Molnár M, Wittmann I, Nagy J
Nephrological and Diabetes Centre, 2nd Department of Internal Medicine, Medical University Medical of Pécs, Hungary.
Med Sci Monit. 2000 Sep-Oct;6(5):929-36.
Contrary to the well-known features of diabetic nephropathy (DNP) in type-1 diabetic patients (pts), the prevalence, course and risk factors of DNP in in type-2 diabetic pts are not clear. The aim of the present study was to assess the prevalence of microalbuminuria (MA) and macroalbuminuria (MAA), their relationship with other diabetic complications and with some known cardiovascular risk factors in 200 in type-2 diabetic pts (100 females and 100 males). 68 pts (33%) were normalbuminuric (NA), 55 (27.5%) had MA and 77 (38.5%) had MAA. There was no significant difference among these three groups in age, BMI or the time actually elapsed since the diabetes and hypertension were diagnosed. BMI was high in each group (28.8 +/- 5.29, 28.0 +/- 5.2 and 29.8 +/- 4.6 kg/m2 mean +/- SD). 65% of pts with NA, 77% of those with MA and 81% of pts with MAA had hypertension. MAA pts were more frequently smokers and former smokers, than MA and NA pts (56% vs 32% and 22%). Average GRF values (ml/min/1.73 m2) were 71.9 +/- 26.8 in NA pts, 82.3 +/- 36.8 in MA pts and 56.3 +/- 32 in MAA pts. There was no significant correlation between the urinary albumin excretion (UAE) and glycemic control, serum (se) cholesterol and se HDL cholesterol. At the same time UAE showed a significant positive correlation with se trigliceride (P < 0.01), se uric acid (P < 0.01) and se creatinine (P < 0.01) while a significant negative correlation was found with GFR (P < 0.01). Diabetic non-proliferative retinopathy (RP) was detected even in NA pts (27%) while 51% of MAA pts were without RP. 56% of NA pts, 57% of MA pts and 93% of MAA pts had macroangiopathy.
(1) renal function can be impaired even in type-2 diabetic pts with NA and MA, (2) well-known cardiovascular risk factors seem to have a close relation with renal damage in type-2 diabetes (3) renal lesions in type-2 diabetic pts may be caused by diseases other than diabetes (e.g. arteriosclerosis, hypertension) (4) unlike in type-1 diabetes, where the strict glycemic control is the main preventive factor of DNP, in type-2 diabetes, the control of hypertension, hyperlipidemia, obesity, hyperuricemia may have priority.
与1型糖尿病患者中广为人知的糖尿病肾病（DNP）特征相反，2型糖尿病患者中DNP的患病率、病程及危险因素尚不清楚。本研究旨在评估200例2型糖尿病患者（100例女性和100例男性）中微量白蛋白尿（MA）和大量白蛋白尿（MAA）的患病率，及其与其他糖尿病并发症和一些已知心血管危险因素的关系。68例患者（33%）为正常白蛋白尿（NA），55例（27.5%）有MA，77例（38.5%）有MAA。这三组在年龄、体重指数（BMI）或自诊断糖尿病和高血压以来实际经过的时间方面无显著差异。每组的BMI均较高（平均±标准差分别为28.8±5.29、28.0±5.2和29.8±4.6kg/m²）。NA患者中有65%、MA患者中有77%、MAA患者中有81%患有高血压。MAA患者中吸烟者和既往吸烟者的比例高于MA和NA患者（56%对32%和22%）。NA患者的平均肾小球滤过率（GRF）值（ml/min/1.73m²）为71.9±26.8，MA患者为82.3±36.8，MAA患者为56.3±32。尿白蛋白排泄量（UAE）与血糖控制、血清胆固醇和血清高密度脂蛋白胆固醇之间无显著相关性。同时，UAE与血清甘油三酯（P<0.01）、血清尿酸（P<0.01）和血清肌酐（P<0.01）呈显著正相关，而与肾小球滤过率（GFR）呈显著负相关（P<0.01）。即使在NA患者中也检测到糖尿病非增殖性视网膜病变（RP）（27%），而51%的MAA患者无RP。NA患者中有56%、MA患者中有57%、MAA患者中有93%患有大血管病变。
（1）即使在2型糖尿病NA和MA患者中肾功能也可能受损；（2）已知的心血管危险因素似乎与2型糖尿病患者的肾脏损害密切相关；（3）2型糖尿病患者的肾脏病变可能由糖尿病以外的疾病（如动脉硬化、高血压）引起；（4）与1型糖尿病中严格血糖控制是DNP的主要预防因素不同，在2型糖尿病中，控制高血压、高脂血症、肥胖、高尿酸血症可能更为重要。
