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国内外均以MA作为诊断DN主要依据被普遍认同,不仅反映肾脏损害,也反应全身血管内皮损害,临床试验已证实。2007年KDOQI糖尿病肾病、ADA指南中均推荐ACR为筛查MA的首选方法。除MA、ACR、GFR、血肌酐等常用指标外,又提出尿液足细胞及nephfin检测、Tamm-Horsfall蛋白(THP)、铜兰蛋白(Cp)等,基因易感性成为近年研究热点,基因诊断未来可能成为DN早期诊断的重要指标。目前仍需寻找更敏感、稳定、准确的监测指标,最大限度排除内源性、外源性因素干扰,可采用多种指标联合检测如核素、彩色多普勒、肾穿刺病检辅助诊断以提高DN诊断率。中医诊断参照王永炎、吕仁和、赵进喜、仝小林的诊断标准,各医家均认为DN以本虚为主。王永炎详述本虚证;吕仁和、赵进喜围绕本虚丰富了标实证;仝小林细化兼证、变证,DN辨证是一次新飞跃,诸家对证型不断拓展,辨证分型既交叉渗透,又各有迥异,充分发挥辨证论治、整体观及三因制宜的中医特色。以本虚标实贯穿始终,具体辨证有异同。
Both MA and MA are widely accepted as the main basis for the diagnosis of DN, not only reflecting the renal damage, but also reflecting the systemic vascular endothelial damage. Clinical trials have confirmed this. 2007 KDOQI diabetic nephropathy, ADA guidelines are recommended ACR screening MA preferred method. Urine podocyte and nephfin assay, Tamm-Horsfall protein (THP) and corti-callan protein (Cp) have also been proposed in addition to the commonly used indexes such as MA, ACR, GFR and serum creatinine. Gene susceptibility has become a hot topic in recent years. The future may become an important indicator of early diagnosis of DN. At present, it is still necessary to find more sensitive, stable and accurate monitoring indicators, to maximize the exclusion of endogenous and exogenous factors, can be combined with a variety of indicators such as radionuclide, color Doppler, renal biopsy Improve the diagnostic rate of DN. Chinese medicine diagnosis reference Wangyong Yan, Lvrenhe, Zhao Jinxi, with the diagnostic criteria of Kobayashi, the doctors believe that DN to the main virtual. Wang Yanyan elaborates on the Benxu syndrome; Lv Renhe and Zhao Jinxi have enriched the standard evidences around the reality; with Xiaolin refinement and transformation, the transformation of syndromes and DN dialectics is a new leap forward. Various types of syndromes are continuously expanding. , But also different, give full play to syndrome differentiation and treatment, the overall concept and three different characteristics of traditional Chinese medicine. Consistent with this virtual standard throughout, the specific dialectical similarities and differences.