Skrivarhaug Torild, Bangstad Hans-Jacob, Stene Lars C, Sandvik Leiv, Hanssen Kristian F, Joner Geir
Department of Pediatrics, Ullevål University Hospital, Oslo, Norway.
Pediatr Diabetes. 2006 Oct;7(5):239-46. doi: 10.1111/j.1399-5448.2006.00204.x.
To estimate the risk of diabetic nephropathy and associated risk factors in a nationwide cohort of childhood-onset type 1 diabetes mellitus (T1DM) and 19-30 yr of diabetes duration.
Patients diagnosed with childhood-onset T1DM (<15 yr) from 1973 through 1982, who previously (1989-1990) participated in a clinical examination to assess diabetic complications, were invited for a new examination in 2002-2003. Of 355 eligible patients, 299 participated (84.2%), and complete urine samples for evaluation of albuminuria were obtained from 295 patients, with a mean age of 33 yr (range 20.9-44.0) and mean diabetes duration of 24 yr (range 19.3-29.9). Persistent microalbuminuria and overt nephropathy [albumin excretion rate (AER) 15-200 microg/min and AER > 200 microg/min, respectively] in at least two out of three consecutive overnight urine samples were defined as diabetic nephropathy.
Overt nephropathy was found in 7.8% [95% confidence interval (CI) 4.7-10.9] and persistent microalbuminuria in 14.9% (95% CI 10.8-19.0) of the subjects. Hemoglobin A1c (HbA1c) (p = 0.001), systolic blood pressure (BP) (p = 0.002), total cholesterol (p = 0.019), and C-reactive protein (CRP) (p = 0.019) were associated with diabetic nephropathy. Significant predictors in 1989-1990 for the development of diabetic nephropathy in 2002-2003 were HbA1c (p < 0.001), AER (p = 0.007), and cholesterol (p = 0.022).
In a subgroup of patients diagnosed with childhood-onset T1DM in 1973-1982, 7.8% had overt nephropathy after 19-30 yr of diabetes duration, which is low compared with studies from other countries. HbA1c, systolic BP, total cholesterol, and CRP were each independently associated with diabetic nephropathy.
评估全国范围内儿童期发病的1型糖尿病（T1DM）且糖尿病病程为19 - 30年的队列中糖尿病肾病的风险及相关危险因素。
邀请1973年至1982年间诊断为儿童期发病的T1DM（<15岁）且曾在1989 - 1990年参加过评估糖尿病并发症临床检查的患者于2002 - 2003年进行新的检查。355名符合条件的患者中，299名参与（84.2%），从295名患者获取了用于评估蛋白尿的完整尿液样本，这些患者的平均年龄为33岁（范围20.9 - 44.0岁），平均糖尿病病程为24年（范围19.3 - 29.9年）。连续三个夜间尿液样本中至少两个样本出现持续性微量白蛋白尿和显性肾病[白蛋白排泄率（AER）分别为15 - 200微克/分钟和AER > 200微克/分钟]被定义为糖尿病肾病。
受试者中显性肾病的发生率为7.8%[95%置信区间（CI）4.7 - 10.9]，持续性微量白蛋白尿的发生率为14.9%（95%CI 10.8 - 19.0）。糖化血红蛋白（HbA1c）（p = 0.001）、收缩压（BP）（p = 0.002）、总胆固醇（p = 0.019）和C反应蛋白（CRP）（p = 0.019）与糖尿病肾病相关。1989 - 1990年时糖尿病肾病在2002 - 2003年发生发展的显著预测因素为HbA1c（p < 0.001）、AER（p = 0.007）和胆固醇（p = 0.022）。
在1973 - 1982年诊断为儿童期发病的T1DM患者亚组中，糖尿病病程19 - 30年后有7.8%出现显性肾病，与其他国家的研究相比这一比例较低。HbA1c、收缩压、总胆固醇和CRP均各自独立与糖尿病肾病相关。
