| <P style="BACKGROUND: white; LINE-HEIGHT: 16.5pt"><SPAN lang=EN-US style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: Arial"> 2010</SPAN><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; mso-bidi-font-family: Arial; mso-ascii-font-family: Arial; mso-hansi-font-family: Arial">年</SPAN><SPAN lang=EN-US style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: Arial">7</SPAN><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; mso-bidi-font-family: Arial; mso-ascii-font-family: Arial; mso-hansi-font-family: Arial">月</SPAN><SPAN lang=EN-US style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: Arial">29</SPAN><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; mso-bidi-font-family: Arial; mso-ascii-font-family: Arial; mso-hansi-font-family: Arial">日在线发表于《美国肾病学会临床杂志》上的一项研究表明，对于终末期肾病（</SPAN><SPAN lang=EN-US style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: Arial">ESRD</SPAN><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; mso-bidi-font-family: Arial; mso-ascii-font-family: Arial; mso-hansi-font-family: Arial">）的糖尿病患者，强化降低血红蛋白不能改善其生存率。研究者指出，应基于潜在获益与风险相平衡的原则，鼓励临床医生在此类患者中继续坚持血糖达标个体化这一治疗原则。</SPAN><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: Arial"> <SPAN lang=EN-US><?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p></SPAN></SPAN></P>
<P style="BACKGROUND: white; LINE-HEIGHT: 16.5pt"><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; mso-bidi-font-family: Arial; mso-ascii-font-family: Arial; mso-hansi-font-family: Arial"> 糖尿病合并</SPAN><SPAN lang=EN-US style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: Arial">ESRD</SPAN><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; mso-bidi-font-family: Arial; mso-ascii-font-family: Arial; mso-hansi-font-family: Arial">患者，强化降糖的获益与风险仍然未明。由于此类患者为数众多，且整体预后较差，强化降糖这一治疗手段仍有重要地位。最近关于糖化血红蛋白水平与慢性糖尿病肾病患者生存率的相关性的大型研究（应用不同的方法学），得出的结论相互矛盾。</SPAN><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: Arial"> <SPAN lang=EN-US><o:p></o:p></SPAN></SPAN></P>
<P style="BACKGROUND: white; LINE-HEIGHT: 16.5pt"><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; mso-bidi-font-family: Arial; mso-ascii-font-family: Arial; mso-hansi-font-family: Arial"> 为此研究者将既往进行的研究（没有发现相关性）进行补充，将随访期延长至</SPAN><SPAN lang=EN-US style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: Arial">3</SPAN><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; mso-bidi-font-family: Arial; mso-ascii-font-family: Arial; mso-hansi-font-family: Arial">年，并应用时间依赖性生存模型及可重复指标。所有</SPAN><SPAN lang=EN-US style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: Arial">24875</SPAN><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; mso-bidi-font-family: Arial; mso-ascii-font-family: Arial; mso-hansi-font-family: Arial">名患者中</SPAN><SPAN lang=EN-US style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: Arial">94.5%</SPAN><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; mso-bidi-font-family: Arial; mso-ascii-font-family: Arial; mso-hansi-font-family: Arial">的患者合并</SPAN><SPAN lang=EN-US style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: Arial">2</SPAN><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; mso-bidi-font-family: Arial; mso-ascii-font-family: Arial; mso-hansi-font-family: Arial">型糖尿病，对</SPAN><SPAN lang=EN-US style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: Arial">1</SPAN><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; mso-bidi-font-family: Arial; mso-ascii-font-family: Arial; mso-hansi-font-family: Arial">型糖尿病患者亚组进行附加分析。在基线时以及在</SPAN><SPAN lang=EN-US style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: Arial">3</SPAN><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; mso-bidi-font-family: Arial; mso-ascii-font-family: Arial; mso-hansi-font-family: Arial">年随访期间的每个季度进行一次分析。</SPAN><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: Arial"> <SPAN lang=EN-US><o:p></o:p></SPAN></SPAN></P>
<P style="BACKGROUND: white; LINE-HEIGHT: 16.5pt"><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; mso-bidi-font-family: Arial; mso-ascii-font-family: Arial; mso-hansi-font-family: Arial"> 经校正的标准与时间依赖性</SPAN><SPAN lang=EN-US style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: Arial">Cox</SPAN><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; mso-bidi-font-family: Arial; mso-ascii-font-family: Arial; mso-hansi-font-family: Arial">模型显示，只有极端的血糖水平才与生存率恶化相关。血清蛋白水平（一种蛋白营养状态标记物）对疗效无明显影响，事后分析中与随机血糖检测亦无趋势关联。在</SPAN><SPAN lang=EN-US style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: Arial">1</SPAN><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; mso-bidi-font-family: Arial; mso-ascii-font-family: Arial; mso-hansi-font-family: Arial">型糖尿病患者当中，糖化血红蛋白水平上限越高则生存风险越低。</SPAN><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: Arial"> <SPAN lang=EN-US><o:p></o:p></SPAN></SPAN></P>
<P style="BACKGROUND: white; LINE-HEIGHT: 16.5pt"><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; mso-bidi-font-family: Arial; mso-ascii-font-family: Arial; mso-hansi-font-family: Arial"> 极端血糖水平仅仅偶然与患者生存率降低相关，且相关性较弱。在缺乏随机对照试验的情况下，研究结果提示，对于那些形血液透析的糖尿病肾病患者，不能够基于降低死亡风险的考虑将强化降糖作为常规治疗手段。</SPAN><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: Arial"> <SPAN lang=EN-US><o:p></o:p></SPAN></SPAN></P><SPAN style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: 宋体; mso-bidi-font-family: Arial; mso-ascii-font-family: Arial; mso-hansi-font-family: Arial; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN; mso-bidi-language: AR-SA"> 原始摘要：</SPAN><SPAN lang=EN-US style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: Arial; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN; mso-bidi-language: AR-SA; mso-fareast-font-family: 宋体"><A href="http://cjasn.asnjournals.org/cgi/content/abstract/CJN.09301209v1?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=Mark+E.+Williams&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT" target=_blank>Glycemic Control and Extended Hemodialysis Survival in Patients with Diabetes Mellitus: Comparative Results of Traditional and Time-Dependent Cox Model Analyses</A></SPAN><SPAN lang=EN-US style="FONT-SIZE: 10.5pt; COLOR: #3e3e3e; FONT-FAMILY: Arial; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN; mso-bidi-language: AR-SA; mso-fareast-font-family: 宋体"> Clinical Journal of the American Society of Nephrology doi: 10.2215/CJN.09301209</SPAN> |
