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«“√ “√ √“™∫— ≥±‘ µ¬ ∂“π ªï ∑’Ë ÛÒ ©∫— ∫∑’Ë Ú ‡¡.¬.-¡‘ .¬. ÚıÙ˘ π√‘ “ øŸ µ√–°Ÿ ≈ ·≈–§≥– 491 ‡æ’ ¬ßµ— «‡¥’ ¬« ·µà æ∫«à “°“√√— °…“∑’Ë ‰¥â º≈¥’ µâ Õߪ√–°Õ∫¥â «¬¬“ÕÕ°ƒ∑∏‘Ï ¢¬“¬À≈Õ¥‡≈◊ Õ¥À≈“¬µ— «√à «¡°— π (angiotensin converting enzyme inhibitor, angiotensin II receptor antagonist, calcium channel blocker ·≈–¬“µâ “π‡°≈Á ¥‡≈◊ Õ¥) ¢â Õ¡Ÿ ≈¥— ß °≈à “«Õ∏‘ ∫“¬∂÷ ߧ«“¡≈â ¡‡À≈«„π°“√ √— °…“∑—Ë «‰ª´÷Ë ß à «π„À≠à ‡°‘ ¥®“°°“√ „™â ¬“ÕÕ°ƒ∑∏‘Ï ¢¬“¬À≈Õ¥‡≈◊ Õ¥µ— « ‡¥’ ¬«‚¥¥ Ê ¡‘ Àπ”´È ”„π°“√√— °…“ ∑—Ë «‰ªµà ÕºŸâ ªÉ «¬‚√§‡∫“À«“π∑’Ë ‰¡à ‰¥â ¡’ §«“¡¥— π‚≈À‘ µ Ÿ ߺ‘ ¥ª√°µ‘ ºŸâ ªÉ «¬ ®–‰¡à ‰¥â √— ∫¬“ÕÕ°ƒ∑∏‘Ï ¢¬“¬À≈Õ¥ ‡≈◊ Õ¥‡≈¬ ´÷Ë ß‡ªì π°“√ªØ‘ ∫— µ‘ ∑’Ë ‰¡à ∂Ÿ ° µâ Õß ‡æ√“–ºŸâ ªÉ «¬‚√§‡∫“À«“π¥— ß °≈à “«·¡â ‰¡à ¡’ §«“¡¥— π‚≈À‘ µ Ÿ ߪ√“°Ø ·µà °“√»÷ °…“∑“ß‚≈À‘ µæ≈»“ µ√å ¢Õ߉µ æ∫§«“¡µâ “π∑“π∑’Ë À≈Õ¥ ‡≈◊ Õ¥®ÿ ≈¿“§„π‰µ Ÿ ߺ‘ ¥ª√°µ‘ À¡“¬ §«“¡«à “ ºŸâ ªÉ «¬‚√§‡∫“À«“π∑’Ë ·¡â ‰¡à ¡’ §«“¡¥— π‚≈À‘ µ Ÿ ß°Á ¬— ßµâ Õß°“√ ¬“ÕÕ°ƒ∑∏‘Ï ¢¬“¬À≈Õ¥‡≈◊ Õ¥‡æ◊Ë Õ §≈“¬°“√À¥√— ¥µ— «¢ÕßÀ≈Õ¥‡≈◊ Õ¥ ‚¥¬¡’ ‡ªÑ “À¡“¬‡æ◊Ë Õ‡æ‘Ë ¡ª√‘ ¡“≥ ‡≈◊ Õ¥À≈à Õ‡≈’È ¬ß à «π‡´≈≈å ∫ÿ ∑à Õ‰µ„Àâ ¥’ ¢÷È π º≈°“√»÷ °…“„πºŸâ ªÉ «¬‰µÕ— °- ‡ ∫®“°‡∫“À«“πæ∫«à “ °“√√— °…“ ¥â «¬¬“ÕÕ°ƒ∑∏‘Ï ¢¬“¬À≈Õ¥‡≈◊ Õ¥ À≈“¬µ— «√à «¡°— π ™à «¬‡æ‘Ë ¡ª√‘ ¡“≥ ‡≈◊ Õ¥À≈à Õ‡≈’È ¬ß‰µ à «π‡´≈≈å ∫ÿ ∑à Õ‰µ ª√‘ ¡“≥‡≈◊ Õ¥À≈à Õ‡≈’È ¬ß‰µ∑’Ë ‡æ‘Ë ¡¢÷È π Õ¥§≈â Õß°— ∫Õ— µ√“°√Õß “√¢Õ߉µ ∑’Ë ‡æ‘Ë ¡¢÷È π °“√√— °…“‚¥¬°≈¬ÿ ∑∏å ¥— ß °≈à “« “¡“√∂øóô πøŸ ¡√√∂¿“æ °“√∑”ß“π¢Õ߉µ‰¥â ¥’ ·≈–√«¥‡√Á « „π°≈ÿà ¡ºŸâ ªÉ «¬‰µÕ— °‡ ∫®“°‚ √§ ‡∫“À«“π∑’Ë ¬— ߉¡à ¡’ °“√√—Ë «¢Õ߉¢à ¢“« (normoalbuminuria) ˜ ”À√— ∫°≈ÿà ¡ ºŸâ ªÉ «¬‰µÕ— °‡ ∫®“°‚√§‡∫“À«“π ∑’Ë ¡’ °“√√—Ë «¢Õ߉¢à ¢“«·≈â «π—È π °“√ µÕ∫ πÕßµà Õ¬“∑’Ë √— °…“¡— °ª√“°Ø ™â “°«à “°≈ÿà ¡·√° ·µà °Á “¡“√∂™à «¬ øóô πøŸ ¡√√∂¿“æ¢Õ߉µ‰¥â ‡™à π°— π ¯ º≈°“√√— °…“¥— ß°≈à “«∑’Ë “¡“√∂øóô πøŸ ¡√√∂¿“æ¢Õ߉µ‰¥â π—È π ·µ°µà “ß ®“°º≈°“√√— °…“∑—Ë «‰ª∑’Ë ∑”‰¥â ‡æ’ ¬ß ·§à ™–≈Õ°“√‡ ◊Ë Õ¡¢Õ߉µ„À⠙⠓≈ß ‡∑à “π—È π ˘ ª√–°“»‡°’ ¬√µ‘ §ÿ ≥ ß“π«‘ ®— ¬π’È ‰¥â √— ∫‡ß‘ π∑ÿ π π— ∫- πÿ π®“° ”π— °ß“π°Õß∑ÿ π π— ∫ πÿ π °“√«‘ ®— ¬ ( °«.) ‡Õ° “√Õâ “ßÕ‘ ß 1. Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population : Third national health and nutrition examination survey. Am J Kidney Dis 2003; 41 : 1-13. 2. Futrakul N, Vongthavarawat V, Sirisalipotch S, Chairatanarat T, Futrakul P, Suwanwalaikorn S. Tubular dysfunction and hemo- dynamic alteration in normoal- buminuric type 2 diabetes. Clin Hemorheol Microcirc 2005; 32 : 59-65. 3. Futrakul P, Yenrudi S, Futrakul N, Sensirivatana R, Kingwatanakul P, Jungthirapanich J, et al. Tubular function and tubulointerstitial disease. Am J Kidney Dis 1999; 33 : 886-891. 4. Schofield I, Malik R, Izzard A, Austin C, Heagerty A. Vascular structural and functional changes in type 2 diabetes mellitus. Circulation 2002; 106 : 3037-3043. 5. Monnipa S, Boonyarathavej A, Futrakul N. (unpublished data). 6. Futrakul N, Yenrudi S, Sensirivatana R, Watana D, Laohapaibul A, Watanapenphaibul K, et al. Peri- tubular capillary flow determines tubulointerstitial disease in idiopathic nephrotic syndrome. Ren Fail 2000; 22 : 329-335. 7. Futrakul N, Butthep P. Early detec- tion of endothelial dysfunction and early therapeutic correction effec- tively restore renal function in type 2 diabetic nephropathy. Ren Fail 2005; 27 : 493, 494. 8. Futrakul N, Butthep P, Vongtha- varawat V, Futrakul P, Sarisalipoch S, Chavatanarat T, Suwanwalaikorn S. Early detection of endothelial injury and dysfunction in conjunction with correction of hemodynamic maladjustment can effectively restore renal function in type 2 diabetic nephropathy. Clin Hemorrheol Microcirc 2006; in press. 9. Amos AF, Mc Certy DJ, Zimmet P. The rising global burden of diabetes and its complications : Estimates and projections to the year 2010. Diabet Med 1997; 14 (suppl 5) : S1-S85.