长期胰岛素依赖型糖尿病患者微量白蛋白尿的预测价值

Predictive value of microalbuminuria in patients with insulin-dependent diabetes of long duration.

作者信息

Forsblom C M, Groop P H, Ekstrand A, Groop L C

机构信息

Fourth Department of Medicine, Helsinki University Hospital, Finland.

出版信息

BMJ. 1992 Oct 31;305(6861):1051-3. doi: 10.1136/bmj.305.6861.1051.

DOI:10.1136/bmj.305.6861.1051

PMID:1467683

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1883577/

Abstract

OBJECTIVE

To investigate the predictive value of microalbuminuria (albumin excretion rate 30-300 mg/24 h) as a risk factor for overt diabetic nephropathy in patients with longstanding insulin dependent diabetes.

DESIGN

10 year follow up of patients with normoalbuminuria (albumin excretion rate < 30 mg/24 h), microalbuminuria (30-300 mg/24 h), and macroalbuminuria (> 300 mg/24 h) based on two out of three timed overnight urine samples.

SETTING

Outpatient clinic of Helsinki University Hospital.

SUBJECTS

72 consecutive patients who had had insulin dependent diabetes for over 15 years.

MAIN OUTCOME MEASURES

Urinary albumin excretion rate, mortality, and prevalence of diabetic complications after 10 years.

RESULTS

56 patients were re-examined at 10 year follow up, 10 had died, five were lost to follow up, and one was excluded because of non-diabetic kidney disease. At initial screening 22 patients had macroalbuminuria, 18 had microalbuminuria, and 26 had normal albumin excretion. Only five (28%, 95% confidence interval 10% to 54%) of the microalbuminuric patients developed macroalbuminuria during the 10 year follow up and none developed end stage renal failure. Two (8%, 1% to 25%) normoalbuminuric patients developed macroalbuminuria and four (15%, 4% to 35%) became microalbuminuric. Seven (32%, 14% to 55%) of the macroalbuminuric patients developed end stage renal failure and six (27%, 11% to 50%) died of cardiovascular complications.

CONCLUSION

Microalbuminuria is not a good predictor of progression to overt nephropathy in patients with longstanding insulin dependent diabetes.

摘要

目的

探讨微量白蛋白尿（白蛋白排泄率30 - 300 mg/24 h）作为长期胰岛素依赖型糖尿病患者显性糖尿病肾病危险因素的预测价值。

设计

基于三个定时过夜尿样中的两个，对正常白蛋白尿（白蛋白排泄率<30 mg/24 h）、微量白蛋白尿（30 - 300 mg/24 h）和大量白蛋白尿（>300 mg/24 h）患者进行10年随访。

地点

赫尔辛基大学医院门诊。

研究对象

72例连续的胰岛素依赖型糖尿病病程超过15年的患者。

主要观察指标

10年后的尿白蛋白排泄率、死亡率和糖尿病并发症患病率。

结果

10年随访时有56例患者接受复查，10例死亡，5例失访，1例因非糖尿病肾病被排除。初始筛查时，22例患者有大量白蛋白尿，18例有微量白蛋白尿，26例白蛋白排泄正常。在10年随访期间，只有5例（28%，95%置信区间10%至54%）微量白蛋白尿患者发展为大量白蛋白尿，无患者发展为终末期肾衰竭。2例（8%，1%至25%）正常白蛋白尿患者发展为大量白蛋白尿，4例（15%，4%至35%）变为微量白蛋白尿。7例（32%，14%至55%）大量白蛋白尿患者发展为终末期肾衰竭，6例（27%，11%至50%）死于心血管并发症。