2型糖尿病肾病患者肾功能的自然病程。

Natural course of kidney function in Type 2 diabetic patients with diabetic nephropathy.

作者信息

Christensen P K, Rossing P, Nielsen F S, Parving H H

机构信息

Steno Diabetes Center, Gentofte, Denmark.

出版信息

Diabet Med. 1999 May;16(5):388-94. doi: 10.1046/j.1464-5491.1999.00063.x.

DOI:10.1046/j.1464-5491.1999.00063.x

PMID:10342338

Abstract

AIMS

To determine the natural course of kidney function and to evaluate the impact of putative progression promoters in Caucasian Type 2 diabetes mellitus (DM) patients with diabetic nephropathy who had never received any antihypertensive treatment.

METHODS

A long-term observational study of 13 normotensive to borderline hypertensive Type 2 DM patients with diabetic nephropathy. Glomerular filtration rate (GFR) was measured approximately every year (51Cr-EDTA plasma clearance technique). Albuminuria, blood pressure (BP) and haemoglobin A1c (HbA1c) was determined 2-4 times per year and serum cholesterol every second year.

RESULTS

The patients (12 males/one female), age 56+/-9 (mean +/- SD) years, with a known duration of diabetes of 10+/-6 years, were followed for 55 (24-105) (median (range)) months. GFR decreased from 104 (50-126) to 80 (39-112) ml x min(-1) x 1.73 m(-2) (P = 0.002) with a median rate of decline of 4.5 (-0.4 to 12) ml x min(-1) x year(-1). During follow-up, albuminuria rose from 494 (301-1868) to 908 (108-2169) mg/24 h (P = 0.25), while BP, HbA1c and serum cholesterol remained essentially unchanged. In univariate analysis the rate of decline in GFR did not correlate significantly with neither baseline nor mean values during follow-up of BP, albuminuria, HbA1c and serum cholesterol.

CONCLUSIONS

Our study suggests that normotensive to borderline hypertensive Type 2 DM patients with diabetic nephropathy have a rather slow decline in kidney function, but we did not unravel the putative progression promoters responsible for the variation in rate of decline in GFR.

摘要

目的

确定肾功能的自然病程，并评估从未接受过任何抗高血压治疗的白种人2型糖尿病（DM）合并糖尿病肾病患者中假定的病情进展促进因素的影响。

方法

对13例血压正常至临界高血压的2型糖尿病肾病患者进行长期观察性研究。每年（采用51Cr-EDTA血浆清除技术）测量一次肾小球滤过率（GFR）。每年测定2 - 4次蛋白尿、血压（BP）和糖化血红蛋白（HbA1c），每两年测定一次血清胆固醇。

结果

患者（12例男性/1例女性），年龄56±9（均值±标准差）岁，已知糖尿病病程10±6年，随访55（24 - 105）（中位数（范围））个月。GFR从104（50 - 126）降至80（39 - 112）ml·min-1·1.73 m-2（P = 0.002），中位下降速率为4.5（-0.4至12）ml·min-1·年-1。随访期间，蛋白尿从494（301 - 1868）升至908（108 - 2169）mg/24 h（P = 0.25），而血压、HbA1c和血清胆固醇基本保持不变。单因素分析显示，GFR下降速率与随访期间血压、蛋白尿、HbA1c和血清胆固醇的基线值及均值均无显著相关性。