Hadjadj S, Duly-Bouhanick B, Bekherraz A, BrIdoux F, Gallois Y, Mauco G, Ebran Jm, Marre M
Endocrinology & Diabetology, University Hospital, BP 577, 86021 Poitiers Cedex, France.
Diabetes Metab. 2004 Feb;30(1):43-51. doi: 10.1016/s1262-3636(07)70088-5.
It is controversial that serum lipIds affect the development and progression of microvascular complications in patients with type 1 diabetes.
We prospectively followed 297 patients with type 1 diabetes without end-stage renal disease for 7 Years (range: 2-10). Serum lipIds were measured at baseline (total and HDL-cholesterol, triglycerIdes and calculated LDL-cholesterol, Lipoprotein (a)). The primary end-point was the occurrence of a renal event and the secondary end-point was the occurrence of a retinal event, defined as the progression to a higher stage of diabetic nephropathy or retinopathy, respectively.
Serum triglycerIde (TG) levels were higher in patients who progressed in nephropathy than in those who dId not [median 1.21 (range 0.41-2.96) vs 0.91 (0.31-11.07) mmol/l; p=0.0037] and in those who developed retinal events than in those who dId not [1.05 (0.46-8.27) vs 0.87 mmol/l (0.31-11.07); p=0.0302], both in the whole cohort and in patients with normoalbuminuria at baseline. After adjustment for systolic blood pressure (SBP), diabetes duration, gender, stage of complications at baseline and glycohemoglobin (HbA1c), the relative risk for progression was 2.01 (95% CI: 1.07-3.77) for nephropathy and 2.30 (95% CI: 1.03-5.12) for retinopathy for patients having serum TG in the highest tertile, compared to the others. This result persisted when only patients with normoalbuminuria were consIdered.
High triglycerIde levels are an independent predictive factor of both renal and retinal complications in patients with type 1 diabetes.
1型糖尿病患者血清脂质是否影响微血管并发症的发生发展存在争议。
我们对297例无终末期肾病的1型糖尿病患者进行了7年的前瞻性随访（范围：2 - 10年）。在基线时测量血清脂质（总胆固醇和高密度脂蛋白胆固醇、甘油三酯以及计算得出的低密度脂蛋白胆固醇、脂蛋白(a)）。主要终点是肾脏事件的发生，次要终点是视网膜事件的发生，分别定义为糖尿病肾病或视网膜病变进展到更高阶段。
肾病进展患者的血清甘油三酯（TG）水平高于未进展患者[中位数1.21（范围0.41 - 2.96） vs 0.91（0.31 - 11.07）mmol/l；p = 0.0037]，发生视网膜事件患者的血清TG水平高于未发生者[1.05（0.46 - 8.27） vs 0.87 mmol/l（0.31 - 11.07）；p = 0.0302]，在整个队列以及基线时白蛋白尿正常的患者中均如此。在调整收缩压（SBP）、糖尿病病程、性别、基线并发症阶段和糖化血红蛋白（HbA1c）后，血清TG处于最高三分位数的患者发生肾病的相对风险为2.01（95%CI：1.07 - 3.77），发生视网膜病变的相对风险为2.30（95%CI：1.03 - 5.12），与其他患者相比。仅考虑白蛋白尿正常的患者时，这一结果仍然成立。
高甘油三酯水平是1型糖尿病患者肾脏和视网膜并发症的独立预测因素。
