高血压患者晚期经常出现心脑肾等靶器官损害,微量蛋白尿(MAU)是靶器官损害危险因素,可用有效措施预防和逆转高血压患者MAU的出现。MAU被认为与高血压、糖尿病患者的肾损害有关,可以预测这些患者的心血管事件。大量的临床研究数据显示降低MAU可以减少心血管事件,未来的研究应更多地关注如何发现更加有效的手段来预防高血压患者MAU及心血管事件的发生。
《国际循环》:目前有证据显示,在高血压和糖尿病患者,微量白蛋白尿能够预测血管疾病的发生。这方面有哪些研究?早期预防高血压患者发生微量白蛋白尿的关键是什么?您刚才提到了控制体重和限盐,除此之外还有其他措施吗?
<International Circulation>: We now have some evidence that MAU predicts the occurrence of vascular disease in some of these particular patients with hypertention and diabetes and etcetera. So what are the real related studies and the key point of early prevention of the condition in hypertension patients? You mentioned just the weight loss and salt reduction or are there other measures that maybe we can take?
Ritz教授:我认为,我刚才提到的那些措施就是预防MAU的主要手段。有人可能会将基于社区的干预措施和针对患者个体的干预手段(即药物治疗)区分开来。就基于社区的干预来讲,我们目前面临着三大挑战。第一是高盐饮食。已经有强有力的证据显示,目前我们的盐摄入量是危险的。《新英格兰医学杂志》最近刊发的一篇文章证实,高盐饮食与心血管疾病和死亡相关。当然,肾脏也同等重要。第二个挑战是肥胖。不过谈到肥胖的话,有一个问题需要我们特别关注。我个人认为,需要就食品中的果糖添加量立法。研究证实,果糖对肾功能的损害是多方面的,我想以果糖作为食品添加剂是完全没有必要的。当然,果糖价格低廉,颇受食品加工商青睐,但是应当大幅减少果糖的使用。如果可能的话,用葡萄糖完全替代果糖。
Prof. Ritz: I think that what I mentioned is the core of the prevention. One should perhaps differentiate between community based interventions on the one hand and individual interventions on the other hand – medication. But as far as community based interventions are concerned I think currently the three most challenging points are number 1 - high salt. There is extremely good evidence that current salt intake is injurious and there has been a recent paper in the New England Journal that they pointed out the cardiac and mortality aspect. The renal is certainly equally important. The second is obesity but I think if we talk about obesity there is one specific factor that must be addressed separately and from my perspective legislation is necessary and that is fructose content. Fructose has been shown to be injurious to various functions of the kidney and I think it is quite unnecessary as an additive. It is of course cheap and therefore favored by the food industry but this should be reduced dramatically and if possible substituted for by glucose.