\u6708\u65f6\u5e73\u5747\u6536\u7f29\u538b\u8f83\u5b89\u6170\u5242\u7ec4\u964d\u4f4e 3.4 mmHg\uff0c\u53d1\u751f\u6536\u7f29\u538b\u4f4e\u4e8e 100 mmHg \u7684\u60a3\u8005\u6bd4\u4f8b\u662f 18.5%\uff08\u5b89\u6170\u5242\u7ec4\u4e3a12.4%\uff09 \uff3b <\/sup>24 \uff3d <\/sup>\u3002<\/p>\n

\u80be\u7d20\u2011\u8840\u7ba1\u7d27\u5f20\u7d20\u7cfb\u7edf\u6291\u5236\u5242\uff08renin\u2011angiotensin system inhibitor\uff0cRASi\uff09\u4e3b\u8981\u5305\u62ec\u8840\u7ba1\u7d27\u5f20\u7d20\u8f6c\u5316\u9176\u6291\u5236\u5242\uff08angiotensin converting enzyme inhibitor\uff0cACEI\uff09\u548c\u8840\u7ba1\u7d27\u5f20\u7d20\u2161\u53d7\u4f53\u62ee\u6297\u5242\uff08angiotensin \u2161 receptor antagonist\uff0cARB\uff09\uff0c\u662f\u7cd6\u5c3f\u75c5\u76f8\u5173 CKD \u7684\u5e38\u89c4\u6cbb\u7597\u836f\u7269\u3002\u7136\u800c\uff0c\u7531\u4e8e\u7cd6\u5c3f\u75c5\u76f8\u5173 CKD \u60a3\u8005\u5b58\u5728 MR \u8fc7\u5ea6\u6fc0\u6d3b\uff0c\u5355\u72ec\u4f7f\u7528 RASi \u6cbb\u7597 CKD \u65f6\uff0c\u968f\u7740\u6cbb\u7597\u65f6\u95f4\u7684\u5ef6\u957f\uff0c\u5bb9\u6613\u51fa\u73b0\u8840\u6d46\u919b\u56fa\u916e\u6c34\u5e73\u5347\u9ad8\uff0c\u5373\u201c\u919b\u56fa\u916e\u9003\u9038\u73b0\u8c61\u201d \uff3b <\/sup>49 \uff3d <\/sup>\u3002\u975e\u5948\u5229\u916e\u53ef\u9ad8\u9009\u62e9\u6027\u963b\u65ad MR \u8fc7\u5ea6\u6fc0\u6d3b\uff0c\u5df2\u6709\u8bc1\u636e\u8868\u660e\uff0c\u5373\u4f7f\u5bf9\u4e8e\u5df2\u4f7f\u7528\u6700\u5927\u8010\u53d7\u5242\u91cf RASi \u7684\u7cd6\u5c3f\u75c5\u76f8\u5173 CKD \u60a3\u8005\uff0c\u975e\u5948\u5229\u916e\u4ecd\u53ef\u8fdb\u4e00\u6b65\u964d\u4f4e UACR\uff0c\u8fbe\u5230\u5fc3\u80be\u53cc\u91cd\u83b7\u76ca \uff3b <\/sup>12-13 \uff3d <\/sup>\u3002<\/p>\n

