Diabetes and Endocrine Unit, Dudley Road Hospital, Birmingham, United Kingdom.
Diabetes Care. 1992 Apr;15(4):495-501. doi: 10.2337/diacare.15.4.495.
To estimate the prevalence of microalbuminuria, overnight urinary albumin excretion rate (AER) greater than or equal to 30 and less than or equal to 250 micrograms/min, in a large sequential sample of nonhypertensive insulin-dependent (type I) diabetic patients attending hospital diabetic clinics, to identify micro- and normoalbuminuric patients in this sample for subsequent intervention and natural history follow-up studies, and to compare the clinical characteristics of the micro- and normoalbuminuric patients identified.
Screening was conducted in two phases. In phase 1, all eligible patients were asked to provide an early morning urine specimen for measurement of albumin concentration and albumin-creatinine ratio. In phase 2, all patients with an albumin concn greater than or equal to 15 mg/L and/or an albumin-creatinine ratio greater than or equal to 3.5 mg/mmol and a random sample of those with an albumin concn less than 15 mg/L and albumin-creatinine ratio less than 3.5 mg/mmol were asked to collect a timed overnight urine specimen for determination of AER.
Among 1888 patients (16-60 yr old, diabetes onset less than 40 yr, and duration of diabetes less than 35 yr) who were screened, the prevalence of microalbuminuria was approximately 3.7% (95% confidence interval (CI) 2.7-7.6%). Duration of diabetes was significantly longer in micro- than normoalbuminuric patients (20 vs. 15 yr, respectively; P less than 0.001), and in no patient with microalbuminuria was the duration of diabetes less than 5 yr. Systolic and diastolic blood pressures, higher in micro- than normoalbuminuric patients (132 vs. 122 mmHg, P less than 0.01; 77 vs. 72 mmHg, P less than 0.01), were strongly associated with AER.
Microalbuminuria in type I diabetes, which appears to represent an earlier phase in the development of clinical nephropathy, is associated with elevated blood pressure and a longer duration of diabetes.
在一大批连续就诊于医院糖尿病门诊的非高血压胰岛素依赖型（I型）糖尿病患者样本中，估算微量白蛋白尿（过夜尿白蛋白排泄率（AER）大于或等于30且小于或等于250微克/分钟）的患病率，识别该样本中的微量白蛋白尿和正常白蛋白尿患者，以便后续进行干预和自然病史随访研究，并比较所识别的微量白蛋白尿和正常白蛋白尿患者的临床特征。
筛查分两个阶段进行。在第一阶段，要求所有符合条件的患者提供清晨尿液样本，用于测量白蛋白浓度和白蛋白-肌酐比值。在第二阶段，要求所有白蛋白浓度大于或等于15毫克/升和/或白蛋白-肌酐比值大于或等于3.5毫克/毫摩尔的患者，以及白蛋白浓度小于15毫克/升且白蛋白-肌酐比值小于3.5毫克/毫摩尔的患者中的一个随机样本，收集定时过夜尿液样本以测定AER。
在筛查的1888例患者（年龄16 - 60岁，糖尿病发病时间小于40年，糖尿病病程小于35年）中，微量白蛋白尿的患病率约为3.7%（95%置信区间（CI）2.7 - 7.6%）。微量白蛋白尿患者的糖尿病病程显著长于正常白蛋白尿患者（分别为20年和15年；P < 0.001），且没有微量白蛋白尿患者的糖尿病病程小于5年。微量白蛋白尿患者的收缩压和舒张压高于正常白蛋白尿患者（分别为132 mmHg对122 mmHg，P < 0.01；77 mmHg对72 mmHg，P < 0.01），且与AER密切相关。
I型糖尿病中的微量白蛋白尿似乎代表临床肾病发展的早期阶段，与血压升高和糖尿病病程延长有关。
