2026 年第 7 期 第 21 卷

共病危险因素指标联合控制阻遏老年糖尿病患者肾功能恶化1例8年随访报道

Combined control of comorbidity risk factors to halt renal function deterioration in elderly diabetic patients: a case 8-year follow-up report

作者：雷欢程果周迎生

英文作者：Lei Huan Cheng Guo Zhou Yingsheng

单位：首都医科大学附属北京安贞医院内分泌代谢科，北京100029

英文单位：Department of Endocrinology and Metabolism Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：2型糖尿病；共病；糖尿病肾病

英文关键词：Type2diabetesmellitus;Comorbidity;Diabeticnephropathy

• 摘要：

• 本文报道1例老年2型糖尿病肾病患者的8年随访治疗观察结果。该患者首诊时已诊断糖尿病肾病［慢性肾脏病（CKD）分期3a期和A2期］，合并高血压、血脂异常、高尿酸血症及肥胖症。降糖药物初始为胰岛素联合二肽基肽酶4抑制剂控制血糖，后续调整为钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）卡格列净；降压药调整为血管紧张素转换酶抑制剂（ACEI）培哚普利联合钙通道阻滞剂（CCB）硝苯地平控释片；降脂药调整为阿托伐他汀联合依折麦布；降低血尿酸使用别嘌醇。根据中国2型糖尿病防治指南等建议，该患者综合控制目标为糖化血红蛋白（HbA1c）＜7.5%、血压＜130/80 mmHg（1 mmHg=0.133 kPa）、低密度脂蛋白胆固醇（LDL-C）＜1.8 mmol/L，阻遏肾功能恶化。该患者在2018—2025年的连续8年随访治疗观察中，病情指标显著改善：HbA1c从9.2%降到7.9%，血压从140/80 mmHg降到131/73 mmHg，LDL-C从2.7 mmol/L降到1.4 mmol/L，血尿酸转归正常，尿白蛋白/肌酐比值从33.2 mg/g降至14.4 mg/g，CKD由A2期改善至A1期。该患者近3年的估算肾小球滤过率（eGFR）稳定在37.1～38.8 ml/（min·1.73 m2），2025年为38.0 ml/（min·1.73 m2）。8年期间的eGFR仅减少16.7 ml/（min·1.73 m2），平均每年仅下降2.1 ml/（min·1.73 m2），表明肾功能恶化被显著阻遏。本例患者综合治疗控制方案基于降糖药SGLT2i、降压药“ACEI联合CCB”以及降脂药“他汀联合胆固醇吸收抑制剂”，显著改善了患者的HbA1c、血压以及LDL-C等多项指标，阻遏了糖尿病肾病的肾功能恶化。

• This article reports the 8-year follow-up and therapeutic observation of one elderly patient with type 2 diabetic nephropathy. The patient was diagnosed with diabetic nephropathy ［chronic kidney disease （CKD） stage G3a and A2］ at the initial visit, accompanied by hypertension, dyslipidemia, hyperuricemia and obesity. Insulin combined with dipeptidyl peptidase Ⅳ inhibitor was initially administered to control blood glucose, which was later adjusted to canagliflozin, a sodium-glucose cotransporter 2 inhibitor (SGLT2i); the antihypertensive regimen was adjusted to perindopril, an angiotensin-converting enzyme inhibitor (ACEI), combined with sustained-release nifedipine, a calcium channel blocker (CCB); lipid-lowering therapy was adjusted to atorvastatin combined with ezetimibe; allopurinol was used to reduce serum uric acid. In accordance with the recommendations of the Chinese guidelines for the prevention and treatment of type 2 diabetes mellitus, the comprehensive control targets for this patient were glycated hemoglobin (HbA1c) ＜7.5%, blood pressure ＜130/80 mmHg and low-density lipoprotein cholesterol (LDL-C) ＜1.8 mmol/L, so as to halt renal function deterioration. During the continuous 8-year follow-up treatment from 2018 to 2025, the patient′s disease indicators were significantly improved: HbA1c decreased from 9.2% to 7.9%, blood pressure dropped from 140/80 mmHg to 131/73 mmHg, LDL-C declined from 2.7 mmol/L to 1.4 mmol/L, serum uric acid returned to normal, and the urinary albumin/creatinine ratio fell from 33.2 mg/g to 14.4 mg/g, with the CKD stage improved from A2 to A1. The estimated glomerular filtration rate (eGFR) remained stable at 37.1-38.8 ml/(min·1.73 m2) in the recent 3 years, reaching 38.0 ml/(min·1.73 m2) in 2025. The eGFR only decreased by 16.7 ml/(min·1.73 m2) over the 8 years, with an average annual decline of merely 2.1 ml/(min·1.73 m2), indicating that renal function deterioration was markedly halted. The comprehensive therapeutic regimen of this patient based on SGLT2i for hypoglycemia, ACEI combined with CCB for hypertension, and statin combined with cholesterol absorption inhibitor for dyslipidemia significantly improved multiple indicators including HbA1c, blood pressure and LDL-C, and retarded the deterioration of renal function caused by diabetic nephropathy.