\u4e34\u5e8a\u4e0a\u4e0d\u80fd\u4f7f\u7528\u6216\u4e0d\u80fd\u8010\u53d7RASi\u7684\u7cd6\u5c3f\u75c5\u5408\u5e76CKD\u60a3\u8005\uff0c\u5982eGFR<30 ml\u00b7min–<\/sup>1<\/sup>\u00b7\uff081.73 m2<\/sup>\uff09–<\/sup>1<\/sup>\u3001\u8840\u538b\u6b63\u5e38\u3001\u6709\u4e0d\u826f\u53cd\u5e94\u7b49\uff0c\u4e5f\u6709\u7740\u5ef6\u7f13CKD\u8fdb\u5c55\u53ca\u964d\u4f4e\u5fc3\u8840\u7ba1\u4e0d\u826f\u4e8b\u4ef6\u98ce\u9669\u7684\u8feb\u5207\u9700\u6c42\u3002FOUNTAIN\u7f8e\u56fd\u56de\u987e\u6027\u89c2\u5bdf\u961f\u5217\u62a5\u544a\u663e\u793a\uff0c\u57fa\u7ebf\u65f6\u6709 49.4% \u7684\u60a3\u8005\u4f7f\u7528RASi\uff0c\u975e\u5948\u5229\u916e\u4ea6\u8868\u73b0\u51fa\u826f\u597d\u7684\u7597\u6548\uff0c\u4e14\u4e0d\u53d7\u57fa\u7ebf\u662f\u5426\u4f7f\u7528RASi\u5f71\u54cd\uff0c\u6574\u4f53\u6cbb\u75974\u4e2a\u6708\u548c12\u4e2a\u6708\u540eUACR\u5206\u522b\u663e\u8457\u964d\u4f4e33.2%\u548c38.4%\uff0c12\u4e2a\u6708\u65f6\u9ad8\u94be\u8840\u75c7\u53d1\u751f\u7387\u4ec5\u4e3a1.2%\u3002\u56e0\u6b64\uff0c\u5bf9\u4e8e\u8fd9\u90e8\u5206\u60a3\u8005\u53ef\u4ee5\u76f4\u63a5\u8d77\u59cb\u975e\u5948\u5229\u916e\u6cbb\u7597 \uff3b <\/sup>15 \uff3d <\/sup>\u3002<\/p>\n

\u975e\u5948\u5229\u916e\u4e34\u5e8a\u5e94\u7528\u7b80\u6613\u6d41\u7a0b\u56fe\u89c1\u56fe1\u3002<\/p>\n

\u56fe1 \u975e\u5948\u5229\u916e\u4e34\u5e8a\u5e94\u7528\u7b80\u6613\u6d41\u7a0b\u56fe<\/p>\n

\u6ce8\u610f\u4e8b\u9879<\/p>\n

\u4e00\u3001\u7528\u836f\u76f8\u5173\u8840\u94be\u7ba1\u7406<\/p>\n

\u975e\u5948\u5229\u916e\u6cbb\u7597\u540e\u53ef\u80fd\u51fa\u73b0\u8840\u94be\u5347\u9ad8\uff0c\u4f7f\u7528\u975e\u5948\u5229\u916e\u65f6\u5e94\u5bc6\u5207\u5173\u6ce8\u8840\u94be\u6c34\u5e73\u3002\u5728FIDELITY\u7814\u7a76\u7684T2DM\u76f8\u5173CKD\u60a3\u8005\u4e2d\uff0c\u975e\u5948\u5229\u916e\u7ec4\u60a3\u8005\u63a5\u53d71\u4e2a\u6708\u6cbb\u7597\u540e\uff0c\u8840\u94be\u5e73\u5747\u5347\u9ad80.17 mmol\/L\uff0c\u5bfc\u81f4\u7684\u9ad8\u94be\u8840\u75c7\u591a\u4e3a\u8f7b\u4e2d\u5ea6\uff0c\u6ca1\u6709\u56e0\u9ad8\u94be\u8840\u75c7\u5bfc\u81f4\u7684\u6b7b\u4ea1\u4e8b\u4ef6\uff0c\u4ec5\u975e\u5e38\u5c11\u6570\u60a3\u8005\u6c38\u4e45\u505c\u836f\uff081.7%\uff09\u6216\u9700\u8981\u4f4f\u9662\u6cbb\u7597\uff080.9%\uff09 \uff3b <\/sup>14 \uff3d <\/sup>\u3002\u5728FINEARTS\u2011HF\u7814\u7a76\u7684HF\u60a3\u8005\u4e2d\uff0c\u975e\u5948\u5229\u916e\u7ec4\u60a3\u8005\u63a5\u53d71\u4e2a\u6708\u6cbb\u7597\u540e\uff0c\u8840\u94be\u5e73\u5747\u5347\u9ad80.19 mmol\/L\uff0c\u540c\u65f6\u76f8\u8f83\u4e8e\u5b89\u6170\u5242\u7ec4\uff0c\u4f4e\u94be\u8840\u75c7\u53d1\u751f\u98ce\u9669\u66f4\u4f4e \uff3b <\/sup>50 \uff3d <\/sup>\u3002\u56e0\u6b64\uff0c\u975e\u5948\u5229\u916e\u8d77\u59cb\u6cbb\u7597\u540e\u5e94\u5bc6\u5207\u76d1\u6d4b\u8840\u94be\uff0c\u5728\u6709\u6548\u63a7\u5236\u8840\u94be\u6c34\u5e73\u7684\u57fa\u7840\u4e0a\u5c3d\u91cf\u907f\u514d\u975e\u5948\u5229\u916e\u7684\u51cf\u91cf\u548c\u505c\u836f\u3002\u975e\u5948\u5229\u916e\u4e0eACEI\/ARB\u3001\u94be\u8865\u5145\u5242\uff08\u5982\u7532\u6c27\u82c4\u5576\u6216\u7532\u6c27\u82c4\u5576\/\u78fa\u80fa\u7532\u5641\u5511\uff09\u3001\u4fdd\u94be\u5229\u5c3f\u5242\uff08\u5982\u963f\u7c73\u6d1b\u5229\u3001\u6c28\u82ef\u8776\u5576\uff09\u7b49\u53ef\u80fd\u4f1a\u5bfc\u81f4\u8840\u94be\u6c34\u5e73\u5347\u9ad8\u7684\u836f\u7269\u8054\u7528\u65f6\uff0c\u5e94\u589e\u52a0\u8840\u94be\u76d1\u6d4b\u9891\u7387\u3002\u5bf9\u4e8e\u975e\u5948\u5229\u916e\u3001RASi\u4e0eSGLT2i\u4e09\u8054\u6cbb\u7597\u7684\u60a3\u8005\uff0c\u5efa\u8bae\u5728\u6cbb\u7597\u8d77\u59cb\u53ca\u5242\u91cf\u8c03\u6574\u540e2~4\u5468\u76d1\u6d4b\u8840\u94be\u6c34\u5e73\uff0c\u5f85\u8840\u94be\u6c34\u5e73\u7a33\u5b9a\u540e\uff0c\u53ef\u6839\u636e\u4e2a\u4f53\u60c5\u51b5\u5ef6\u957f\u76d1\u6d4b\u95f4\u9694\u3002<\/p>\n

