Kazumi T, Hozumi T, Ishida Y, Ikeda Y, Kishi K, Hayakawa M, Yoshino G
Department of Medicine, Hyogo Rehabilitation Center Hospital, Kobe, Japan.
Diabetes Care. 1999 Jul;22(7):1176-80. doi: 10.2337/diacare.22.7.1176.
We studied whether increased urinary transferrin excretion rates (TERs) (urinary transferrin-to-urinary creatinine ratio > or = 107 micrograms/mmol, which is the sum of an average and 2 SDs in 431 healthy nondiabetic individuals) would predict the development of microalbuminuria (urinary albumin-to-urinary creatinine ratio > or = 2.8 mg/mmol) in patients with type 2 diabetes and normal urinary albumin excretion rates (AERs) (albumin-to-creatinine ratio < 2.8 mg/mmol). We also studied the influence of blood pressure, glycemic control, and serum levels of lipids and apolipoproteins on the later development of microalbuminuria.
In 77 diabetic patients with normal AER, AER and TER were measured at baseline and after 24 months of follow-up. Blood pressure, glycemic control, and serum levels of lipids and apolipoproteins were measured at 1- to 2-month intervals during the follow-up period.
Of the 16 patients who initially had increased TER, 5 (31%) developed microalbuminuria. In contrast, of the 61 who initially had normal TER, 4 (7%) developed microalbuminuria (P = 0.016). At baseline, no difference was found in age, sex, diabetes duration, diabetic medications, prevalence of hypertension, blood pressure, HbA1c levels, or serum lipid and apolipoprotein concentrations between the two group of patients with normal and increased TER. There was also no difference in duration of hypertension and prevalence of users of ACE inhibitors between two subgroups of hypertensive patients with normal and increased TER. During the 24 month follow-up period, those whose condition progressed to microalbuminuria had increased serum levels of triglycerides (1.87 +/- 0.49 vs. 1.29 +/- 0.64 mmol/l, P = 0.003) and apolipoprotein B (114 +/- 20 vs. 102 +/- 24 mg/dl, P = 0.05) and tended to have increased HbA1c levels (7.7 +/- 1.0 vs. 7.1 +/- 1.1%, P = 0.10) compared with those in whom microalbuminuria did not develop. Blood pressure, however, did not differ. In multivariate stepwise logistic regression analysis, the association between increased TER at baseline and subsequent development of microalbuminuria was significant (odds ratio 7.04 [95% CI 1.02-48.5], P = 0.04).
In patients with type 2 diabetes and normal AER, increased TER may predict the development of microalbuminuria and abnormalities in triglyceride-rich lipoprotein metabolism, and poor glycemic control may be associated with this progression.
我们研究了尿转铁蛋白排泄率（TERs）升高（尿转铁蛋白与尿肌酐比值≥107微克/毫摩尔，这是431名健康非糖尿病个体的平均值加2个标准差之和）是否能预测2型糖尿病且尿白蛋白排泄率（AERs）正常（白蛋白与肌酐比值<2.8毫克/毫摩尔）患者微量白蛋白尿（尿白蛋白与尿肌酐比值≥2.8毫克/毫摩尔）的发生。我们还研究了血压、血糖控制以及血脂和载脂蛋白水平对随后微量白蛋白尿发生的影响。
对77例AER正常的糖尿病患者，在基线和随访24个月后测量AER和TER。在随访期间，每隔1至2个月测量血压、血糖控制以及血脂和载脂蛋白水平。
最初TER升高的16例患者中，5例（31%）发生了微量白蛋白尿。相比之下，最初TER正常的61例患者中，4例（7%）发生了微量白蛋白尿（P = 0.016）。基线时，TER正常和升高的两组患者在年龄、性别、糖尿病病程、糖尿病用药、高血压患病率、血压、糖化血红蛋白水平或血脂及载脂蛋白浓度方面无差异。TER正常和升高的高血压患者亚组在高血压病程和使用血管紧张素转换酶抑制剂的患病率方面也无差异。在24个月的随访期内，病情进展为微量白蛋白尿的患者甘油三酯水平升高（1.87±0.49对1.29±0.64毫摩尔/升，P = 0.003）、载脂蛋白B升高（114±20对102±24毫克/分升，P = 0.05），糖化血红蛋白水平也有升高趋势（7.7±1.0对7.1±1.1%，P = 0.10），而血压无差异。在多变量逐步逻辑回归分析中，基线时TER升高与随后微量白蛋白尿的发生之间的关联具有显著性（优势比7.04[95%可信区间1.02 - 48.5]，P = 0.04）。
在2型糖尿病且AER正常的患者中，TER升高可能预测微量白蛋白尿的发生以及富含甘油三酯脂蛋白代谢异常，血糖控制不佳可能与这一进展相关。
