Jensen T, Deckert T
Steno Memorial Hospital, Gentofte, Denmark.
Horm Metab Res Suppl. 1992;26:68-70.
The most serious complication of diabetes mellitus is clinical nephropathy. The development of persistent proteinuria (urinary excretion of more than 300 mg albumin/24 hours) implies an extremely high risk of early death. Renal failure is the most frequent cause of death but the mortality of cardiovascular diseases is also increased. Besides the link between albuminuria (nephropathy) and atherosclerosis in coronary arteries, albuminuria is also a predictor of microangiopathy in other organs than the kidneys. The annual incidence of proliferative retinopathy in early nephropathy is 10-15% compared to only 1% in patients without nephropathy. Also signs of cardiomyopathy have been demonstrated in early nephropathy. Further we have described markers of universal endothelial damage in these patients, and we hypothesize that albuminuria not only is a predictor of renal disease but also of widespread vascular disease. Long-term improvement of metabolic control by use of insulin infusion pumps and early antihypertensive treatment seem to stop the further progression of early diabetic nephropathy and to significantly improve the prognosis of clinical nephropathy.
糖尿病最严重的并发症是临床肾病。持续性蛋白尿（尿白蛋白排泄量超过300mg/24小时）的出现意味着早期死亡风险极高。肾衰竭是最常见的死亡原因，但心血管疾病的死亡率也会增加。除了蛋白尿（肾病）与冠状动脉粥样硬化之间的联系外，蛋白尿还是肾脏以外其他器官微血管病变的一个预测指标。早期肾病患者增殖性视网膜病变的年发病率为10%-15%，而无肾病患者仅为1%。早期肾病患者也已出现心肌病迹象。此外，我们还描述了这些患者普遍存在的内皮损伤标志物，并且我们推测蛋白尿不仅是肾病的预测指标，也是广泛血管疾病的预测指标。使用胰岛素输注泵长期改善代谢控制以及早期进行抗高血压治疗似乎能够阻止早期糖尿病肾病的进一步进展，并显著改善临床肾病的预后。
