Wirta O, Pasternack A, Mustonen J, Laippala P, Lähde Y
Department of Medicine, Tampere University Hospital, University of Tampere, Finland.
Clin Nephrol. 1999 Jun;51(6):329-34.
AIM, SUBJECTS AND METHODS: To evaluate whether microalbuminuria is related to retinopathy in type 2 diabetes, we studied a sample of 125 known diabetic subjects with a mean disease duration of 11 years (range 5-22 years), aged 46-71 years, by ophthalmoscopy, fundus photography and fluoresceine angiography. Urinary albumin excretion rate (UAER) was measured by nephelometry and the fractional clearance of albumin, i.e. in relation to creatinine was calculated from spot samples. The subjects were classified into groups based on the UAER/24 h.
Microalbuminuria was present if UAER was 30-300 mg/24 h and overt nephropathy when UAER > or = 300 mg/24 h. Background (> or = 2 microaneurysms or > or = 2 hemorrhages or > or = 1 more advanced lesions, except proliferative changes) and proliferative retinopathies were found in 21% and in 3%, respectively. Subjects with microalbuminuria (p = 0.026) and overt nephropathy (p = 0.002) had more frequently background retinopathy than their counterparts with a normal UAER (chi2-test). A multivariate logistic regression model was obtained for background retinopathy (chi2 = 37.5, p = 0.0000039, OR 14.9, correct prediction of negative outcome in 97% and of positive outcome in 30.4%) including the following variables. The fractional clearance of albumin independently explained background retinopathy (OR 3.9, 95% CI 1.3-12, p = 0.028). Insulin therapy (p = 0.0017), diabetes duration (p = 0.048), blood glucose at 2 h in standard oral glucose tolerance test (p = 0.009) and low fasting serum HDL cholesterol (p = 0.023) also independently explained retinopathy. Age, gender, BMI, systolic blood pressure, ACE inhibitor therapy, fasting serum total cholesterol and triglyceride, blood glucose or insulin, hemoglobin A1c, glucagon-stimulated C peptide response, glomerular filtration rate or smoking habits did not independently explain retinopathy.
We conclude that microalbuminuria is related to background retinopathy in type 2 diabetes.
目的、研究对象与方法：为评估微量白蛋白尿是否与2型糖尿病视网膜病变相关，我们对125例已知糖尿病患者进行了研究，这些患者平均病程为11年（范围5 - 22年），年龄46 - 71岁，采用检眼镜检查、眼底摄影和荧光素血管造影术。通过散射比浊法测量尿白蛋白排泄率（UAER），并根据即时样本计算白蛋白与肌酐的清除分数。根据UAER/24小时将受试者分组。
若UAER为30 - 300mg/24小时则存在微量白蛋白尿，若UAER≥300mg/24小时则为显性肾病。分别在21%和3%的患者中发现了背景性（≥2个微动脉瘤或≥2处出血或≥1处更晚期病变，不包括增殖性改变）和增殖性视网膜病变。微量白蛋白尿患者（p = 0.026）和显性肾病患者（p = 0.002）比UAER正常的患者更常出现背景性视网膜病变（卡方检验）。建立了一个关于背景性视网膜病变的多因素逻辑回归模型（卡方 = 37.5，p = 0.0000039，OR 14.9，阴性结果正确预测率为97%，阳性结果正确预测率为30.4%），包括以下变量。白蛋白清除分数独立解释背景性视网膜病变（OR 3.9，95%CI 1.3 - 12，p = 0.028）。胰岛素治疗（p = 0.0017）、糖尿病病程（p = 0.048）、标准口服葡萄糖耐量试验2小时血糖（p = 0.009）和空腹血清高密度脂蛋白胆固醇水平低（p = 0.023）也独立解释视网膜病变。年龄、性别、BMI、收缩压、ACE抑制剂治疗、空腹血清总胆固醇和甘油三酯、血糖或胰岛素、糖化血红蛋白、胰高血糖素刺激的C肽反应、肾小球滤过率或吸烟习惯不能独立解释视网膜病变。
我们得出结论，微量白蛋白尿与2型糖尿病的背景性视网膜病变相关。
