1型糖尿病正常白蛋白尿患者对心房利钠肽的白蛋白尿反应增强——一项初步研究。

Enhanced albuminuric response to atrial natriuretic peptide in normoalbuminuric patients with Type 1 diabetes mellitus--a pilot study.

作者信息

McKenna K, Smith D, Moore K, Glen A, Kesson C M, Thompson C J

机构信息

Diabetes Centre, Victoria Infirmary, Glasgow, Scotland, UK.

出版信息

Diabet Med. 2000 Jun;17(6):463-8. doi: 10.1046/j.1464-5491.2000.00303.x.

DOI:10.1046/j.1464-5491.2000.00303.x

PMID:10975216

Abstract

AIMS

To ascertain whether intravenous infusion of atrial natriuretic peptide (ANP) can induce microalbuminuria in patients with Type 1 diabetes mellitus (DM), as already demonstrated in patients with microalbuminuria, and to compare the albuminuric response to ANP infusion in Type 1 DM and a matched group of healthy non-diabetic controls.

METHODS

Eight normoalbuminuric DM patients participated in a three limb, randomized, double-blind, placebo-controlled study. Subjects were kept euglycaemic by insulin infusion, and subsequently water-loaded (20 ml/kg orally plus urinary losses). When in steady state, a 30-min infusion of either placebo, ANP 0.025 mg x kg(-1).min(-1) or ANP 0.05 mg x kg(-1) x min(-1) was administered intravenously. Urine was collected every 15 min for 90 min for the estimation of albumin-creatinine ratio (ACR). In addition, eight nondiabetic volunteers received a single infusion of ANP 0.025 mg x kg(-1) x min(-1).

RESULTS

ACR was unaltered by placebo in DM subjects (1.4 +/- 0.7-1.7 +/- 1.1 mg/mmol, mean +/- SD, ANOVA, P > 0.9), and by low dose ANP in controls (1.4 +/- 0.9-2.6 +/- 1.9 mg/mmol, P = 0.4). ACR increased with low dose ANP (1.3 +/- 0.5-14.6 +/- 13.6 mg/mmol, P = 0.02), and high dose ANP (1.3 +/- 0.7-26.4 +/- 31 mg/mmol, P = 0.01) in DM subjects. The ACR response to low dose ANP was greater in the DM than control subjects (P = 0.02).

CONCLUSIONS

ANP increases urine albumin excretion rate in normoalbuminuric Type 1 DM patients, and this effect is more pronounced than in healthy volunteers.

摘要

目的

确定静脉输注心房利钠肽（ANP）是否会像在微量白蛋白尿患者中已证实的那样，在1型糖尿病（DM）患者中诱发微量白蛋白尿，并比较1型糖尿病患者和一组匹配的健康非糖尿病对照者对ANP输注的白蛋白尿反应。

方法

8名正常白蛋白尿的糖尿病患者参与了一项三阶段、随机、双盲、安慰剂对照研究。通过胰岛素输注使受试者保持血糖正常，随后进行水负荷（口服20 ml/kg加尿排量）。当处于稳定状态时，静脉输注安慰剂、0.025 mg·kg⁻¹·min⁻¹的ANP或0.05 mg·kg⁻¹·min⁻¹的ANP 30分钟。每15分钟收集尿液90分钟，用于估算白蛋白-肌酐比值（ACR）。此外，8名非糖尿病志愿者接受了一次0.025 mg·kg⁻¹·min⁻¹的ANP输注。

结果

糖尿病受试者中安慰剂对ACR无影响（1.4±0.7 - 1.7±1.1 mg/mmol，均值±标准差，方差分析，P>0.9），对照组中低剂量ANP对ACR也无影响（1.4±0.9 - 2.6±1.9 mg/mmol，P = 0.4）。糖尿病受试者中低剂量ANP（1.3±0.5 - 14.6±13.6 mg/mmol，P = 0.02）和高剂量ANP（1.3±0.7 - 26.4±31 mg/mmol，P = 0.01）使ACR升高。糖尿病患者对低剂量ANP的ACR反应比对照组更显著（P = 0.02）。