Hansen K W, Mau Pedersen M, Christensen C K, Schmitz A, Christiansen J S, Mogensen C E
Medical Department M (Diabetes and Endocrinology), Aarhus Kommunehospital, Denmark.
J Intern Med. 1992 Aug;232(2):161-7. doi: 10.1111/j.1365-2796.1992.tb00566.x.
Recent reports have suggested that impaired renal function in type 1 diabetic patients may be present despite normal urinary albumin excretion (UAE). We have studied kidney function by means of a constant-infusion technique in normoalbuminuric type 1 diabetic patients without antihypertensive medication (UAE less than 20 micrograms min-1, n = 134), in microalbuminuric patients (20 greater than or equal to UAE less than 200 micrograms min-1, n = 50) and in 27 non-diabetic control subjects. Mean UAE was 4.5 micrograms min-1 (range 1.0-19.3 micrograms min-1) in normoalbuminuric patients, 53.1 micrograms min-1 (range 20.8-147.5 micrograms min-1) in microalbuminuric patients, and 4.0 micrograms min-1 (range 2.1-17.9 micrograms min-1) in controls. Glycosylated haemoglobin A1c was significantly higher in microalbuminuric patients (8.9%, range 5.9-12.6%) than in normoalbuminuric patients (7.9%, range 5.5-11.5%) (P less than 0.0001). Glomerular filtration rate in normoalbuminuric patients (135 ml min-1, range 97-198 ml min-1) was significantly higher than in controls (118 ml min-1, range 94-139 ml min-1) (P less than 1 x 10(-6), and significantly lower than in microalbuminuric patients (142 ml min-1, range 100-186 ml min-1) (P less than 0.05). Mean arterial blood pressure was lower in normoalbuminuric patients (91 mmHg, range 78-108 mmHg) than in microalbuminuric patients (98 mmHg, range 82-131 mmHg) (P less than 1 x 10(-6), but not significantly different from that of controls (89 mmHg, range 73-103 mmHg). We conclude that normal UAE is a reliable indicator of well-preserved renal function. Glomerular hyperfiltration, elevated blood pressure and poor metabolic control are characteristic features of microalbuminuric patients.
最近的报告表明，1型糖尿病患者尽管尿白蛋白排泄（UAE）正常，但仍可能存在肾功能受损。我们采用持续输注技术，对未服用抗高血压药物的正常白蛋白尿型1型糖尿病患者（UAE小于20微克/分钟，n = 134）、微量白蛋白尿患者（20≤UAE小于200微克/分钟，n = 50）以及27名非糖尿病对照者的肾功能进行了研究。正常白蛋白尿患者的平均UAE为4.5微克/分钟（范围1.0 - 19.3微克/分钟），微量白蛋白尿患者为53.1微克/分钟（范围20.8 - 147.5微克/分钟），对照者为4.0微克/分钟（范围2.1 - 17.9微克/分钟）。微量白蛋白尿患者的糖化血红蛋白A1c（8.9%，范围5.9 - 12.6%）显著高于正常白蛋白尿患者（7.9%，范围5.5 - 11.5%）（P小于0.0001）。正常白蛋白尿患者的肾小球滤过率（135毫升/分钟，范围97 - 198毫升/分钟）显著高于对照者（118毫升/分钟，范围94 - 139毫升/分钟）（P小于1×10⁻⁶），且显著低于微量白蛋白尿患者（142毫升/分钟，范围100 - 186毫升/分钟）（P小于0.05）。正常白蛋白尿患者的平均动脉血压（91 mmHg，范围78 - 108 mmHg）低于微量白蛋白尿患者（98 mmHg，范围82 - 131 mmHg）（P小于1×10⁻⁶），但与对照者（89 mmHg，范围73 - 103 mmHg）无显著差异。我们得出结论，正常UAE是肾功能良好保存的可靠指标。肾小球高滤过、血压升高和代谢控制不佳是微量白蛋白尿患者的特征。
