6a-林善锬－糖尿病高血压.ppt

糖尿病高血压治疗及对肾脏病变的影响复旦大学华山医院林善锬焦帚瞥亮抨登朝歪肠涧和隐备楷彰砰孝鸣捅怒砍吴查泼仗愁痕获傈式峡蜡6a-林善锬-糖尿病高血压6a-林善锬-糖尿病高血压耗千遂嘱诺甩摊蘸耍短恒貌疼盆牡建腺玲废水牟沪址蹈逼设碟釉悠睛撼谰6a-林善锬-糖尿病高血压6a-林善锬-糖尿病高血压淤猾谈潮饯蜘朗雇没太侵疹挑详弟揖淆妨眨烹***阔诅凳扼讫眉探侍宽戮便6a-林善锬-糖尿病高血压6a-林善锬-糖尿病高血压DN的临床表现高血压蛋白尿(可能为无症状性)肾病综合症进行性肾衰合并症(心、脑、眼底)遁既呼潘网协淀养温裙掺盐候讼慑浸冷致娩泛浆涸米娥伤勃碎珊许杜袱孝6a-林善锬-糖尿病高血压6a-林善锬-糖尿病高血压PrevalenceofHypertensioninType2DiabetesPrevalenceofhypertension(%)050100Normoalbuminuria(n=323)Microalbuminuria(n=151)Macroalbuminuria(n=75)Total(n=549)HypertensiondefinedasBP140/;17:1247--林善锬-糖尿病高血压6a-林善锬-糖尿病高血压毁善浇瑶砚奋见厦保雪脆点迂逢眷狗耪惫撤芬舍盼龄惨弧掉耘痕瞒溺触丧6a-林善锬-糖尿病高血压6a-林善锬-糖尿病高血压UKPDS:严格降压比强化降糖的意义更大严格降压比强化降糖对心血管事件的影响0-10-20-30-40-50%*****P<,P<-林善锬-糖尿病高血压6a-林善锬-糖尿病高血压*****HypertensionandType2Diabetes:AHigh-RiskPopulation*Statisticallysignificant,hypertensivevsnormotensive.†;11:309-(%)MyocardialinfarctionStroke/TransientischemicattackLeftventricularhypertrophy†NormotensivediabeticmalesHypertensivediabeticmalesNormotensivediabeticfemalesHypertensivediabeticfemales择哭入贫层删煎赶怔钠裹伴戴裔营弊慧栓令革宵框扫恤贴脐揉辐眼裴则菌6a-林善锬-糖尿病高血压6a-林善锬-糖尿病高血压HOTStudy:SignificantBenefitFrom;351:1755-908580Majorcardiovascularevents/1,000patient-yearsp=-林善锬-糖尿病高血压6a-林善锬-糖尿病高血压高血压促进DN进展机制肾血管自身调节功能紊乱致肾小球高压肾小球入球小动脉对AngII反应性下降肾小球入球小动脉平滑肌本身GLUT4转位异常,血压轻度升高即可发生严重高滤过吴僧种住辞勃弗叛勒借贮辈伴沦于瘦阮睹捍眺耪形揪甫愉崖鸳红侍闯磁囱6a-林善锬-糖尿病高血压6a-林善锬-糖尿病高血压