Takahashi Naohiko, Anan Futoshi, Nakagawa Mikiko, Yufu Kunio, Ooie Tatsuhiko, Nawata Tomoko, Shigematsu Sakuji, Hara Masahide, Saikawa Tetsunori, Yoshimatsu Hironobu
Department of Internal Medicine I, Oita University, Idaigaoka, Hasama, Japan.
Metabolism. 2004 Oct;53(10):1359-64. doi: 10.1016/j.metabol.2004.03.024.
Urinary albumin excretion/microalbuminuria and cardiovascular autonomic dysfunction are associated with high mortality in type 2 diabetic patients. We tested the hypothesis that the presence of microalbuminuria would correlate with cardiovascular autonomic dysfunction and insulin resistance in type 2 diabetic patients. The study group consisted of 15 Japanese patients with type 2 diabetes and microalbuminuria (age: 56 +/- 10 years, mean +/- SD). The control group consisted of 19 age-matched patients with normalbuminuria (56 +/- 7 years). Cardiovascular autonomic function was assessed by baroreflex sensitivity (BRS), heart rate variability, plasma norepinephrine concentration, and cardiac 123I-metaiodobenzylguanidine (MIBG) scintigraphy. BRS was lower in the microalbuminuria group than in the normalbuminuria group (P < .05). Early and delayed 123I-MIBG myocardial uptake values were lower (P < .05 and P < .005, respectively) and the percent washout rate of 123I-MIBG was higher (P < .0005) in the microalbuminuria group than in the normalbuminuria group. Fasting plasma glucose (P < .05) and insulin concentrations (P < .05), and the homeostasis model assessment (HOMA) index (P < .01) were higher in the microalbuminuria group than in the normalbuminuria group. Multiple regression analysis showed that urinary albumin excretion was independently predicted by the myocardial uptake of 123I-MIBG at delayed phase, fasting plasma insulin concentration, and the HOMA index. Our results indicate that the presence of microalbuminuria in our Japanese patients with type 2 diabetes is characterized by depressed cardiovascular autonomic function and insulin resistance, and that the myocardial uptake of 123I-MIBG at delayed phase, fasting plasma insulin, and HOMA index are independent predictors of urinary albumin excretion.
尿白蛋白排泄/微量白蛋白尿与2型糖尿病患者的高死亡率相关。我们检验了这样一个假设：微量白蛋白尿的存在与2型糖尿病患者的心血管自主神经功能障碍及胰岛素抵抗相关。研究组由15例患有2型糖尿病和微量白蛋白尿的日本患者组成（年龄：56±10岁，均值±标准差）。对照组由19例年龄匹配的白蛋白尿正常患者组成（56±7岁）。通过压力反射敏感性（BRS）、心率变异性、血浆去甲肾上腺素浓度及心脏123I-间碘苄胍（MIBG）闪烁显像评估心血管自主神经功能。微量白蛋白尿组的BRS低于正常白蛋白尿组（P<.05）。微量白蛋白尿组123I-MIBG心肌早期和延迟摄取值较低（分别为P<.05和P<.005），123I-MIBG的清除率百分比更高（P<.0005）。微量白蛋白尿组的空腹血糖（P<.05）、胰岛素浓度（P<.05）及稳态模型评估（HOMA）指数（P<.01）均高于正常白蛋白尿组。多元回归分析显示，延迟期123I-MIBG心肌摄取、空腹血浆胰岛素浓度及HOMA指数可独立预测尿白蛋白排泄。我们的结果表明，在我们的日本2型糖尿病患者中，微量白蛋白尿的存在表现为心血管自主神经功能降低及胰岛素抵抗，且延迟期123I-MIBG心肌摄取、空腹血浆胰岛素及HOMA指数是尿白蛋白排泄的独立预测因素。
