1型糖尿病患儿24小时动态血压的早期变化与高正常白蛋白排泄率相关。

Early changes in 24-hour ambulatory blood pressure are associated with high normal albumin excretion rate in children with type 1 diabetes mellitus.

作者信息

Gallego P H, Gilbey A J, Grant M T, Bulsara M K, Byme G C, Jones T W, Frazer F L

机构信息

Department of Endocrinology and Diabetes, Princess Margaret Hospital, Subiaco, Western Australia.

出版信息

J Pediatr Endocrinol Metab. 2005 Sep;18(9):879-85. doi: 10.1515/jpem.2005.18.9.879.

DOI:10.1515/jpem.2005.18.9.879

PMID:16279366

Abstract

OBJECTIVE

The relationship between urinary albumin excretion rate (AER) and elevated blood pressure (BP) is unclear as a cause-effect phenomenon in the development of diabetic nephropathy. The aim of this study was to examine the association between AER, HbA1c and BP in children with normoalbuminuria.

METHODS

24-hour ambulatory BP assessment was performed in 78 children with type 1 diabetes mellitus (DM1), age mean +/- SD 13.4 +/- 2.7 yr, range 7.3-18.3 yr, DM1 duration mean +/- SD 6.6 +/- 2.9 yr, range 2.1-11.9 yr. Using generalised linear mixed models with systolic (SBP) and diastolic (DBP) blood pressure as dependent variables, the effects of AER and HbA1c were examined, adjusting for age, gender, DM1 duration and insulin dose.

RESULTS

Patients with high normal AER (7-20 microg/min) had higher SBP during daytime and night-time compared to the low normal AER (< or = 7 microg/min) (mean +/- SD 118.20 +/- 7.98 and 110.33 +/- 7.08 mm Hg, p = 0.02; mean +/- SD 108.76 +/- 9.21 and 100.20 +/- 7.75 mm Hg, p = 0.03, respectively). DBP was also higher both during day- and night-time when compared to the < or = 7 microg/min group (mean +/- SD 73.40 +/- 6.50 and 64.86 +/- 5.67 mm Hg, p = 0.002; mean +/- SD 62.50 +/- 6.75 and 56.30 +/- 5.56 mm Hg, p = 0.03 day- and night-time, respectively).

CONCLUSION

A rise in SBP and DBP is associated with increased levels of AER even within the normal range.

摘要

目的

在糖尿病肾病发展过程中，尿白蛋白排泄率（AER）与血压升高（BP）之间的因果关系尚不清楚。本研究旨在探讨正常白蛋白尿儿童中AER、糖化血红蛋白（HbA1c）与BP之间的关联。

方法

对78例1型糖尿病（DM1）儿童进行24小时动态血压评估，年龄平均±标准差为13.4±2.7岁，范围为7.3 - 18.3岁，DM1病程平均±标准差为6.6±2.9年，范围为2.1 - 11.9年。以收缩压（SBP）和舒张压（DBP）为因变量，采用广义线性混合模型，在调整年龄、性别、DM1病程和胰岛素剂量的情况下，检验AER和HbA1c的影响。

结果

与低正常AER（≤7μg/min）相比，高正常AER（7 - 20μg/min）患者白天和夜间的SBP更高（平均±标准差分别为118.20±7.98和110.33±7.08mmHg，p = 0.02；平均±标准差分别为108.76±9.21和100.20±7.75mmHg，p = 0.03）。与≤7μg/min组相比，白天和夜间的DBP也更高（平均±标准差分别为73.40±6.50和64.86±5.67mmHg，p = 0.002；平均±标准差分别为62.50±6.75和56.30±5.56mmHg，白天和夜间p = 0.03）。