Twyman S, Rowe D, Mansell P, Schapira D, Betts P, Leatherdale B
Department of Chemical Pathology, Southampton General Hospital, Southampton, UK.
Diabet Med. 2001 May;18(5):402-8. doi: 10.1046/j.1464-5491.2001.00484.x.
This study was established to follow changes in albumin/creatinine ratio (ACR) and to determine the prevalence and degree of progression of microalbuminuria (MA) or of clinical proteinuria (CP) in children with Type 1 diabetes. The study has investigated subjects for up to 12 years in establishing the correlation between MA and gender, age, duration of diabetes and glycated haemoglobin (HbA1c). The study has defined clinical cut-offs for MA in daytime clinic urine samples in young diabetic subjects.
Three hundred and sixty-one patients were involved in the study, with 221 (61.2%) having over six sets of data. Urine samples were collected at routine annual clinic visits and analysed without prior freezing for ACR. Blood samples were taken for HbA1c measurement. Data including sex, age and duration of diabetes were recorded.
A random clinic ACR of < 4.5 mg/mmol (males) and 5.2 mg/mmol (females) creatinine was used as the 'clinical cut-off' to define the presence of MA. The presence of MA was independent of HbA1c and duration of diabetes but appeared be associated with the adolescent years (> 10 years). There was little evidence of progression from normoalbuminuria to MA, or from MA to CP. Of patients aged 10-18 years, 30.9% of males and 40.4% of females had one or more episodes of MA.
Persistent MA and random episodes of MA or CP may be associated with the adolescent years but not with duration of diabetes. Further study will reveal if the substantial increases in ACR sometimes seen during adolescence are predictive of diabetic nephropathy. Clinical cut-offs of < 4.5 and < 5.2 mg/mmol creatinine for males and females, respectively, are suggested for the interpretation of changes in ACR in random urine samples in young people with Type 1 diabetes.
本研究旨在追踪1型糖尿病患儿白蛋白/肌酐比值（ACR）的变化，确定微量白蛋白尿（MA）或临床蛋白尿（CP）的患病率及进展程度。该研究对受试者进行了长达12年的调查，以确立MA与性别、年龄、糖尿病病程及糖化血红蛋白（HbA1c）之间的相关性。本研究还确定了年轻糖尿病受试者日间门诊尿样中MA的临床临界值。
361名患者参与了本研究，其中221名（61.2%）有超过6组数据。在每年的常规门诊就诊时收集尿样，不经预先冷冻直接分析ACR。采集血样测定HbA1c。记录包括性别、年龄和糖尿病病程在内的数据。
随机门诊中，以肌酐ACR < 4.5 mg/mmol（男性）和5.2 mg/mmol（女性）作为“临床临界值”来定义MA的存在。MA的存在与HbA1c和糖尿病病程无关，但似乎与青春期（>10岁）有关。几乎没有证据表明从正常白蛋白尿进展为MA，或从MA进展为CP。在10 - 18岁的患者中，30.9%的男性和40.4%的女性有一次或多次MA发作。
持续性MA以及MA或CP的随机发作可能与青春期有关，而非与糖尿病病程有关。进一步的研究将揭示青春期有时出现的ACR大幅升高是否可预测糖尿病肾病。对于1型糖尿病青少年随机尿样中ACR变化的解读，建议男性和女性的临床临界值分别为肌酐< 4.5和< 5.2 mg/mmol。
