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强化降糖真的能减少微血管并发症吗?

2016-03-04 郭艺芳 郭艺芳教授微博

国内外指南均称强化降糖能够显着降低糖尿病患者微血管并发症发生率,并将其作为强化血糖控制的重要依据。但深入分析现有研究证据,可以发现强化降糖所带来的微血管获益并非人们所想象的那样显着。 UKPDS研究 在UKPDS研究中(Lancet1999,354:602),强化降糖组微血管事件发生率降低25%(p=0.0099),但这一降低主要是由视网膜光凝治疗的减少所致的,强化降糖组玻璃体出血(p=0.5

国内外指南均称强化降糖能够显着降低糖尿病患者微血管并发症发生率,并将其作为强化血糖控制的重要依据。但深入分析现有研究证据,可以发现强化降糖所带来的微血管获益并非人们所想象的那样显着。

UKPDS研究

在UKPDS研究中(Lancet1999,354:602),强化降糖组微血管事件发生率降低25%(p=0.0099),但这一降低主要是由视网膜光凝治疗的减少所致的,强化降糖组玻璃体出血(p=0.51)、致盲(p=0.39)、肾衰(p=0.45)、肾脏性死亡(p=0.53)等严重微血管并发症均未减少。

ADVANCE研究

在ADVANCE研究中(NEJM2008,358:2560),强化降糖组大量蛋白尿发生率降低(p<0.001),但肾脏替代治疗或肾脏性死亡无显着降低(p=0.09),肌酐水平倍增也无减少(p=0.42),视力恶化无减少。

VADT研究

在VADT研究中(NEJM2009,360:129),除尿蛋白排泄量减少外,强化降糖组患者白内障手术、光凝治疗、玻璃体切除、视网膜病变、肌酐倍增、终末期肾病等微血管并发症均无减少。

ACCORD研究

在ACCORD研究中(LANCET2010,376:419),至研究终止时,强化降糖组患者微量蛋白尿发生率无降低,大量蛋白尿发生率显着降低,两组间肾衰发生率相似(p=0.713)。强化降糖组糖尿病眼病发生率较标准降糖组降低6%(p=0.05),白内障摘除术减少11%(p=0.026),其他糖尿病眼病发生率无显着差异。

28065例入组的大型荟萃分析

一项纳入28065例患者的大型荟萃分析显示(ArchIntern Med2012,172:761),强化降糖仅能降低微量或大量蛋白尿发生率,但肌酐水平倍增、终末期肾病以及肾脏性死亡等严重微血管并发症发生率并未减少。

强化降糖真的能减少微血管并发症吗?

心脑血管并发症是糖尿病患者致死致残的主要原因,但迄今为止,我们尚不能通过降低血糖水平减少这些并发症的发生。

糖尿病肾病与糖尿病眼病也是常见并发症,对患者生活质量产生显着的不利影响。但由上述分析可见:强化降糖预防微血管并发症的作用也非常有限。

在叙述降糖治疗与大血管或微血管获益之间关系时,应该尊重现有研究证据,客观描述,不宜过分夸大强化降糖所带来的临床获益。

来源:@郭艺芳微博授权转载

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    2016-09-01 丁鹏鹏
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    2016-03-26 白兔糖

