<International Circulation>:  In nephrotic syndrome secondary to diabetes when blood glucose and blood pressure are all under good control  but the level of proteinuria still remains high will the use of hormone therapy be advisable and if so what is the best way to go about this avenue?

 《国际循环》：若肾病综合征及糖尿病患者的血糖和血压得到有效控制，但尿蛋白浓度仍很高时，采用激素疗法是可行的。那么这种状态下最佳治疗方法是什么？

    Prof Juliana Chan: Usually， for patients with diabetic proteinuria aggressive control of blood pressure and blood glucose is still the main treatment directive particularly for those who do not have CVD. This is because these are the two main driving forces downstream of this condition. Lipid levels are also very important but randomized controlled studies are not yet available but there are a lot of observational studies telling us that the use of statins might reduce lipotoxicity and protect the kidney. In addition， the use of drugs that target the renin angiotensin pathway such as ACE inhibitors and ARBs will also be very important. Certainly， there is emerging evidence that dual blockade in people with moderate renal impairment may also be useful by reducing proteinuria， slowing the rate of decline in renal function and may also provide CV protection.

    Chan教授：对于糖尿病合并蛋白尿且无心血管疾病的患者来说，控制血糖和血压仍是最主要的治疗措施。之所以选择这种治疗措施主要是因2个主要驱动力。此外血脂水平也是很重要的指标，随机对照试验的研究结果尚未公布，但大量临床观察研究表明使用他汀类药物可以减少脂毒性并保护肾脏。此外，使用针对肾素-血管紧张素途径的药物如ACE抑制剂和ARBs同样也很重要。当然，现在有新的证据表明对中度肾功能衰竭患者施行双重封锁治疗可以有效地降低尿蛋白，延缓肾功能衰竭的速度，也可以保护心血管系统。

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