\u5bf9\u4e8e\u9ad8\u94be\u8840\u75c7\u98ce\u9669\u8f83\u9ad8\u8005\uff0c\u5e94\u79ef\u6781\u7b5b\u67e5\u5e76\u7ea0\u6b63\u9ad8\u94be\u8840\u75c7\u7684\u6f5c\u5728\u8bf1\u56e0\u3002\u5efa\u8bae\u540c\u6b65\u91c7\u53d6\u4f4e\u94be\u996e\u98df\uff0c\u51cf\u5c11\u9ad8\u94be\u98df\u7269\uff08\u5982\u8349\u8393\u3001\u9999\u8549\u3001\u725b\u6cb9\u679c\u3001\u5357\u74dc\u3001\u7ea2\u85af\u3001\u80e1\u841d\u535c\u3001\u7389\u7c73\u3001\u8c46\u7c7b\u3001\u8089\u7c7b\u548c\u575a\u679c\u7b49\uff09\u7684\u6444\u5165\u3002\u56e0\u8461\u8404\u67da\u5177\u6709 CYP3A4 \u6d3b\u6027\u6291\u5236\u4f5c\u7528\uff0c\u5728\u975e\u5948\u5229\u916e\u6cbb\u7597\u671f\u95f4\u4e0d\u5e94\u98df\u7528\u8461\u8404\u67da\u6216\u996e\u7528\u8461\u8404\u67da\u6c41\u3002\u6025\u6027\u9ad8\u94be\u8840\u75c7\u7684\u4e34\u5e8a\u7ba1\u7406\u5efa\u8bae\u8be6\u89c1\u76f8\u5173\u8bca\u7597\u5171\u8bc6 \uff3b <\/sup>51-52 \uff3d<\/sup>\uff0c\u53ef\u8054\u5408\u4f7f\u7528\u65b0\u578b\u94be\u79bb\u5b50\u7ed3\u5408\u5242\uff08\u5982\u73af\u7845\u9178\u9506\u94a0\u6216\u4f20\u7edf\u9633\u79bb\u5b50\u4ea4\u6362\u6811\u8102\u805a\u82ef\u4e59\u70ef\u78fa\u9178\u94a0\u3001\u805a\u82ef\u4e59\u70ef\u78fa\u9178\u9499\uff09\u7528\u4e8e\u9ad8\u94be\u8840\u75c7\u7684\u77ed\u671f\u6cbb\u7597\u3002\u5bf9\u4e8e\u9700\u6301\u7eed\u975e\u5948\u5229\u916e\u6cbb\u7597\u4ee5\u63a7\u5236\u75be\u75c5\u8fdb\u5c55\u7684\u6162\u6027\u9ad8\u94be\u8840\u75c7\u9ad8\u5371\u60a3\u8005\uff0c\u53ef\u957f\u671f\u4f7f\u7528\u65b0\u578b\u94be\u79bb\u5b50\u7ed3\u5408\u5242\uff08\u5982\u73af\u7845\u9178\u9506\u94a0\uff09\u7ef4\u6301\u6cbb\u7597\u4ee5\u964d\u4f4e\u8840\u94be\u6c34\u5e73 \uff3b <\/sup>53 \uff3d <\/sup>\uff0c\u5e76\u91c7\u53d6\u66f4\u5bc6\u5207\u7684\u8840\u94be\u76d1\u6d4b\u3002<\/p>\n