    真的吗

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1740207, encodeId=cfef1e4020716, content=<a href='/topic/show?id=9fa950e84cb' target=_blank style='color:#2F92EE;'>#微血管并发症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50784, encryptionId=9fa950e84cb, topicName=微血管并发症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=455434680785, createdName=ms8888626721583891, createdTime=Mon Aug 08 01:37:00 CST 2016, time=2016-08-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2003845, encodeId=d44f200384529, content=<a href='/topic/show?id=4d8650150ce' target=_blank style='color:#2F92EE;'>#强化降糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50150, encryptionId=4d8650150ce, topicName=强化降糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3547346, createdName=dongjia2010, createdTime=Wed Dec 14 03:37:00 CST 2016, time=2016-12-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1757697, encodeId=0b651e57697eb, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Thu Sep 01 14:37:00 CST 2016, time=2016-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73904, encodeId=38a3e390468, content=真的吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=158, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f28c1704850, createdName=白兔糖, createdTime=Sat Mar 26 19:41:00 CST 2016, time=2016-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1365293, encodeId=7cf61365293a1, content=<a href='/topic/show?id=2a2150e76fd' target=_blank style='color:#2F92EE;'>#微血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50776, encryptionId=2a2150e76fd, topicName=微血管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=669d219, createdName=mgqwxj, createdTime=Sun Mar 06 00:37:00 CST 2016, time=2016-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1545341, encodeId=d25915453418a, content=<a href='/topic/show?id=a803896303f' target=_blank style='color:#2F92EE;'>#血管并发症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89630, encryptionId=a803896303f, topicName=血管并发症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b67913724176, createdName=ms3892185887221420, createdTime=Sun Mar 06 00:37:00 CST 2016, time=2016-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=67354, encodeId=babe6e35429, content=继续研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=168, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sat Mar 05 16:06:00 CST 2016, time=2016-03-05, status=1, ipAttribution=)]
    2016-03-06 mgqwxj
  6. [GetPortalCommentsPageByObjectIdResponse(id=1740207, encodeId=cfef1e4020716, content=<a href='/topic/show?id=9fa950e84cb' target=_blank style='color:#2F92EE;'>#微血管并发症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50784, encryptionId=9fa950e84cb, topicName=微血管并发症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=455434680785, createdName=ms8888626721583891, createdTime=Mon Aug 08 01:37:00 CST 2016, time=2016-08-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2003845, encodeId=d44f200384529, content=<a href='/topic/show?id=4d8650150ce' target=_blank style='color:#2F92EE;'>#强化降糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50150, encryptionId=4d8650150ce, topicName=强化降糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3547346, createdName=dongjia2010, createdTime=Wed Dec 14 03:37:00 CST 2016, time=2016-12-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1757697, encodeId=0b651e57697eb, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Thu Sep 01 14:37:00 CST 2016, time=2016-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73904, encodeId=38a3e390468, content=真的吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=158, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f28c1704850, createdName=白兔糖, createdTime=Sat Mar 26 19:41:00 CST 2016, time=2016-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1365293, encodeId=7cf61365293a1, content=<a href='/topic/show?id=2a2150e76fd' target=_blank style='color:#2F92EE;'>#微血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50776, encryptionId=2a2150e76fd, topicName=微血管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=669d219, createdName=mgqwxj, createdTime=Sun Mar 06 00:37:00 CST 2016, time=2016-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1545341, encodeId=d25915453418a, content=<a href='/topic/show?id=a803896303f' target=_blank style='color:#2F92EE;'>#血管并发症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89630, encryptionId=a803896303f, topicName=血管并发症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b67913724176, createdName=ms3892185887221420, createdTime=Sun Mar 06 00:37:00 CST 2016, time=2016-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=67354, encodeId=babe6e35429, content=继续研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=168, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sat Mar 05 16:06:00 CST 2016, time=2016-03-05, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1740207, encodeId=cfef1e4020716, content=<a href='/topic/show?id=9fa950e84cb' target=_blank style='color:#2F92EE;'>#微血管并发症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50784, encryptionId=9fa950e84cb, topicName=微血管并发症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=455434680785, createdName=ms8888626721583891, createdTime=Mon Aug 08 01:37:00 CST 2016, time=2016-08-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2003845, encodeId=d44f200384529, content=<a href='/topic/show?id=4d8650150ce' target=_blank style='color:#2F92EE;'>#强化降糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50150, encryptionId=4d8650150ce, topicName=强化降糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3547346, createdName=dongjia2010, createdTime=Wed Dec 14 03:37:00 CST 2016, time=2016-12-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1757697, encodeId=0b651e57697eb, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Thu Sep 01 14:37:00 CST 2016, time=2016-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73904, encodeId=38a3e390468, content=真的吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=158, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f28c1704850, createdName=白兔糖, createdTime=Sat Mar 26 19:41:00 CST 2016, time=2016-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1365293, encodeId=7cf61365293a1, content=<a href='/topic/show?id=2a2150e76fd' target=_blank style='color:#2F92EE;'>#微血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50776, encryptionId=2a2150e76fd, topicName=微血管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=669d219, createdName=mgqwxj, createdTime=Sun Mar 06 00:37:00 CST 2016, time=2016-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1545341, encodeId=d25915453418a, content=<a href='/topic/show?id=a803896303f' target=_blank style='color:#2F92EE;'>#血管并发症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89630, encryptionId=a803896303f, topicName=血管并发症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b67913724176, createdName=ms3892185887221420, createdTime=Sun Mar 06 00:37:00 CST 2016, time=2016-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=67354, encodeId=babe6e35429, content=继续研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=168, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sat Mar 05 16:06:00 CST 2016, time=2016-03-05, status=1, ipAttribution=)]
    2016-03-05 忠诚向上

    继续研究

    0

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