Chaturvedi N, Bandinelli S, Mangili R, Penno G, Rottiers R E, Fuller J H
EURODIAB, University College London, London, England, United Kingdom.
Kidney Int. 2001 Jul;60(1):219-27. doi: 10.1046/j.1523-1755.2001.00789.x.
The occurrence of microalbuminuria in type 1 diabetes is strongly predictive of renal and cardiovascular disease and is still likely to occur despite improvements in glycemic control. A better understanding of microalbuminuria is required to inform new interventions. We determined the incidence and risk factors for microalbuminuria [albumin excretion rate (AER) 20 to 200 microg/min] in the EURODIAB Prospective Complications Study.
This is a seven-year follow-up (between 1988 and 1991) of 1134 normoalbuminuric men and women (aged 15 to 60) with type 1 diabetes from 31 European centers. Risk factors and AER were measured centrally.
The incidence of microalbuminuria was 12.6% over 7.3 years. Independent baseline risk factors were HbA1c (7.1 vs. 6.2%, P = 0.0001) and AER (9.6 vs. 7.8 microg/min, P = 0.0001) and, independent of these, fasting triglyceride (0.99 vs. 0.88 mmol/L, P = 0.01), low-density lipoprotein cholesterol (3.5 vs. 3.2 mmol/L, P = 0.02), body mass index (24.0 vs. 23.4 kg/m2, P = 0.01), and waist to hip ratio (WHR; 0.85 vs. 0.83, P = 0.009). Triglyceride and WHR risk factors were nearly as strong as AER in predicting microalbuminuria (standardized regression effects of 1.3 for triglyceride and WHR and 1.5 for AER). Blood pressure at follow-up, but not at baseline, was also raised in those who progressed. There was no evidence of a threshold of HbA1c on microalbuminuria risk.
The incidence of microalbuminuria in patients with type 1 diabetes remains high, and there is no apparent glycemic threshold for it. Markers of insulin resistance, such as triglyceride and WHR, are strong risk factors. Systemic blood pressure is not raised prior to the onset of microalbuminuria.
1型糖尿病患者微量白蛋白尿的出现强烈预示着肾脏和心血管疾病的发生，并且即便血糖控制有所改善，微量白蛋白尿仍有可能出现。为了制定新的干预措施，需要对微量白蛋白尿有更深入的了解。我们在欧洲糖尿病前瞻性并发症研究中确定了微量白蛋白尿[白蛋白排泄率（AER）20至200微克/分钟]的发生率和危险因素。
这是一项对来自31个欧洲中心的1134名1型糖尿病正常白蛋白尿男性和女性（年龄15至60岁）进行的为期七年（1988年至1991年）的随访研究。危险因素和AER在中心实验室进行测定。
在7.3年的时间里，微量白蛋白尿的发生率为12.6%。独立的基线危险因素为糖化血红蛋白（HbA1c）（7.1%对6.2%，P = 0.0001）和AER（9.6微克/分钟对7.8微克/分钟，P = 0.0001），除此之外，空腹甘油三酯（0.99毫摩尔/升对0.88毫摩尔/升，P = 0.01）、低密度脂蛋白胆固醇（3.5毫摩尔/升对3.2毫摩尔/升，P = 0.02）、体重指数（24.0千克/平方米对23.4千克/平方米，P = 0.01）以及腰臀比（WHR；0.85对0.83，P = 0.009）也是危险因素。甘油三酯和WHR危险因素在预测微量白蛋白尿方面几乎与AER一样强（甘油三酯和WHR的标准化回归效应为1.3，AER为1.5）。病情进展者随访时的血压升高，但基线时血压未升高。没有证据表明HbA1c存在微量白蛋白尿风险阈值。
1型糖尿病患者微量白蛋白尿的发生率仍然很高，且不存在明显的血糖阈值。胰岛素抵抗指标，如甘油三酯和WHR，是很强的危险因素。在微量白蛋白尿发作之前，全身血压并未升高。
