目的：分析小儿紫癜性肾炎的临床特点。方法：回顾分析两院儿科最近8年收治的小儿紫癜性肾炎180例的临床表现、实验室检查结果，治疗和预后等方面的资料。结果(1)临床以血尿蛋白尿型最多见(61/180)，其次为急性肾炎型(36/180)、肾病综合征型(31/180)和单纯血尿或蛋白尿型(25/180)。(2)重症病儿短期使用激素可改善肾脏损害。(3)所有病例均有必要长期随访。结论：小儿紫癜性肾炎绝大多数预后良好，但病情反复不愈者可发展为终末期肾脏损害，故需要长期随访。
Objective To formulate an evidence-based treatment plan for a patient with type 2 diabetes and microalbuminuria. Methods According to the patient’s clinical conditions, we put forward 5 clinical problems. We searched the Cochrane Library (Issue 4, 2005), ACP Journal Club (1991 to 2005), and MEDLINE (1991 to 2005) databases. Systematic review, meta-analysis and randomized controlled trials about the treatment of diabetic nephropathy were included. The treatment plan was developed accordingly. Results Thirteen eligible studies were included. Evidence indicated that an intensive intervention aimed at the multiple potential risk factors could be applied to delay or prevent the progression of diabetic nephropathy, which included intensive blood glucose control, tight blood-pressure control, lipid modulation, restriction of protein intake and smoking cessation. The individualized treatment plan was based on the high quality evidence as well as the patient’s specific condition. The patient is still being followed-up. Conclusion Interventions for risk factors of type 2 diabetes like changing living style, decreasing serum glucose, blood pressure, and level of blood fat help to release the clinical symptom and better the long-term living quality of patients.
目的:探讨老年原发性高血压(EH)患者早期肾损害指标微量白蛋白尿(MAU)和动脉粥样硬化的早期征象颈动脉内中膜厚度(C-IMT)之间的关系。方法:99名老年EH患者按尿白蛋白/肌酐比值(ACR)分为异常ACR组和正常ACR组,对两组的C-IMT、斑块发生率、ACR水平及血中尿素氮(Bun)、肌酐(Cr)、总胆固醇(TC)、甘油三酯(TG)、血糖(Glu)、体重指数(BMI)等进行分析和比较。结果:异常ACR组的年龄、尿酸、ACR、C-IMT、24小时平均收缩压,平均动脉压及脉压均高于正常ACR组(Plt;0.05);且C-IMT与ACR水平呈正相关(Plt;0.05)。结论:微量白蛋白尿和颈动脉IMT密切相关,提示微量白蛋白尿不仅和老年高血压肾脏病变有关,也是亚临床期动脉粥样硬化的早期标志.
Objective To search evidence of angiotensin-converting-enzyme inhibitors for microalbumin-uria in type 2 diabetes for guiding clinical practice. Methods We searched MEDLINE （ 1970 -Jun. 2005 ） to identify randomized controlled trials （RCT）of the effect on angiotensin-converting-enzyme inhibitors to prevent microalbuminuria in type 2 diabetes. Results One RCT （n =1 204）was identified. The result showed that angiotensin-converting-enzyme inhibitors were significantly more effective in prevention of microalbuminuria than other medicines in type 2 diabetes. However, angiotensin-converting-enzyme inhibitors may increase the risk of cardiac mortality. We explained the evidence to patients and they were satisfied with our explanation. Conclusions Angiotensin-converting-enzyme inhibitors can decrease the incidence of microalbuminuria in patients with type 2 diabetes and hypertension.