\u4e8c\u3001\u7528\u836f\u76f8\u5173\u65e9\u671feGFR\u53d8\u5316<\/p>\n

\u975e\u5948\u5229\u916e\u4e0e RASi \u548c SGLT2i \u76f8\u4f3c\uff0c\u5747\u4f1a\u5728\u7528\u836f\u8d77\u59cb\u9636\u6bb5\u5feb\u901f\u5f71\u54cd\u80be\u5c0f\u7403\u8840\u6d41\u52a8\u529b\u5b66\uff0c\u56e0\u800c\u5728\u6cbb\u7597\u65e9\u671f\u5747\u53ef\u80fd\u51fa\u73b0 eGFR\u8f83\u660e\u663e\u5730\u4e0b\u964d\uff0c\u591a\u96c6\u4e2d\u5728\u8d77\u59cb\u6cbb\u7597\u7684 1 \u4e2a\u6708\u3002FIDELITY \u7814\u7a76\u6570\u636e\u663e\u793a\uff0c\u975e\u5948\u5229\u916e\u7ec4\u4e0e\u5b89\u6170\u5242\u7ec4\u5206\u522b\u6709 5.3% \u548c 4.2%\u7684\u60a3\u8005\u51fa\u73b0eGFR\u964d\u4f4e\uff0c\u591a\u4e3a\u8f7b\u5ea6\u6216\u4e2d\u5ea6\uff0c\u5728\u8d77\u59cb\u6cbb\u7597\u7684\u7b2c 1 \u4e2a\u6708\uff0c\u975e\u5948\u5229\u916e\u7ec4\u51fa\u73b0 eGFR \u964d\u4f4e>30% \u7684\u60a3\u8005\u6bd4\u4f8b\u4ec5\u4e3a 3%\u3002\u5bf9\u4e8e\u8d77\u59cb\u975e\u5948\u5229\u916e\u540e\u51fa\u73b0eGFR \u4e0b\u964d>30%\uff0c\u4f46\u8840\u94be\u6c34\u5e73\u6b63\u5e38\uff08 \u5982<5.0 mmol\/L\uff09\uff0c\u4e14\u505c\u836f\u540e eGFR \u6062\u590d\u81f3\u57fa\u7ebf\u6c34\u5e73\u7684\u60a3\u8005\uff0c\u63d0\u793a\u4e4b\u524d\u7684 eGFR \u4e0b\u964d\u5f88\u53ef\u80fd\u4e3a\u836f\u7269\u7684\u8840\u6d41\u52a8\u529b\u5b66\u6548\u5e94\uff0c\u800c\u975e\u5668\u8d28\u6027\u80be\u635f\u4f24\u3002\u6b64\u7c7b\u60a3\u8005\u4ecd\u7136\u662f\u975e\u5948\u5229\u916e\u6cbb\u7597\u7684\u6f5c\u5728\u83b7\u76ca\u4eba\u7fa4\u3002\u5728\u8003\u8651\u91cd\u65b0\u542f\u7528\u65f6\uff0c\u5efa\u8bae\u5173\u6ce8\u4ee5\u4e0b\u51e0\u65b9\u9762\uff1a\uff081\uff09\u5168\u9762\u8bc4\u4f30\uff1a\u786e\u8ba4\u5bfc\u81f4eGFR \u4e0b\u964d\u7684\u53ef\u9006\u6027\u56e0\u7d20\uff08\u5982\u8840\u5bb9\u91cf\u4e0d\u8db3\u3001\u5408\u7528\u80be\u6bd2\u6027\u836f\u7269\u3001\u611f\u67d3\u3001HF\u5931\u4ee3\u507f\u7b49\uff09\u5df2\u88ab\u7ea0\u6b63\uff0c\u6392\u9664\u80be\u52a8\u8109\u72ed\u7a84\u7b49\u60c5\u51b5\uff1b\uff082\uff09\u91cd\u65b0\u542f\u7528\u7684\u65f6\u673a\uff1a\u5728\u60a3\u8005 eGFR \u7a33\u5b9a\u3001\u4e34\u5e8a\u72b6\u51b5\u826f\u597d\u540e\uff0c\u53ef\u8003\u8651\u4ee5\u8f83\u4f4e\u5242\u91cf\uff08\u598210 mg\/d\uff09\u91cd\u65b0\u5c1d\u8bd5\u542f\u7528\u975e\u5948\u5229\u916e\uff1b\uff083\uff09\u52a0\u5f3a\u76d1\u6d4b\uff1a\u91cd\u65b0\u542f\u7528\u540e\u7684 2~4 \u5468\u5185\uff0c\u5e94\u8fdb\u884c\u5bc6\u5207\u80be\u529f\u80fd\u76d1\u6d4b\uff0c\u786e\u8ba4 eGFR \u4e0b\u964d\u5e45\u5ea6\u5728\u53ef\u63a5\u53d7\u8303\u56f4\u5185\uff08\u5982\u226430%\uff09\uff0c\u4e14\u8840\u94be\u7ef4\u6301\u7a33\u5b9a\uff0c\u5219\u53ef\u7ee7\u7eed\u957f\u671f\u6cbb\u7597\uff0c\u4ee5\u4fdd\u969c\u60a3\u8005\u8fdc\u671f\u5fc3\u80be\u83b7\u76ca\u3002<\/p>\n

