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JCEM:2型糖尿病患者质子泵抑制剂、肾病和心血管疾病有何关系?

2017-06-10 MedSci MedSci原创

由此可见,PPIs的使用与2型糖尿病患者经uACR评估的血管内皮功能持续的不利影响无关。然而,开始服用PPI与肾病恶化以及5年CVD风险增加之间的相关性,具有潜在的临床意义。

越来越多的证据表明慢性质子泵抑制剂(PPI)治疗会产生一系列不良反应。近日,内分泌和代谢性疾病领域权威杂志Journal of Clinical Endocrinology & Metabolism上发表了一篇研究文章,研究人员旨在评估PPI对2型糖尿病患者蛋白尿、肾功能和心血管疾病(CVD)风险的影响。

该研究是在城市居住社区进行的纵向观察性研究。研究参与者来自于纵向观察性弗里曼特尔糖尿病研究II期的2型糖尿病患者,这些参与者稳定地服用肾素-血管紧张素系统阻断剂治疗,并被分为一直未用PPI治疗组(1组,n=686),全程PPI治疗组(2组,n=174),开始定期的PPI治疗组(3组,n=109)或停止定期的PPI治疗组(4组,n=67),在两次评估间隔两年。该研究的主要观察指标为尿白蛋白肌酐(UACR)的变化值(Δ),估计的肾小球滤过率(eGFR)和经过验证的方程预测的5年心血管疾病风险。

研究人员发现各组间ΔuACR没有统计学差异(方差分析,P=0.36),但ΔeGFR有所差异(ANOVA,P=0.002),其中3组表现出比1组显著降低(调整后的Δ平均差异(95%可信区间)为-2.7(-4.5至-0.8)毫升/分钟/1.73平方米)P=0.005)。Δ5年的CVD风险表现出了类似的模式(方差分析,P<0.001),其中3组比1组有更大的增加(调整后的Δ平均差异(95%可信区间)为1.7(0.6-2.8)%;P=0.002)。

由此可见,PPIs的使用与2型糖尿病患者经uACR评估的血管内皮功能持续的不利影响无关。然而,开始服用PPI与肾病恶化以及5年CVD风险增加之间的相关性,具有潜在的临床意义。

原始出处:

Timothy M E Davis,et al. Proton pump inhibitors, nephropathy and cardiovascular disease in type 2 diabetes: The Fremantle Diabetes Study. J Clin Endocrinol Metab. 2017. https://doi.org/10.1210/jc.2017-00354

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    2017-07-19 achengzhao
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    2017-11-03 jklm09
  4. 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encodeId=60302093e103, content=学习啦,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLK1wzJZRTON4gxYUibhUyOypBwMibC4R7SsppicGhz5Ogoy0VVq4CWnqaD2Moeib8RWxI5lOiaVmnxpan/0, createdBy=c53f1730331, createdName=tanxingdoctor, createdTime=Sun Jun 11 11:06:18 CST 2017, time=2017-06-11, status=1, ipAttribution=)]
    2017-07-31 smallant2015
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encodeId=60302093e103, content=学习啦,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLK1wzJZRTON4gxYUibhUyOypBwMibC4R7SsppicGhz5Ogoy0VVq4CWnqaD2Moeib8RWxI5lOiaVmnxpan/0, createdBy=c53f1730331, createdName=tanxingdoctor, createdTime=Sun Jun 11 11:06:18 CST 2017, time=2017-06-11, status=1, ipAttribution=)]
    2017-06-13 往日如昨

    学习了谢谢分享

    0

  6. 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encodeId=60302093e103, content=学习啦,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLK1wzJZRTON4gxYUibhUyOypBwMibC4R7SsppicGhz5Ogoy0VVq4CWnqaD2Moeib8RWxI5lOiaVmnxpan/0, createdBy=c53f1730331, createdName=tanxingdoctor, createdTime=Sun Jun 11 11:06:18 CST 2017, time=2017-06-11, status=1, ipAttribution=)]
    2017-06-12 圣艮山

    学习了不少事情!

    0

  7. 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    2017-06-11 tanxingdoctor

    学习啦,谢谢分享

    0

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即将到来的重大研究可能提供对尿路感染额外的重要见解,并且需要更多的努力以解决每个服用SGLT2抑制剂的个体对感染的比较效应。

JCEM:DSST评分可提示糖尿病患者心血管疾病风险!

科学家经过研究已经发现糖尿病患者中患心血管疾病和认知功能障碍的风险增加。而近日发表在JCEM上的一篇事后流行病学分析研究对于CVD和认知功能的评分进行了深入研究,这项名为ACCORD-MIND的研究旨在调查2型糖尿病患者中认知功能的简单测量评分与CVD事件的发生和死亡率之间关联。以下是对这项研究的简单介绍。

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