Donnelly Richard, Yeung Justin M C, Manning Gillian
School of Medical and Surgical Sciences, University of Nottingham, Southern Derbyshire Acute Hospitals Trust, Derby, UK.
J Hypertens Suppl. 2003 Mar;21(1):S7-12.
Microalbuminuria (defined as an albumin-creatinine ratio of 10-25 mg/mmol on the first-morning urine sample, or an albumin excretion rate of 20-200 microg/min on a timed collection) is present in 20-30% of all patients with type 2 diabetes, and is especially common in those with hypertension, endothelial dysfunction and other features of insulin resistance. Although microalbuminuria is predictive of worsening microvascular disease in the kidney (5-10% per year progress to overt diabetic nephropathy), an increased albumin excretion rate (AER) reflects a generalized abnormality of vascular function and is associated with 2-4-fold increases in cardiovascular and all-cause mortality. The extent to which microalbuminuria is a risk factor independent of other variables in type 2 diabetes, e.g. blood pressure and smoking, has been highlighted by recent cohort studies, e.g. the Heart Outcome Prevention Evaluation study and the Wisconsin Epidemiological Study of Diabetic Retinopathy. In the former study, for example, microalbuminuria at baseline increased the adjusted relative risks (RR) of a major cardiovascular event (RR 1.83), all-cause death (RR 2.09) and hospitalization for heart failure (RR 3.23) in both diabetic and non-diabetic subjects. These studies also highlighted that AER is a continuous risk factor, and that levels of AER below the arbitrary threshold for defining microalbuminuria are associated with relatively increased cardiovascular risk. Similarly, microalbuminuria affects 10-15% of middle-aged non-diabetics and is associated with coronary, peripheral and cerebral vascular complications. Detection of microalbuminuria, especially in type 2 diabetes, signifies the need to intensify blood pressure control as part of a multiple risk factor intervention strategy in a high-risk group. As hypertensive patients with type 2 diabetes are frequently treated by more than one antihypertensive agent, ACE inhibitors and low-dose diuretics are preferably recommended in order to provide sufficient blood pressure control and target organ protection.
微量白蛋白尿（定义为首次晨尿样本中白蛋白与肌酐比值为10 - 25mg/mmol，或定时收集尿液时白蛋白排泄率为20 - 200μg/min）在所有2型糖尿病患者中占20% - 30%，在伴有高血压、内皮功能障碍及其他胰岛素抵抗特征的患者中尤为常见。尽管微量白蛋白尿可预测肾脏微血管疾病的恶化（每年有5% - 10%进展为显性糖尿病肾病），但白蛋白排泄率（AER）升高反映了血管功能的普遍异常，并与心血管疾病和全因死亡率增加2 - 4倍相关。近期队列研究，如心脏结局预防评估研究和威斯康星糖尿病视网膜病变流行病学研究，凸显了微量白蛋白尿作为2型糖尿病中独立于其他变量（如血压和吸烟）的危险因素的程度。例如，在前一项研究中，基线时的微量白蛋白尿增加了糖尿病和非糖尿病受试者发生主要心血管事件（相对风险[RR] 1.83）、全因死亡（RR 2.09）和因心力衰竭住院（RR 3.23）的校正相对风险。这些研究还强调AER是一个连续的危险因素，且低于定义微量白蛋白尿的任意阈值的AER水平与相对增加的心血管风险相关。同样，微量白蛋白尿影响10% - 15%的中年非糖尿病患者，并与冠状动脉、外周血管和脑血管并发症相关。检测到微量白蛋白尿，尤其是在2型糖尿病患者中，意味着需要强化血压控制，作为高危人群多重危险因素干预策略的一部分。由于2型糖尿病高血压患者常使用多种抗高血压药物治疗，因此优选推荐使用ACE抑制剂和低剂量利尿剂，以提供充分的血压控制和靶器官保护。