\u4f7f\u7528\u975e\u5948\u5229\u916e\u521d\u671f\u5e94\u5bc6\u5207\u5173\u6ce8eGFR\u6c34\u5e73\uff0c\u7279\u522b\u662f\u4e0e\u53ef\u80fd\u4f1a\u51fa\u73b0eGFR\u4e00\u8fc7\u6027\u4e0b\u964d\u7684\u836f\u7269\uff08\u5982RASi\u3001SGLT2i\u7b49\uff09\u8054\u7528\u65f6\uff0c\u5e94\u6ce8\u610f\u7b5b\u67e5\u60a3\u8005\u662f\u5426\u5b58\u5728\u8840\u808c\u9150\u5347\u9ad8\u7684\u9ad8\u5371\u56e0\u7d20\uff0c\u5982\u8840\u5bb9\u91cf\u4e0d\u8db3\u3001\u80be\u52a8\u8109\u72ed\u7a84\u53ca\u6b63\u5728\u670d\u7528\u5f71\u54cd\u80be\u529f\u80fd\u7684\u836f\u7269\u7b49\u3002\u5df2\u4f7f\u7528\u975e\u5948\u5229\u916e\u7684\u60a3\u8005\uff0c\u5728\u5bc6\u5207\u76d1\u6d4b\u8840\u94be\u53caeGFR\u6c34\u5e73\u7684\u524d\u63d0\u4e0b\uff0c\u82e5eGFR\u672a\u8fdb\u5c55\u81f3<15 ml\u00b7min–<\/sup>1<\/sup>\u00b7\uff081.73 m2<\/sup>\uff09–<\/sup>1<\/sup>\uff0c\u5efa\u8bae\u575a\u6301\u957f\u671f\u7528\u836f\u4ee5\u4fdd\u8bc1\u60a3\u8005\u8fdc\u671f\u5fc3\u80be\u83b7\u76ca\u3002\u5bf9\u4e8e\u63a5\u53d7\u975e\u5948\u5229\u916e\u6cbb\u7597\u540eUACR\u663e\u8457\u964d\u4f4e\u751a\u81f3\u6062\u590d\u6b63\u5e38\u7684T2DM\u76f8\u5173CKD\u60a3\u8005\uff0c\u4e0d\u5e94\u5c06UACR\u6062\u590d\u6b63\u5e38\u89c6\u4e3a\u505c\u836f\u7684\u6307\u5f81\u3002T2DM\u5408\u5e76CKD\u60a3\u8005\u6cbb\u7597\u4ee5\u5fc3\u80be\u7ed3\u5c40\u83b7\u76ca\u4e3a\u4e3b\u8981\u76ee\u6807\uff0c\u800c\u975e\u4ec5\u4ec5\u662fUACR\u964d\u4f4e\u3002\u975e\u5948\u5229\u916e\u7684\u5fc3\u80be\u4fdd\u62a4\u4f5c\u7528\u4f9d\u8d56\u4e8e\u6301\u7eed\u6cbb\u7597\u4ee5\u6291\u5236MR\u8fc7\u5ea6\u6fc0\u6d3b\u3002\u5f53\u5bfc\u81f4MR\u8fc7\u5ea6\u6fc0\u6d3b\u7684\u56e0\u7d20\u4ecd\u7136\u5b58\u5728\u65f6\uff0c\u505c\u836f\u53ef\u80fd\u5bfc\u81f4\u5176\u6297\u708e\u3001\u6297\u7ea4\u7ef4\u5316\u7684\u4fdd\u62a4\u4f5c\u7528\u4e2d\u65ad\u3002\u9488\u5bf9FIDELITY\u7814\u7a76\u4e2d\u60a3\u8005\u6cbb\u7597\u4e2d\u65ad\u5bf9\u4e34\u5e8a\u7ed3\u5c40\u7684\u5f71\u54cd\u5206\u6790\u63d0\u793a\uff0c\u975e\u5948\u5229\u916e\u6cbb\u7597\u505c\u836f\u53ef\u80fd\u51cf\u5f31\u5176\u5bf9T2DM\u76f8\u5173CKD\u60a3\u8005\u7684\u5fc3\u80be\u4fdd\u62a4\u6548\u5e94\u3002\u56e0\u6b64\uff0c\u5982\u60a3\u8005\u80fd\u8010\u53d7\uff08\u8840\u94be\u53caeGFR\u6c34\u5e73\u5728\u53ef\u63a7\u8303\u56f4\u5185\uff09\uff0c\u4e14\u672a\u8fdb\u5c55\u81f3\u7ec8\u672b\u671f\u80be\u75c5\uff0c\u5747\u5efa\u8bae\u957f\u671f\u4f7f\u7528\u975e\u5948\u5229\u916e\u6cbb\u7597\uff0c\u4ee5\u6301\u7eed\u83b7\u5f97\u5fc3\u80be\u7ed3\u5c40\u7684\u8fdc\u671f\u6539\u5584\u3002<\/p>\n

