微量白蛋白尿的正常血压I型糖尿病患者动态血压负荷的早期紊乱

Early disturbances of ambulatory blood pressure load in normotensive type I diabetic patients with microalbuminuria.

作者信息

Benhamou P Y, Halimi S, De Gaudemaris R, Boizel R, Pitiot M, Siche J P, Bachelot I, Mallion J M

机构信息

Service d'Endocrinologie Diabétologie Nutrition, CHRU Michallon, Grenoble, France.

出版信息

Diabetes Care. 1992 Nov;15(11):1614-9. doi: 10.2337/diacare.15.11.1614.

DOI:10.2337/diacare.15.11.1614

PMID:1468293

Abstract

OBJECTIVE

To compare 24-h ABP in normotensive type 1 diabetic patients with and without microalbuminuria.

RESEARCH DESIGN AND METHODS

The study was a retrospective comparison of cases and matched control subjects. The first phase included 35 type 1 diabetic patients, normotensive by OMS criteria. The 23 patients with normoalbuminuria (< 15 micrograms/min) were compared with 12 patients with microalbuminuria (> or = 15 micrograms/min). In the second phase, the 12 microalbuminuric patients were paired by sex- and age-matched with 12 normoalbuminuric patients and 12 nondiabetic healthy control subjects. We measured casual systolic and diastolic BP and HR, 24-h ABP and AHR (recorded with a Spacelabs automatic recorder), and microalbuminuria.

RESULTS

No correlation between microalbuminuria and casual BP was observed. Microalbuminuria was correlated significantly with diastolic 24-h APR and nocturnal systolic and diastolic ABP (r = 0.35, 0.38, and 0.33, respectively; P < 0.05) and with AHR during all time periods (24-h, r = 0.46; day, r = 0.39; night, r = 0.39; P < 0.05). Normo- and microalbuminuric patients did not differ in casual BP and HR. However, microalbuminuric patients had a significant increase in systolic 24-h ABP (119.1 +/- 8.2 vs. 113.1 +/- 8.1, P = 0.05), diastolic 24-h ABP (74.9 +/- 7.5 vs. 70.2 +/- 5.7, P = 0.04), nocturnal systolic ABP (112.8 +/- 7.1 vs. 105.8 +/- 7.9, P = 0.01), and AHR during all time periods. The same results were observed when patients were paired by age and sex.

CONCLUSIONS

Normotensive microalbuminuric type 1 patients, although strictly comparable with normoalbuminuric patients for casual BP and HR, have an increased ABP and HR, especially during the night. This difference might reflect dysautonomia. Ambulatory measurement of BP and HR is more appropriate than casual measurements in hemodynamic studies of incipient diabetic nephropathies and could be proposed as an interesting tool for an early prediction of diabetic nephropathy.

摘要

目的

比较无微白蛋白尿和有微量白蛋白尿的血压正常的1型糖尿病患者的24小时动态血压。

研究设计与方法

本研究是对病例与匹配对照受试者的回顾性比较。第一阶段纳入35例符合世界卫生组织（OMS）标准的血压正常的1型糖尿病患者。将23例正常白蛋白尿（<15微克/分钟）患者与12例微量白蛋白尿（≥15微克/分钟）患者进行比较。在第二阶段，将12例微量白蛋白尿患者按性别和年龄与12例正常白蛋白尿患者及12例非糖尿病健康对照受试者配对。我们测量了随意收缩压和舒张压、心率、24小时动态血压和动态心率（用太空实验室自动记录仪记录）以及微量白蛋白尿。

结果

未观察到微量白蛋白尿与随意血压之间存在相关性。微量白蛋白尿与24小时动态舒张压平均压、夜间收缩压和舒张压显著相关（r分别为0.35、0.38和0.33；P<0.05），并且与所有时间段的动态心率相关（24小时，r = 0.46；白天，r = 0.39；夜间，r = 0.39；P<0.05）。正常白蛋白尿和微量白蛋白尿患者在随意血压和心率方面无差异。然而，微量白蛋白尿患者的24小时动态收缩压（119.1±8.2对113.1±8.1，P = 0.05）、24小时动态舒张压（74.9±7.5对70.2±5.7，P = 0.04）、夜间收缩压（112.8±7.1对105.8±7.9，P = 0.01）以及所有时间段的动态心率均显著升高。按年龄和性别配对患者时观察到相同结果。