糖尿病肾病治疗新策略——美国Vanderbilt大学医学中心Raymond Harris教授访谈

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糖尿病肾病治疗新策略
——美国Vanderbilt大学医学中心Raymond Harris教授访谈
来源：本站原创  作者：国际糖尿病   日期： 2008年5月10日
《国际糖尿病》：请问在糖尿病肾病的防止方面，目前有哪些研究进展？《国际糖尿病》：目前已经开展了很多关于糖尿病肾病的研究，请问您认为将来的研究将着眼何处？
《International Diabetes》：Are there any updated progressions in the field of the prevention and treatment of diabetic nephropathy?
《国际糖尿病》：请问在糖尿病肾病的防止方面，目前有哪些研究进展？
     Prof. Raymond Harris：To date, the most consistently successful approaches to prevent progression of diabetic nephropathy include control of diabetes, control of blood pressure and agents that target the renin-angiotensin system (ACE inhibitors and AT1 receptor blockers). Newer strategies currently being evaluated include: ①aggressive RAS blockade, including dual blockade with ACE inhibitors and ARBs or aldosterone inhibitors with ACEI or ARBS; ② the PDE4 inhibitor, pentoxifilline; ③ statins; ④PKC-beta inhibitors; and ⑤agents that target TGF-?. A recent trial evaluating the potential therapeutic effects of the glycosaminoglycan, sulodexide, did not indicate that this approach was effective in slowing progression of diabetic nephropathy.
    Raymond Harris教授：到目前为止，在成功预防糖尿病肾病方面，比较一致的策略包括控制糖尿病、控制血压及控制肾素-血管紧张素系统（如应用ACEI与ARB）。目前正在评价的较新的治疗手段包括：①对肾素血管紧张素系统进行积极、有力的阻滞，即应用ACE及AT1受体的双重拮抗剂，或将醛固酮抑制剂、ACEI、ARB联合应用；②PDE4抑制剂；③他汀类药物；④蛋白激酶C β抑制因子；5）以TGF-?为治疗靶点的药物。近期有一项评价葡萄糖胺聚糖、舒洛地希潜在疗效的研究，结果并未提示这一策略可以延缓糖尿病肾病的进展。
   《International Diabetes》：Though there are a lot of trials about diabetic nephropathy by now, they are still not enough. What do you think will be paid attention to in the future trials?
   《国际糖尿病》：目前已经开展了很多关于糖尿病肾病的研究，请问您认为将来的研究将着眼何处？

    Prof. Raymond Harris：Multicenter trials have provided good evidence indicating that control of blood sugar and blood pressure can have a significant impact on development of diabetic microvascular complications, including nephropathy. However, there is also evidence for a genetic component in the development of both diabetic and non-diabetic progressive nephropathy. The future goals will be not only to identify the genes involved but also to understand the interplay of genetic predisposition with environmental influences.
    Raymond Harris教授：多项多中心研究已经很好地证实，控制血糖、血压能显著影响糖尿病微血管并发症（包括糖尿病肾病）的发展。然而，也有证据显示，基因因素亦参与了糖尿病及非糖尿病性肾病的发展。将来的研究目标不仅要明确参与疾病发生、发展的基因，还要了解遗传易感性与环境因素对于疾病发生的相互作用。
(河北省秦皇岛市卢龙县医院  王仁友摘《国际糖尿病》***)

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