\u4e09\u3001\u5176\u4ed6\u6ce8\u610f\u4e8b\u9879<\/p>\n

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\u603b\u7ed3\u548c\u5c55\u671b<\/p>\n

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\u9648   \u521a \u798f\u5efa\u7701\u7acb\u533b\u9662\u5185\u5206\u6ccc\u79d1<\/p>\n

\u9648   \u5b8f \u5357\u65b9\u533b\u79d1\u5927\u5b66\u73e0\u6c5f\u533b\u9662\u5185\u5206\u6ccc\u79d1<\/p>\n

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\u9648   \u4e3d \u5c71\u4e1c\u5927\u5b66\u9f50\u9c81\u533b\u9662\u5185\u5206\u6ccc\u79d1<\/p>\n

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\u9648   \u5d34 \u4e2d\u5c71\u5927\u5b66\u9644\u5c5e\u7b2c\u4e00\u533b\u9662\u80be\u5185\u79d1<\/p>\n

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\u90ed\u7acb\u65b0 \u5317\u5185\u5206\u6ccc\u79d1<\/p>\n

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\u6d2a\u5bcc\u6e90 \u798f\u5efa\u7701\u7acb\u533b\u9662\u80be\u5185\u79d1<\/p>\n

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\u9ec4   \u607a \u6b66\u6c49\u5927\u5b66\u4eba\u6c11\u533b\u9662\u5fc3\u5185\u79d1<\/p>\n

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