Gaede Peter, Tarnow Lise, Vedel Pernille, Parving Hans-Henrik, Pedersen Oluf
Steno Diabetes Center, Gentofte, Denmark.
Nephrol Dial Transplant. 2004 Nov;19(11):2784-8. doi: 10.1093/ndt/gfh470. Epub 2004 Aug 24.
Intervention studies in microalbuminuric type 2 diabetic patients have demonstrated that it is possible to avoid progression to overt diabetic nephropathy and even to achieve regression to normoalbuminuria. However, the long-term impact of stabilization/regression in albuminuria on decline in glomerular filtration rate (GFR) has not been established.
151 patients with type 2 diabetes and microalbuminuria at baseline in whom GFR was measured at least three times during 7.8 years of follow-up were divided into three groups according to the level of albuminuria during follow-up. Overt nephropathy was diagnosed as a urinary albumin excretion rate (AER) >300 mg/24 h and remission to normoalbuminuria was defined as an AER <30 mg/24 h at the last examination.
During follow-up, 46 patients achieved remission to normoalbuminuria, 58 remained microalbuminuric and 47 patients progressed to overt nephropathy. The mean (+/- SE) yearly decline in GFR was lowest (2.3+/-0.4 ml/min/year) in patients who obtained remission, in comparison with patients remaining microalbuminuric, in whom the decline was 3.7+/-0.4 ml/min/year, and patients progressing to overt nephropathy, who had a decline in GFR of 5.4+/-0.5 ml/min/year (ANOVA, P<0.001). Start of antihypertensive treatment during follow-up was strongly associated with remission to normoalbuminuria [odds ratio: 2.32; 95% confidence interval (CI): 1.09-4.93] whereas a decrease in HbA(1c) by 1% increased the probability for remission (odds ratio: 1.48; 95% CI: 1.11-1.97).
Remission to normoalbuminuria was associated with a decreased GFR decline during 7.8 years of follow-up in type 2 diabetic patients with microalbuminuria. Antihypertensive therapy and improved glycaemic control were independent predictors for remission.
对微量白蛋白尿的2型糖尿病患者进行的干预研究表明，有可能避免进展为显性糖尿病肾病，甚至实现回归至正常白蛋白尿状态。然而，白蛋白尿稳定/回归对肾小球滤过率（GFR）下降的长期影响尚未明确。
151例基线时有2型糖尿病和微量白蛋白尿且在7.8年随访期间GFR至少测量3次的患者，根据随访期间白蛋白尿水平分为三组。显性肾病诊断为尿白蛋白排泄率（AER）>300mg/24h，回归至正常白蛋白尿定义为最后一次检查时AER<30mg/24h。
随访期间，46例患者回归至正常白蛋白尿，58例仍为微量白蛋白尿，47例进展为显性肾病。与仍为微量白蛋白尿的患者（GFR下降为3.7±0.4ml/min/年）和进展为显性肾病的患者（GFR下降为5.4±0.5ml/min/年）相比，回归至正常白蛋白尿的患者GFR平均（±SE）每年下降最低（2.3±0.4ml/min/年）（方差分析，P<0.001）。随访期间开始抗高血压治疗与回归至正常白蛋白尿密切相关[比值比：2.32；95%置信区间（CI）：1.09 - 4.93]，而糖化血红蛋白（HbA1c）降低1%增加回归的概率（比值比：1.48；95%CI：1.11 - 1.97）。
在7.8年的随访中，微量白蛋白尿的2型糖尿病患者回归至正常白蛋白尿与GFR下降减少有关。抗高血压治疗和改善血糖控制是回归的独立预测因素。
