Schultz C J, Neil H A, Dalton R N, Konopelska Bahu T, Dunger D B
Division of Public Health and Primary Health Care, University of Oxford, UK.
Diabetes Care. 2001 Mar;24(3):555-60. doi: 10.2337/diacare.24.3.555.
To examine whether a rise in blood pressure could be detected before the onset of microalbuminuria (MA) in a cohort of children followed from diagnosis of type 1 diabetes.
The Oxford Regional Prospective Study is an incident cohort study of children with type 1 diabetes aged (mean +/- SD) 9.8 +/- 3.7 years at diagnosis. Subjects were assessed annually from diagnosis, with measurement of HbA1c, arterial blood pressure (random zero), and three urine samples for estimation of the albumin/creatinine ratio. During follow-up, 63 of 494 children developed MA at one or more annual assessments and were designated as cases for a nested case-control study. Each case was matched for sex and age at diagnosis with two normoalbuminuric control subjects. Blood pressure (BP) data were compared at corresponding years of diabetes duration.
Cases with MA were similar to normoalbuminuric control subjects with respect to age and BMI, but they had higher mean HbA1c levels (mean difference 1.1%, P < 0.001). In the years before the onset of MA, the diastolic BP standard deviation score (SDS) was significantly higher than zero in cases (mean 0.49, P < 0.001) and in control subjects (0.50, P < 0.001). No difference could be detected between cases and control subjects before the onset of MA in either systolic or diastolic BP (mean difference systolic -1.2 mmHg [95% CI -4.7 to 2.7], mean difference diastolic 0.1 mmHg [-2.4 to 2.6]). However, within the cases, the onset of MA was associated with elevations in systolic and diastolic BP SDSs (F = 16.1, P < 0.001; and F = 18.0, P < 0.001). BMI, but not HbA1c, was associated with systolic and diastolic BP SDSs in the subjects with MA (F = 0.6, P = 0.4; and F = 12.3, P = 0.001). However, the association of BP with MA remained signifcant for systolic BP (P = 0.001) and for diastolic BP (P < 0.001) after adjusting for BMI.
A rise in systemic BP cannot be detected before the first appearance of MA in children with type 1 diabetes. BP rises concurrently with the onset of MA and is also closely related to BMI.
在一组自1型糖尿病确诊后开始随访的儿童中，检查在微量白蛋白尿（MA）发作之前是否能检测到血压升高。
牛津地区前瞻性研究是一项针对确诊时年龄为（平均±标准差）9.8±3.7岁的1型糖尿病儿童的队列研究。自确诊起每年对受试者进行评估，测量糖化血红蛋白（HbA1c）、动脉血压（随机零点）以及三份尿液样本以估算白蛋白/肌酐比值。在随访期间，494名儿童中有63名在一次或多次年度评估中出现MA，并被指定为巢式病例对照研究的病例。每个病例在确诊时按性别和年龄与两名正常白蛋白尿对照受试者进行匹配。比较糖尿病病程对应年份的血压（BP）数据。
MA病例在年龄和体重指数（BMI）方面与正常白蛋白尿对照受试者相似，但他们的平均HbA1c水平更高（平均差异1.1%，P<0.001）。在MA发作前的几年中，病例组的舒张压标准差评分（SDS）显著高于零（平均0.49，P<0.001），对照组也是如此（0.50，P<0.001）。在MA发作前，病例组和对照组在收缩压或舒张压方面均未检测到差异（收缩压平均差异-1.2 mmHg[95%可信区间-4.7至2.7]，舒张压平均差异0.1 mmHg[-2.4至2.6]）。然而，在病例组中，MA的发作与收缩压和舒张压SDS的升高相关（F=16.1，P<0.001；F=18.0，P<0.001）。在MA受试者中，BMI而非HbA1c与收缩压和舒张压SDS相关（F=0.6，P=0.4；F=12.3，P=0.001）。然而，在调整BMI后，血压与MA的关联在收缩压（P=0.001）和舒张压（P<0.001）方面仍然显著。
在1型糖尿病儿童中，在MA首次出现之前无法检测到全身血压升高。血压在MA发作时同时升高，并且也与BMI密切相关。
