Stone Monique L, Craig Maria E, Chan Albert K, Lee Jenny W, Verge Charles F, Donaghue Kim C
Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Hawkesbury Road, Westmead, Sydney, Australia.
Diabetes Care. 2006 Sep;29(9):2072-7. doi: 10.2337/dc06-0239.
To describe the natural history and risk factors for persistent microalbuminuria in children and adolescents with type 1 diabetes followed for up to 15 years.
This study contained a longitudinal cohort of 972 patients; analysis of baseline risk factors was performed using logistic regression and predictors over time using survival analysis. Albumin excretion rate was measured on three consecutive timed overnight urine collections on at least two occasions. Normoalbuminuria was defined as a median albumin excretion rate < 7.5 microg/min, borderline microalbuminuria as 7.5-20 microg/min, and microalbuminuria as 20-200 microg/min. Microalbuminuria was further classified as persistent if its duration was >12 months. Median age was 12.7 years (interquartile range 11.5-14.4) and diabetes duration 6.5 years (4.1-9.3) at first assessment, and median follow-up was 6.2 years (range 1-15.3).
The incidence of persistent microalbuminuria was 4.6 (95% CI 3.3-6.1) per 1,000 patient-years. Predictors of persistent microalbuminuria from the first assessment using multiple logistic regression were high cholesterol (odds ratio 2.2 [95% CI 1.2-4.0]) and borderline microalbuminuria (2.5 [1.2-5.2]). Predictors using Cox regression were HbA(1c) (hazard ratio 1.4 [95% CI 1.1-1.7]), age at diagnosis (1.2 [1.1-1.3]), obesity (3.6 [0.8-15.5]), and insulin dose (2.7 [1.0-7.5]).
Children and adolescents with type 1 diabetes who have borderline microalbuminuria are more than twice as likely to develop persistent microalbuminuria. In addition to poor glycemic control, clinical markers of insulin resistance were associated with an increased risk of microalbuminuria.
描述随访长达15年的1型糖尿病儿童及青少年持续性微量白蛋白尿的自然病程及危险因素。
本研究纳入了972例患者的纵向队列；使用逻辑回归分析基线危险因素，并使用生存分析随时间推移分析预测因素。至少两次连续三个定时夜间尿样收集来测量白蛋白排泄率。正常白蛋白尿定义为白蛋白排泄率中位数<7.5微克/分钟，临界微量白蛋白尿为7.5 - 20微克/分钟，微量白蛋白尿为20 - 200微克/分钟。如果微量白蛋白尿持续时间>12个月，则进一步分类为持续性微量白蛋白尿。首次评估时的中位年龄为12.7岁（四分位间距11.5 - 14.4），糖尿病病程为6.5年（4.1 - 9.3），中位随访时间为6.2年（范围1 - 15.3）。
持续性微量白蛋白尿的发病率为每1000患者年4.6例（95%可信区间3.3 - 6.1）。使用多元逻辑回归从首次评估得出的持续性微量白蛋白尿预测因素为高胆固醇（比值比2.2 [95%可信区间1.2 - 4.0]）和临界微量白蛋白尿（2.5 [1.2 - 5.2]）。使用Cox回归的预测因素为糖化血红蛋白（风险比1.4 [95%可信区间1.1 - 1.7]）、诊断时年龄（1.2 [1.1 - 1.3]）、肥胖（3.6 [0.8 - 15.5]）和胰岛素剂量（2.7 [1.0 - 7.5]）。
有临界微量白蛋白尿的1型糖尿病儿童及青少年发生持续性微量白蛋白尿的可能性是常人的两倍多。除血糖控制不佳外，胰岛素抵抗的临床指标与微量白蛋白尿风险增加相关。
